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FreeStyle Libre Pro system  //  Coverage & Reimbursement

Professional continuous glucose monitoring (CGM)

a reimbursable procedure with broad coverage for people with diabetes*

88% of commercial lives are members of a plan with written pro-CGM coverage

88%

of commercial lives are members of a plan with written pro-CGM coverage1

100% of fee-for-service Medicare patients have pro-CGM coverage

100%

of fee-for-service Medicare patients have pro-CGM coverage2†

Professional CGM Coverage Lookup*

Select State

Coverage information as of: 09/01/2016

Plan name Plan typeI T1I T2I Req Prior Auth§ Plan Phone Plan Fax Plan Web Site
STATEPlan namePlan typeT1T2Req Prior AuthPlan PhonePlan FaxPlan Web Site
AKAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
AKANTHEM / WELLPOINTCOMMERCIALNo published policy available. Contact health plan for information.
AKAVIA PARTNERS UNSPECCOMMERCIAL-No published policy available. Contact health plan for information.
AKCIGNACOMMERCIALYYU800-882-4462-Visit Link
AKHCA INCCOMMERCIAL-No published policy available. Contact health plan for information.
AKKROGER COMPANYCOMMERCIAL-No published policy available. Contact health plan for information.
AKODS HEALTH PLANSCOMMERCIALYYN877-337-0650503-243-3964No published policy available. Contact health plan for information.
AKPREMERACOMMERCIALYNU800-843-1114-Visit Link
AKPROVIDENCE HEALTH SYSTEMSCOMMERCIAL-No published policy available. Contact health plan for information.
AKTHE REGENCE GROUPCOMMERCIAL--No published policy available. Contact health plan for information.
AKUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
AKUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
AKUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
AKFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-562-1011-No published policy available. Contact health plan for information.
AKPUBLIC EDU HEALTH TRUST (AK)GOVERNMENT-No published policy available. Contact health plan for information.
AKTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
AKCARESOURCEMEDICAID-No published policy available. Contact health plan for information.
AKMEDICAID ALASKA (AK)MEDICAID-No published policy available. Contact health plan for information.
AKMEDICAID MONTANA (MT)MEDICAID-No published policy available. Contact health plan for information.
AKUHC - PACIFICAREMEDICAREYUU--Visit Link
ALAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
ALANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
ALAT AND TCOMMERCIAL-No published policy available. Contact health plan for information.
ALBCBS ALABAMA (AL)COMMERCIALYNU205-220-9560-Visit Link
ALBCBS TENNESSEE (TN)COMMERCIAL-No published policy available. Contact health plan for information.
ALCIGNACOMMERCIALYYU800-882-4462-Visit Link
ALEMDEON/WEBMD UNSPECCOMMERCIAL-No published policy available. Contact health plan for information.
ALHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
ALUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
ALVIVA HEALTH (AL)COMMERCIAL-No published policy available. Contact health plan for information.
ALWALMARTCOMMERCIAL-No published policy available. Contact health plan for information.
ALBCBS ALABAMA (AL)GOVERNMENT-No published policy available. Contact health plan for information.
ALFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-248-2342-No published policy available. Contact health plan for information.
ALPEEHIPGOVERNMENT-No published policy available. Contact health plan for information.
ALTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
ALMEDICAID ALABAMA (AL)MEDICAID-No published policy available. Contact health plan for information.
ALBCBS ALABAMA (AL)MEDICAREYNU205-220-9560-Visit Link
ALHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
ALHUMANAMEDICAREYUU--Visit Link
ALUHC - PACIFICAREMEDICAREYUU--Visit Link
ARAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
ARANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
ARBCBS ARKANSAS (AR)COMMERCIALYNU800-827-4814-Visit Link
ARCIGNACOMMERCIALYYU800-882-4462-Visit Link
ARNATIONAL MEDICAL HEALTH CARD - (NMHCRX)COMMERCIAL-No published policy available. Contact health plan for information.
ARQCA HEALTH PLAN (AR)COMMERCIAL-No published policy available. Contact health plan for information.
ARRESTATCOMMERCIAL-No published policy available. Contact health plan for information.
ARTYSON FOODSCOMMERCIAL-No published policy available. Contact health plan for information.
ARUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
ARWALMARTCOMMERCIAL-No published policy available. Contact health plan for information.
ARAR STATE/PUBLIC SCHOOL EBD (AR)GOVERNMENT-No published policy available. Contact health plan for information.
ARFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU602-864-4102-No published policy available. Contact health plan for information.
ARTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
ARUNIVERSITY OF ARKANSAS (AR)GOVERNMENT-No published policy available. Contact health plan for information.
ARCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
ARHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
ARHUMANAMEDICAREYUU--Visit Link
ARUHC - PACIFICAREMEDICAREYUU--Visit Link
ARWELLCAREMEDICAREYNU855-538-0454-Visit Link
ARXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
AZAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
AZARIZONA STATE UNIV (AZ)COMMERCIAL-No published policy available. Contact health plan for information.
AZBCBS ARIZONA (AZ)COMMERCIALYNU--Visit Link
AZCIGNACOMMERCIALYYU800-882-4462-Visit Link
AZHEALTH NETCOMMERCIALYYU--Visit Link
AZUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
AZFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-451-7302-No published policy available. Contact health plan for information.
