Overview
Cohere Guidelines are created from an adaptation of peer-reviewed clinical research, medical society guidelines, and coordinated peer reviews. Medical Necessity Criteria and Site of Service Criteria are derived from this knowledge base within the guidelines and serve as a decision support tool to help approve prior authorizations for the most appropriate treatment, setting, and help assure consistency of care for each individual. These guidelines do not replace payer-specific policies, NCDs, or LCDs.
Cohere utilizes payer policy, national and local coverage determinations (NCDs and LCDs), and more in order to make an authorization determination. Please review the appropriate policies prior to submitting an authorization. When there are no NCDs or LCDs, our clinicians will use the Cohere guidelines found on this page for decisioning.
Select a line of business and applicable service below to download the guideline.
Commercial Guidelines
Commercial Guidelines
Cardiovascular Services (Commercial)
Musculoskeletal Services (Commercial)
Radiology Services (Commercial)
Other Services (Commercial)
Medicare Advantage Guidelines
Medicare Advantage Guidelines
Cardiovascular Services (Medicare Advantage)
Musculoskeletal Services (Medicare Advantage)
Radiology Services (Medicare Advantage)
Other Services (Medicare Advantage)
Commercial and Medicare Advantage Guidelines
Commercial and Medicare Advantage Guidelines
State Specific Medicaid Policies
State Specific Medicaid Policies
Radiology Services (Medicaid)
Master Consolidated Guidelines
Master Consolidated Guidelines
Commercial and Medicare Advantage