Medical Policies

When applicable coverage criteria are not fully established in Medicare statutes, regulations, NCDs, LCDs, or Original Medicare manuals and instructions, CommunityCare may use publicly accessible internal coverage criteria based on current evidence in widely used treatment guidelines or clinical literature.

CommunityCare uses an applicable CommunityCare Medical Policy when one is available. When an applicable CommunityCare medical policy is not available, CommunityCare may use nationally recognized clinical criteria.

CommunityCare used InterQual® criteria for requests received before October 3, 2026, and uses MCG™ Care Guidelines for requests received on or after October 3, 2026.

• InterQual® Transparency
• MCG Care Guidelines Transparency

Medical Policies

• Implantable VNS Devices for Stroke Rehabilitation - MA-002
  Date posted: 9/1/2026Effective Date: 11/01/2026
• Medical Drug Site of Care PolicyEffective Date: 01/01/2026
• Powered Upper Extremity Range of Motion Assist Devices - MA-001
  Date posted: 8/1/2026Effective Date: 10/01/2026
• Site of Care for Advanced Imaging - MA-006
  Date posted: 12/9/2025Effective Date: 03/01/2026

Medical Drug Policies