AZCARE 1ST HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
AZIASIS HEALTHCAREMEDICAID-No published policy available. Contact health plan for information.
AZMERCY CARE (AZ)MEDICAID-No published policy available. Contact health plan for information.
AZUHC - AMERICHOICEMEDICAID-No published policy available. Contact health plan for information.
AZUNIVERSITY OF AZ HEALTH PLN (AZ)MEDICAID-No published policy available. Contact health plan for information.
AZBCBS ARIZONAMEDICARE-No published policy available. Contact health plan for information.
AZCAREMOREMEDICARE-No published policy available. Contact health plan for information.
AZHEALTH NETMEDICAREYYU--Visit Link
AZHUMANAMEDICAREYUU--Visit Link
AZMERCY CARE (AZ)MEDICARE-No published policy available. Contact health plan for information.
AZPHOENIX MEMORIAL HOSPITAL (AZ)MEDICARE-No published policy available. Contact health plan for information.
AZUHC - PACIFICAREMEDICAREYUU--Visit Link
CAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
CAANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
CABLUE SHIELD OF (CA)COMMERCIALYYU--Visit Link
CACIGNACOMMERCIALYYU800-882-4462-Visit Link
CAHEALTH NETCOMMERCIALYYU--Visit Link
CANAVITUS - OTHERSCOMMERCIAL-No published policy available. Contact health plan for information.
CAUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
CAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-633-4581-No published policy available. Contact health plan for information.
CACAL - OPTIMA (CA)MEDICAID-No published policy available. Contact health plan for information.
CACARE 1ST HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
CAHEALTH NETMEDICAIDYYU--Visit Link
CALA CAREMEDICAID-No published policy available. Contact health plan for information.
CAMEDICAID CALIFORNIA (CA)MEDICAID-No published policy available. Contact health plan for information.
CAMOLINA HEALTH CAREMEDICAIDYNU--Visit Link
CAPARTNERSHIP HEALTH PLAN (CA)MEDICAID-No published policy available. Contact health plan for information.
CABLUE SHIELD OF (CA)MEDICARE-No published policy available. Contact health plan for information.
CACARE 1ST HEALTH PLANMEDICARE-No published policy available. Contact health plan for information.
CACAREMOREMEDICARE-No published policy available. Contact health plan for information.
CASCAN HEALTH PLANMEDICARE-No published policy available. Contact health plan for information.
CAUHC - PACIFICAREMEDICAREYUU--Visit Link
COAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
COANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
COCIGNACOMMERCIALYYU800-882-4462-Visit Link
COCOLORADO EMP BEN TRUST/CEBT (CO)COMMERCIAL-No published policy available. Contact health plan for information.
COHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
COKAISER - (CARVED)COMMERCIAL-No published policy available. Contact health plan for information.
COKROGER COMPANYCOMMERCIAL-No published policy available. Contact health plan for information.
COROCKY MOUNTAINCOMMERCIAL-No published policy available. Contact health plan for information.
COUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
COUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
COFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
COTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
COCOLORADO ACCESS (CO)MEDICAID-No published policy available. Contact health plan for information.
COMEDICAID COLORADO (CO)MEDICAID-No published policy available. Contact health plan for information.
COROCKY MOUNTAINMEDICAID-No published policy available. Contact health plan for information.
COCOLORADO ACCESS (CO)MEDICARE-No published policy available. Contact health plan for information.
COHUMANAMEDICAREYUU--Visit Link
COKAISER - (CARVED)MEDICARE-No published policy available. Contact health plan for information.
COROCKY MOUNTAINMEDICARE-No published policy available. Contact health plan for information.
COUHC - PACIFICAREMEDICAREYUU--Visit Link
CTAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
CTANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
CTCIGNACOMMERCIALYYU800-882-4462-Visit Link
CTCITY OF HARTFORD RETIREES (CT)COMMERCIAL-No published policy available. Contact health plan for information.
CTGENERAL DYNAMICS (VA)COMMERCIAL-No published policy available. Contact health plan for information.
CTHIP/CONNECTICARECOMMERCIAL-No published policy available. Contact health plan for information.
CTUHC - OXFORDCOMMERCIALYUN800-666-1353-Visit Link
CTUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
CTUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
CTUNITED TECHNOLOGIES CORPCOMMERCIAL-No published policy available. Contact health plan for information.
CTFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
CTSAYLES SCHOOL (CT)GOVERNMENT-No published policy available. Contact health plan for information.
CTSTATE OF CONNECTICUT EMP (CT)GOVERNMENT-No published policy available. Contact health plan for information.
CTTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
CTMEDICAID CONNECTICUT (CT)MEDICAID-No published policy available. Contact health plan for information.
CTAETNAMEDICAREYNU888-968-7241-Visit Link
CTANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
CTCONNECTICARE MAPDMEDICARE-No published policy available. Contact health plan for information.
CTUHC - PACIFICAREMEDICAREYUU--Visit Link
CTWELLCAREMEDICAREYNU866-334-7927-Visit Link
DCAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
DCANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
DCCIGNACOMMERCIALYYU800-882-4462-Visit Link
DCUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
DCFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-553-8700-No published policy available. Contact health plan for information.
