You may contact your health plan to confirm coverage and their medical necessity requirements. Medical Policies, Coverage
Determination Guidelines, and Utilization Review Guidelines are developed by individual health plans for services and
procedures, as needed, and are subject to change. Regardless of level of CPT coding, in the absence of written medical
policy, medical necessity determinations for coverage are made on a case-by-case basis.

To increase the likelihood of achieving payment, Francis Medical recommends not proceeding with commercial insurance cases, including Medicare Advantage, unless prior authorization or predetermination is obtained in writing.