Coverage Policies

Use the index below to search for coverage information on specific medical conditions.

Note: For Arkansas State or Public School employees, services subject to pre-authorization are managed by Active Health Management, as noted in their Summary Plan Description.

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Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 05/21/2004 Title: Autopsy
Revision Date: 08/02/2006 Document: BI035:00
CPT Code(s): 88000-88016, 88020-88029, 88036-88037, 88040, 88045, 88099
Public Statement
Effective Date: a) This policy will apply to all services performed on or after the above revision date which will become the new effective date. b) For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply. An autopsy (post mortem examination, an examination after death) is not a covered service. It is never medically necessary because it produces no benefit for the patient.
Medical Statement

An autopsy is performed for reasons of forensic examination, clinical research, provider protection, public health investigation, or family comfort. An autopsy is not medically necessary for the welfare of the patient; therefore, autopsies are not a paid benefit of the plan. However, this should not discourage autopsy in cases where the concerns are forensic or public health, when the autopsy is performed by a government agency.


Codes Used In This BI:

88000 Autopsy (necropsy) gross
88005 Autopsy (necropsy) gross
88007 Autopsy (necropsy) gross
88012 Autopsy (necropsy) gross
88014 Autopsy (necropsy) gross
88016 Autopsy (necropsy) gross
88020 Autopsy (necropsy) complete
88025 Autopsy (necropsy) complete
88027 Autopsy (necropsy) complete
88028 Autopsy (necropsy) complete
88029 Autopsy (necropsy) complete
88036 Limited autopsy
88037 Limited autopsy
88040 Forensic autopsy (necropsy)
88045 Coroner’s autopsy (necropsy)
88099 Necropsy (autopsy) procedure
 


Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
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