DCGOVRNMNT EMPLOYEE HOSP ASSC/GEHAGOVERNMENT-No published policy available. Contact health plan for information.
DCPRINCE GEORGES CNTY PUB SCH (MD)GOVERNMENT-No published policy available. Contact health plan for information.
DCTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
DCANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
DCDC HEALTHCARE ALLIANCE (DC)MEDICAID-No published policy available. Contact health plan for information.
DCJAI MEDICAL SYS (MD)MEDICAID-No published policy available. Contact health plan for information.
DCMARYLAND PHYSICIANS CARE (MPC)MEDICAID-No published policy available. Contact health plan for information.
DCMEDICAID WASHINGTON D.C. (DC)MEDICAID-No published policy available. Contact health plan for information.
DCMEDSTAR HEALTHMEDICAID-No published policy available. Contact health plan for information.
DCPRIORITY PARTNERS (MD)MEDICAID-No published policy available. Contact health plan for information.
DCSELECT HEALTH OF SCMEDICAID-No published policy available. Contact health plan for information.
DCTRUSTED HEALTH PLAN (DC)MEDICAID-No published policy available. Contact health plan for information.
DCUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
DCHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
DCUHC - PACIFICAREMEDICAREYUU--Visit Link
DEAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
DEBANK OF AMERICACOMMERCIAL-No published policy available. Contact health plan for information.
DECIGNACOMMERCIALYYU800-882-4462-Visit Link
DEHIGHMARKCOMMERCIALYYU800-572-2872Visit LinkShort term interstitial continuous glucose monitoring (up to and including 72 hour) may be considered medically necessary when ANY ONE of the following criteria are met: * An individual who has type I diabetes and requires determination of basal insulin level measurements prior to insulin pump initiation or * An individual who has type I or type II diabetes and documentation of ALL of the following: * Has received diabetes self-management education and instruction from a health care professional with expertise in the management of diabetes and * Has a documented average of at least three glucose self-tests per day during the previous month and * Has a documented history of severe ketosis or hypoglycemic unawareness) and * Is on an intensive insulin regimen, requiring two or more insulin injections per day, or utilizes an insulin pump and * Has ONE or MORE of the following while on an intensive insulin regimen: - Glycated hemoglobin (HbA1c) values less than four or greater than nineor - Unexplained large fluctuations in daily glucose values before mealsor - Unexplained frequent hypoglycemic attacks or - Episodes of ketoacidosis or hospitalizations for significantly elevated glucose levels. For short-term diagnostic use, no more than two continuous glucose monitoring periods may be considered medically necessary within a 12-month period.
DEIBC COMMERCIALCOMMERCIAL-No published policy available. Contact health plan for information.
DEJ P MORGAN CHASECOMMERCIAL-No published policy available. Contact health plan for information.
DEUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
DEFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-572-2872-No published policy available. Contact health plan for information.
DESTATE OF DELAWARE EMPLOYEES (DE)GOVERNMENT-No published policy available. Contact health plan for information.
DETRICAREGOVERNMENTNo published policy available. Contact health plan for information.
DEHEALTH PARTNERS OF (PA)MEDICAID-No published policy available. Contact health plan for information.
DEHIGHMARKMEDICAID-No published policy available. Contact health plan for information.
DEKEYSTONE MERCYMEDICAID-No published policy available. Contact health plan for information.
DEMEDICAID DELAWARE (DE)MEDICAID-No published policy available. Contact health plan for information.
DEUHC COMMUNITY PLAN (DE)MEDICAIDYUU800-366-7304877-877-8230Visit Link
DEAETNAMEDICAREYNU888-968-7241-Visit Link
DECIGNAMEDICAREYYU800-882-4462-Visit Link
DEHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
DEHUMANAMEDICAREYUU--Visit Link
DESTATE OF DELAWARE EMPLOYEES (DE)MEDICARE-No published policy available. Contact health plan for information.
FLAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
FLAV - MEDCOMMERCIALYUU800-816-5465800-552-8633Visit Link
FLBCBS FLORIDA (FL)COMMERCIALYYU800-397-7337-Visit Link
FLCIGNACOMMERCIALYYU800-882-4462-Visit Link
FLHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
FLUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
FLFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-955-5692-No published policy available. Contact health plan for information.
FLFLORIDA STATE EMPLOYEES PPOGOVERNMENT-No published policy available. Contact health plan for information.
FLTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
FLANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
FLMEDICAID FLORIDA (FL)MEDICAID-No published policy available. Contact health plan for information.
FLUHC - UNISON HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
FLWELLCAREMEDICAIDYNU855-538-0454-Visit Link
FLAV - MEDMEDICARE-No published policy available. Contact health plan for information.
FLCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
FLHUMANAMEDICAREYUU--Visit Link
FLMEDICA HEALTHCARE (FL)MEDICARE-No published policy available. Contact health plan for information.
FLSIMPLY HEALTHCARE (FL)MEDICARE-No published policy available. Contact health plan for information.
FLUHC - PACIFICAREMEDICAREYUU--Visit Link
FLWELLCAREMEDICARE-No published policy available. Contact health plan for information.
GAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
GAANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
GAAT AND TCOMMERCIAL-No published policy available. Contact health plan for information.
