Geisinger Health Plan (GHP) uses medical policies as guidelines for coverage decisions made within the insured individuals' written benefit documents. Coverage may vary by line of business and providers and members are encouraged to verify benefit questions regarding eligibility before applying the terms of the policy.
Medicare
What are NCDs and LCDs?
Both NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) help determine if a service or item is covered by Medicare. CMS directly develops NCDs, whereas MACs (Medicare Administrative Contractors) are responsible for the development of LCDs. While NCDs supersede LCDs, it is still important to review related LCDs as they often expand on the applicable NCDs.
What if there is not an NCD, LCD, or related article?
It is the expectation that appropriate published clinical practice guidelines, statutes, regulations, manuals, specific medical necessity criteria, published evidence, instructions for use, etc. are followed. These factors will be taken into consideration for authorizations.
Geisinger Policies
Please visit Geisinger Health Plan's website at www.geisinger.org/health-plan-pages/providers to review the most up-to-date policies prior to submitting an authorization.
Click here to view codes that require prior authorization through Cohere for Geisinger Health Plan services.