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.

For coverage information on high tech imaging (MRI, CT, PET) and nuclear medicine, administered by Evicore, click here.

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.

If not specified in a QualChoice coverage policy (Benefit Interpretation), 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
Policies
Calcitonin Gene Related Peptide (CGRP) Inhibitors
Calquence (acalabrutinib)
Cancer Prevention Surgery
Caprelsa (Vandetanib)
Capsule Endoscopy
Carbaglu (Carglumic Acid)
Cardiac Event Recorder, External Loop Recorder
Cardiac Event Recorder, Insertable Loop Recorder
Cardiac Rehabilitation
Cardioverter-Defibrillators
Care Plan Oversight Services
Carrier Screening in Pregnancy
Cartilage Transplants of Lower Extremity
Cayston (Aztreonam)
Cequa
Cerdelga (Eligustat)
Chelation Therapy
CHI Residential Treatment Program
Childhood Attention Deficit / Hyperactivity Disorder Treatment (ADHD)
Chiropractic Care
Chiropractic X-Rays
Cholbam (Cholic Acid)
Chorionic Villus Sampling
Cimzia (Certolizumabpegol)
Clear Light Phototherapy for Acne
Clinical Edits
Clinical Trial Coverage
Cochlear Implants
Cognitive Rehabilitation
Cometriq (Cabozanitinib)
Compression Devices
Computer Aided Detection (CAD) Mammography
Conscious Sedation
Contact Lenses
Continuity of Care
Continuity of Care: Prescription Drug Coverage
Continuous Glucose Monitoring
Corneal Graft with Amniotic Membrane Transplant for Eye
Corneal Pachymetry
Corneal Remodeling (Refractive Surgery)
Corneal Topography
Corticosteroid Intravitreal Implants (Ozurdex, Retisert, Iluvien)
Cosentyx (Secukinumab)
Cosmetic/ Reconstructive Surgery
Cotellic (Cobimetinib)
Cranial Remodeling Bands & Helmets (Plagiocephaly)
Craniofacial Anomaly Reconstructive Surgery
Cresemba (Isavuconazonium)
Cryoablation of Breast Lesions
Crysvita
Cycloset (Bromocriptine)
Cyramza (Ramucir4umab)