GACIGNACOMMERCIALYYU800-882-4462-Visit Link
GAEMORY UNIVERSITYCOMMERCIALNo published policy available. Contact health plan for information.
GAHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
GAUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
GABOARD OF REGENTS UNIV SYS (GA)GOVERNMENT-No published policy available. Contact health plan for information.
GAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
GASHBP (GA)GOVERNMENT-No published policy available. Contact health plan for information.
GATRICAREGOVERNMENT-No published policy available. Contact health plan for information.
GAANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
GAMEDICAID GEORGIA (GA)MEDICAID-No published policy available. Contact health plan for information.
GAWELLCAREMEDICAIDYNU888-505-1201-Visit Link
GAAETNAMEDICAREYNU888-968-7241-Visit Link
GAHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
GAHUMANAMEDICAREYUU--Visit Link
GAUHC - PACIFICAREMEDICAREYUU--Visit Link
GAWELLCAREMEDICAREYNU866-231-1821-Visit Link
GAXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
HIAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
HICATALYSTCOMMERCIALNo published policy available. Contact health plan for information.
HIHAWAII MGM ALLIANCE ASSOC HMAACOMMERCIAL-No published policy available. Contact health plan for information.
HIHMSACOMMERCIALYYN808-944-5611-No published policy available. Contact health plan for information.
HIRESTATCOMMERCIAL-No published policy available. Contact health plan for information.
HISIERRA HEALTHCOMMERCIAL-No published policy available. Contact health plan for information.
HIUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
HIUNIVERSITY HEALTH ALLIANCE (HI)COMMERCIALYNN808-532-4006866-572-4384Visit Link
HIFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-966-6198-No published policy available. Contact health plan for information.
HIHAWAII EMPLOYER UNION HEALTH BENEFITSGOVERNMENT-No published policy available. Contact health plan for information.
HITRICAREGOVERNMENT-No published policy available. Contact health plan for information.
HIALOHACAREMEDICAID-No published policy available. Contact health plan for information.
HIHMSA QUESTMEDICAIDYYN808-944-5611-No published policy available. Contact health plan for information.
HIUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
HIWELLCAREMEDICAIDYNU855-538-0454-Visit Link
HIHMSAMEDICARE-No published policy available. Contact health plan for information.
HIHUMANAMEDICAREYUU--Visit Link
HIUHC - PACIFICAREMEDICAREYUU--Visit Link
HIWELLCAREMEDICAREYNU888-846-4262-Visit Link
IAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
IAANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
IABCBS MINNESOTA (MN)COMMERCIAL-No published policy available. Contact health plan for information.
IACIGNACOMMERCIALYYU800-882-4462-Visit Link
IACOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
IATYSON FOODSCOMMERCIAL-No published policy available. Contact health plan for information.
IAUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
IAUHC - RIVER VALLEYCOMMERCIALYUU800-747-1446
888-242-9058
-No published policy available. Contact health plan for information.
IAUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
IAWELLMARKCOMMERCIAL-No published policy available. Contact health plan for information.
IAWELLS FARGO CORP/NORWESTCOMMERCIAL-No published policy available. Contact health plan for information.
IAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-552-3993-No published policy available. Contact health plan for information.
IATRICAREGOVERNMENT-No published policy available. Contact health plan for information.
IAMEDICAID IOWA (IA)MEDICAID-No published policy available. Contact health plan for information.
IAAETNAMEDICAREYNU888-968-7241-Visit Link
IACOVENTRYMEDICARE-No published policy available. Contact health plan for information.
IADEERE AND COMPANYMEDICARE-No published policy available. Contact health plan for information.
IAHUMANAMEDICAREYUU--Visit Link
IAUHC - PACIFICAREMEDICAREYUU--Visit Link
IAXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
IDAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
IDBLUE CROSS IDAHO (ID)COMMERCIALYNU800-743-1871208-331-7344Visit Link
IDCIGNACOMMERCIALYYU800-882-4462-Visit Link
IDCOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
IDODS HEALTH PLANSCOMMERCIAL-No published policy available. Contact health plan for information.
IDPREMERACOMMERCIAL-No published policy available. Contact health plan for information.
IDPROVIDENCE HEALTH SYSTEMSCOMMERCIAL-No published policy available. Contact health plan for information.
IDSELECT HEALTHCOMMERCIAL-No published policy available. Contact health plan for information.
IDSIERRA HEALTHCOMMERCIAL-No published policy available. Contact health plan for information.
IDTHE REGENCE GROUPCOMMERCIAL-No published policy available. Contact health plan for information.
IDUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
IDFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-627-1187-No published policy available. Contact health plan for information.
IDTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
IDMEDICAID IDAHO (ID)MEDICAID-No published policy available. Contact health plan for information.
IDBLUE CROSS IDAHO (ID)MEDICARE-No published policy available. Contact health plan for information.
IDHUMANAMEDICAREYUU--Visit Link
IDPACIFICSOURCE (OR)MEDICARE-No published policy available. Contact health plan for information.
IDSELECT HEALTHMEDICARE-No published policy available. Contact health plan for information.
IDTHE REGENCE GROUPMEDICARE-No published policy available. Contact health plan for information.
