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 service below to download the applicable guideline.
Commercial Guidelines (All services)
Commercial Guidelines (All services)
Cardiovascular Services (Commercial)
Musculoskeletal Services (Commercial)
Other Services (Commercial)
Medicare Advantage Guidelines (All services)
Medicare Advantage Guidelines (All services)
Cardiovascular Services (Medicare Advantage)
Musculoskeletal Services (Medicare Advantage)
Other Services (Medicare Advantage)
Master Consolidated Guidelines
Master Consolidated Guidelines
Commercial & Medicare Advantage