IDUHC - PACIFICAREMEDICAREYUU--Visit Link
ILAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
ILANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
ILCATERPILLAR INCCOMMERCIAL-No published policy available. Contact health plan for information.
ILCIGNACOMMERCIALYYU800-882-4462-Visit Link
ILHEALTH ALLIANCE MEDICAL (IL)COMMERCIAL-No published policy available. Contact health plan for information.
ILHUMANA - THIRD PARTYCOMMERCIALYUU-Visit Link
ILUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
ILUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
ILFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-227-6591-No published policy available. Contact health plan for information.
ILSTATE OF IL EMP HP/SERS (IL)GOVERNMENT-No published policy available. Contact health plan for information.
ILAETNA BETTER HEALTHMEDICAID-No published policy available. Contact health plan for information.
ILCENTENEMEDICAID-No published policy available. Contact health plan for information.
ILFAMILY HEALTH NETWORK (IL)MEDICAID-No published policy available. Contact health plan for information.
ILHEALTH ALLIANCE MEDICAL (IL)MEDICAID-No published policy available. Contact health plan for information.
ILMEDICAID ILLINOIS (IL)MEDICAID-No published policy available. Contact health plan for information.
ILCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
ILHEALTH ALLIANCE MEDICAL (IL)MEDICARE-No published policy available. Contact health plan for information.
ILHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
ILHUMANAMEDICAREYUU--Visit Link
ILUHC - PACIFICAREMEDICAREYUU--Visit Link
INAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
INANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
INCIGNACOMMERCIALYYU800-882-4462-Visit Link
INELI LILLY AND COMPANYCOMMERCIAL-No published policy available. Contact health plan for information.
INHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
ININTERNATIONAL STEEL GROUP INCCOMMERCIAL-No published policy available. Contact health plan for information.
INUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
INUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
INFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
INSTATE OF INDIANA EMPLOYEES (IN)GOVERNMENT-No published policy available. Contact health plan for information.
INTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
INANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
INCENTENEMEDICAID-No published policy available. Contact health plan for information.
INMD WISE (IN)MEDICAID-No published policy available. Contact health plan for information.
INMEDICAID INDIANA (IN)MEDICAID-No published policy available. Contact health plan for information.
INANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
INHUMANAMEDICAREYUU--Visit Link
INUHC - PACIFICAREMEDICAREYUU--Visit Link
INUPMC (PA)MEDICARE-No published policy available. Contact health plan for information.
INXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
KSAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
KSBCBS KANSAS (KS)COMMERCIALYNU800-676-2583-Visit Link
KSBCBS KANSAS CITY (KC)COMMERCIAL-No published policy available. Contact health plan for information.
KSCATALYSTCOMMERCIAL-No published policy available. Contact health plan for information.
KSCIGNACOMMERCIALYYU800-882-4462-Visit Link
KSCOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
KSHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
KSMEDCOCOMMERCIAL--No published policy available. Contact health plan for information.
KSTEXTRON INCCOMMERCIAL-No published policy available. Contact health plan for information.
KSUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
KSFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-782-4437-No published policy available. Contact health plan for information.
KSKANSAS STATE EMPLOYEES (KS)GOVERNMENT-No published policy available. Contact health plan for information.
KSANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
KSCENTENEMEDICAID-No published policy available. Contact health plan for information.
KSMEDICAID KANSAS (KS)MEDICAID-No published policy available. Contact health plan for information.
KSMEDICAID MISSOURI (MO)MEDICAID-No published policy available. Contact health plan for information.
KSUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
KSCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
KSHUMANAMEDICAREYUU--Visit Link
KSUHC - PACIFICAREMEDICAREYUU--Visit Link
KYAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
KYANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
KYBAPTIST HEALTH SYSTEM (KY)COMMERCIAL-No published policy available. Contact health plan for information.
KYHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
KYKENTUCKY HEALTH COOPERATIVE (KY)COMMERCIAL-No published policy available. Contact health plan for information.
KYUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
KYUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
KYCOMMONWEALTH OF KENTUCKY (KY)GOVERNMENT-No published policy available. Contact health plan for information.
KYFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
KYTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
KYANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
KYCARESOURCEMEDICAIDYUN855-852-7005888-246-7043Visit Link
KYCOVENTRYMEDICAID-No published policy available. Contact health plan for information.
KYMEDICAID KENTUCKY (KY)MEDICAID-No published policy available. Contact health plan for information.
KYPASSPORT HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
KYWELLCAREMEDICAIDYNU855-538-0454-Visit Link
KYANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
KYCOMMONWEALTH OF KENTUCKY (KY)MEDICARE-No published policy available. Contact health plan for information.
KYHUMANAMEDICAREYUU--Visit Link
KYUHC - PACIFICAREMEDICAREYUU--Visit Link
LAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
LABCBS LOUISIANA (LA)COMMERCIALYNU800-523-6435-Visit Link
LACIGNACOMMERCIALYYU800-882-4462-Visit Link
LACOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
LAHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
LANAVITUS - OTHERSCOMMERCIAL-No published policy available. Contact health plan for information.
LAUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
LAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-523-6435-No published policy available. Contact health plan for information.
LAOFFICE OF GROUP BENEFITS (LA)GOVERNMENT-No published policy available. Contact health plan for information.
LATRICAREGOVERNMENT-No published policy available. Contact health plan for information.
LAAETNAMEDICAIDYNU855-242-0802-Visit Link
LAANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
LACENTENEMEDICAID-No published policy available. Contact health plan for information.
LAMEDICAID LOUISIANA (LA)MEDICAID-No published policy available. Contact health plan for information.
LASELECT HEALTH OF SCMEDICAID-No published policy available. Contact health plan for information.
LAUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
LAHUMANAMEDICAREYUU--Visit Link
LAOFFICE OF GROUP BENEFITS (LA)MEDICARE-No published policy available. Contact health plan for information.
LAUHC - PACIFICAREMEDICAREYUU--Visit Link
LAWELLCAREMEDICAREYNU800-322-6027-Visit Link
MAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MABCBS MASSACHUSETTS (MA)COMMERCIALYNN--Visit Link
MACIGNACOMMERCIALYYU800-882-4462Visit Link
MAFALLON COMMUNITY HEALTH - (FCHP)COMMERCIALYYN508-368-9700-No published policy available. Contact health plan for information.
MAHARVARD PILGRIMCOMMERCIALYYN800-708-4414-Visit Link
MAHEALTH NEW ENGLAND (MA)COMMERCIALYNU413-233-2700-No published policy available. Contact health plan for information.
MAPARTNERS HEALTHCARECOMMERCIAL-No published policy available. Contact health plan for information.
MATUFTS HEALTH PLAN (MA)COMMERCIALYNN617-972-9409-Visit Link
MAUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MACOMMONWEALTH OF MASSACHUSETTS (MA)GOVERNMENT-No published policy available. Contact health plan for information.
MAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-634-2828-No published policy available. Contact health plan for information.
MABOSTON MEDICAL CENTERMEDICAIDYYY888-566-0008617-897-0801Visit Link
MAMEDICAID MASSACHUSETTS (MA)MEDICAID-No published policy available. Contact health plan for information.
MANEIGHBORHOOD HEALTH PLAN - (MA)MEDICAIDYYN--Visit Link
MATUFTS HEALTH PLAN (MA)MEDICAIDYNN617-972-9409-Visit Link
MABCBS MASSACHUSETTS (MA)MEDICAREYNN--Visit Link
MACOMMONWEALTH CARE ALLIANCE (MA)MEDICARE-No published policy available. Contact health plan for information.
MASENIOR WHOLE HEALTHMEDICARE-No published policy available. Contact health plan for information.
MATUFTS HEALTH PLAN (MA)MEDICARE-No published policy available. Contact health plan for information.
MAUHC - PACIFICAREMEDICAREYUU--Visit Link
MDAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MDANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
MDCIGNACOMMERCIALYYU800-882-4462Visit Link
MDUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MDUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
MDBALTIMORE CNTY PUBLIC SCHLS (MD)GOVERNMENT-No published policy available. Contact health plan for information.
MDFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-443-5434-No published policy available. Contact health plan for information.
MDMONTGOMERY COUNTY PUBL SCHLS(MD)GOVERNMENT-No published policy available. Contact health plan for information.
MDPRINCE GEORGES CNTY PUB SCH (MD)GOVERNMENT-No published policy available. Contact health plan for information.
MDSTATE OF MARYLAND EMPLOYEES (MD)GOVERNMENT-No published policy available. Contact health plan for information.
MDTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
MDANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
MDJAI MEDICAL SYS MEDICAID (MD)MEDICAID-No published policy available. Contact health plan for information.
MDMARYLAND PHYSICIANS CARE (MPC)MEDICAID-No published policy available. Contact health plan for information.
MDMEDICAID MARYLAND (MD)MEDICAID-No published policy available. Contact health plan for information.
MDMEDSTAR HEALTHMEDICAID-No published policy available. Contact health plan for information.
MDPRIORITY PARTNERS (MD)MEDICAID-No published policy available. Contact health plan for information.
MDUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
MDHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
MDUPMC (PA)MEDICARE-No published policy available. Contact health plan for information.
MEAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MEANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
MEBCBS MASSACHUSETTS (MA)COMMERCIAL-No published policy available. Contact health plan for information.
MECIGNACOMMERCIALYYU800-882-4462-Visit Link
MEDELHAIZE GROUPCOMMERCIAL-No published policy available. Contact health plan for information.
MEHARVARD PILGRIMCOMMERCIALYYN800-708-4414-Visit Link
MEMAINE COMMUNITY HEALTH OPT (ME)COMMERCIAL-No published policy available. Contact health plan for information.
MENAVITUS - OTHERSCOMMERCIAL-No published policy available. Contact health plan for information.
MERESTATCOMMERCIAL-No published policy available. Contact health plan for information.
MEUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MEUNIONS - NATIONALCOMMERCIAL--No published policy available. Contact health plan for information.
MEFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-523-6435800-732-8318No published policy available. Contact health plan for information.
METRICAREGOVERNMENT-No published policy available. Contact health plan for information.
MEMEDICAID MAINE (ME)MEDICAID-No published policy available. Contact health plan for information.
MEAETNAMEDICAREYNU888-968-7241-Visit Link
MEANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
MEHUMANAMEDICAREYUU--Visit Link
MEMARTINS POINT HEALTH CARE (ME)MEDICARE-No published policy available. Contact health plan for information.
MEUHC - PACIFICAREMEDICAREYUU--Visit Link
MEUNIVERSAL AMERICANMEDICARE-No published policy available. Contact health plan for information.
MIAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MIANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
MIBCBS MICHIGAN (MI)COMMERCIALYNU--Visit Link
MICIGNACOMMERCIALYYU800-882-4462-Visit Link
MIHEALTH PLUS (MI)COMMERCIAL-No published policy available. Contact health plan for information.
MIPRIORITY HEALTH (MI)COMMERCIALYYN800-942-4765-Visit Link
MIUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MIUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
MIFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-245-2513-No published policy available. Contact health plan for information.
MISTATE OF MICHIGAN EMPLOYEES (MI)GOVERNMENT-No published policy available. Contact health plan for information.
MIBCBS MICHIGAN (MI)MEDICAID-No published policy available. Contact health plan for information.
MIHEALTH PLUS (MI)MEDICAID-No published policy available. Contact health plan for information.
MIMCLAREN HEALTH PLAN (MI)MEDICAID-No published policy available. Contact health plan for information.
MIMEDICAID MICHIGAN (MI)MEDICAID-No published policy available. Contact health plan for information.
MIMOLINA HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
MIPRIORITY HEALTH (MI)MEDICAIDYYN800-942-4765616-942-0024Visit Link
MIUHC - AMERICHOICEMEDICAID-No published policy available. Contact health plan for information.
MIHUMANAMEDICAREYUU--Visit Link
MIMOLINA HEALTH CAREMEDICARE-No published policy available. Contact health plan for information.
MIPRIORITY HEALTH (MI)MEDICARE-No published policy available. Contact health plan for information.
MNBCBS MINNESOTA (MN)COMMERCIALYYU800-262-0820Visit Link
MNCIGNACOMMERCIALYYU800-882-4462-Visit Link
MNHEALTH PARTNERS (MN)COMMERCIALUUN--Visit Link
MNMEDICACOMMERCIALYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
MNNAVITUS - OTHERSCOMMERCIAL-No published policy available. Contact health plan for information.
MNPREFERREDONE (MN)COMMERCIAL-No published policy available. Contact health plan for information.
MNUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MNUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
MNFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-382-2000-No published policy available. Contact health plan for information.
MNNAVITUS - MN ADVANTAGE HEALTH PLANGOVERNMENT-No published policy available. Contact health plan for information.
MNBCBS MINNESOTA (MN)MEDICAID-No published policy available. Contact health plan for information.
MNMEDICAMEDICAIDYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
MNMEDICAID MINNESOTA (MN)MEDICAID-No published policy available. Contact health plan for information.
MNNAVITUS - OTHERSMEDICAID-No published policy available. Contact health plan for information.
MNPRIMEWEST HEALTH SYSTEMS (MN)MEDICAID-No published policy available. Contact health plan for information.
MNUCARE MINNESOTAMEDICAIDYNU612-884-2500-Visit Link
MNHEALTH PARTNERS (MN)MEDICARE-No published policy available. Contact health plan for information.
MNHUMANAMEDICAREYUU--Visit Link
MNMEDICAMEDICAREYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
MNUCARE MINNESOTAMEDICAREYNU612-884-2499-Visit Link
MOAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MOANTHEM / WELLPOINTCOMMERCIALYUN--Visit Link
MOBCBS KANSAS CITY (KC)COMMERCIALYNU816-395-3989-Visit Link
MOCIGNACOMMERCIALYYU800-882-4462-Visit Link
MOCOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
MOHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
MOUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
MOUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MOUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
MOFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156
816-395-3989
-No published policy available. Contact health plan for information.
MOMO CONSOLIDATED HEALTHCARE PLANGOVERNMENT-No published policy available. Contact health plan for information.
MOTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
MOMEDICAID ILLINOIS (IL)MEDICAID-No published policy available. Contact health plan for information.
MOMEDICAID MISSOURI (MO)MEDICAID-No published policy available. Contact health plan for information.
MOAETNAMEDICAREYNU888-968-7241-Visit Link
MOCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
MOESSENCE HEALTHCAREMEDICARE-No published policy available. Contact health plan for information.
MOHUMANAMEDICAREYUU--Visit Link
MOUHC - PACIFICAREMEDICAREYUU--Visit Link
MOXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
MSAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MSANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
MSAT AND TCOMMERCIAL-No published policy available. Contact health plan for information.
MSBCBS ALABAMA (AL)COMMERCIAL-No published policy available. Contact health plan for information.
MSBCBS FLORIDA (FL)COMMERCIAL-No published policy available. Contact health plan for information.
MSBCBS MISSISSIPPI (MS)COMMERCIALYNU800-257-5825-Visit Link
MSBCBS TENNESSEE (TN)COMMERCIAL-No published policy available. Contact health plan for information.
MSCIGNACOMMERCIALYYU800-882-4462-Visit Link
MSEMDEON/WEBMD UNSPECCOMMERCIAL-No published policy available. Contact health plan for information.
MSHIGHMARKCOMMERCIAL-No published policy available. Contact health plan for information.
MSHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
MSUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MSFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-841-9659-No published policy available. Contact health plan for information.
MSSTATE OF MISSISSIPPI EESGOVERNMENT-No published policy available. Contact health plan for information.
MSTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
MSUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
MSHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
MSHUMANAMEDICAREYUU--Visit Link
MSUHC - PACIFICAREMEDICAREYUU--Visit Link
MSWELLCAREMEDICAREYNU888-453-2534-Visit Link
MTAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
MTASSURANTCOMMERCIAL-No published policy available. Contact health plan for information.
MTBCBS MINNESOTA (MN)COMMERCIAL-No published policy available. Contact health plan for information.
MTBCBS MONTANA (MT)COMMERCIALYYU--Visit Link
MTBCBS NORTH DAKOTA (ND)COMMERCIAL-No published policy available. Contact health plan for information.
MTCIGNACOMMERCIALYYU800-882-4462-Visit Link
MTCOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
MTNAVITUS - OTHERSCOMMERCIAL-No published policy available. Contact health plan for information.
MTPACIFICSOURCE (OR)COMMERCIAL-No published policy available. Contact health plan for information.
MTPREMERACOMMERCIAL-No published policy available. Contact health plan for information.
MTTHE REGENCE GROUPCOMMERCIAL-No published policy available. Contact health plan for information.
MTUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
MTWELLS FARGO CORP/NORWESTCOMMERCIAL-No published policy available. Contact health plan for information.
MTFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU877-885-3751-No published policy available. Contact health plan for information.
MTSTATE OF MONTANA EMPLOYEES (MT)GOVERNMENT-No published policy available. Contact health plan for information.
MTTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
MTMEDICAID MONTANA (MT)MEDICAID-No published policy available. Contact health plan for information.
MTHUMANAMEDICAREYUU--Visit Link
MTNEW WEST HEALTH SERVICES (MT)MEDICARE-No published policy available. Contact health plan for information.
MTUHC - PACIFICAREMEDICAREYUU--Visit Link
NCAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NCANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
NCBCBS NORTH CAROLINA (NC)COMMERCIALYNU800-672-7897800-571-7942Visit Link
NCBCBS SOUTH CAROLINA (SC)COMMERCIAL-No published policy available. Contact health plan for information.
NCCIGNACOMMERCIALYYU800-882-4462-Visit Link
NCCOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
NCDUKE ENERGY CORPORATIONCOMMERCIAL-No published policy available. Contact health plan for information.
NCLOWES COMPANIESCOMMERCIAL-No published policy available. Contact health plan for information.
NCNATIONAL MEDICAL HEALTH CARD - (NMHCRX)COMMERCIAL-No published policy available. Contact health plan for information.
NCUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NCWELLS FARGO CORP/NORWESTCOMMERCIAL-No published policy available. Contact health plan for information.
NCFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-672-7897-No published policy available. Contact health plan for information.
NCNC TEACHERS AND STATE EMP (NC)GOVERNMENT-No published policy available. Contact health plan for information.
NCTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
NCMEDICAID NORTH CAROLINA (NC)MEDICAID-No published policy available. Contact health plan for information.
NCAETNAMEDICAREYNU888-968-7241-Visit Link
NCBCBS NORTH CAROLINA (NC)MEDICARE-No published policy available. Contact health plan for information.
NCHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
NCHUMANAMEDICAREYUU--Visit Link
NCUHC - PACIFICAREMEDICAREYUU--Visit Link
NDAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NDBCBS MINNESOTA (MN)COMMERCIAL-No published policy available. Contact health plan for information.
NDBCBS NORTH DAKOTA (ND)COMMERCIALYNU800-368-2312701-277-2253Visit Link
NDCIGNACOMMERCIALYYU800-882-4462-Visit Link
NDEMDEON/WEBMD UNSPECCOMMERCIAL-No published policy available. Contact health plan for information.
NDHEALTH PARTNERS (MN)COMMERCIAL-No published policy available. Contact health plan for information.
NDMEDICACOMMERCIALYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
NDSANFORD HEALTH PLANCOMMERCIAL-No published policy available. Contact health plan for information.
NDUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NDFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-952-8462-No published policy available. Contact health plan for information.
NDND PUBLIC EMPLOYEES RET SYS (ND)GOVERNMENT-No published policy available. Contact health plan for information.
NDTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
NDBCBS MINNESOTA (MN)MEDICAID-No published policy available. Contact health plan for information.
NDMEDICAMEDICAIDYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
NDMEDICAID NORTH DAKOTA (ND)MEDICAID-No published policy available. Contact health plan for information.
NDSANFORD HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
NDUCARE MINNESOTAMEDICAID-No published policy available. Contact health plan for information.
NDHUMANAMEDICAREYUU--Visit Link
NDMEDICAMEDICAREYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
NDUCARE MINNESOTAMEDICARE-No published policy available. Contact health plan for information.
NEAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NEBCBS NEBRASKA (NE)COMMERCIALYYY800-247-1103402-392-4141Visit Link
NECIGNACOMMERCIALYYU800-882-4462-Visit Link
NECOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
NERESTATCOMMERCIAL-No published policy available. Contact health plan for information.
NESELECT HEALTHCOMMERCIAL-No published policy available. Contact health plan for information.
NEUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
NEUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NEWELLMARKCOMMERCIAL-No published policy available. Contact health plan for information.
NEFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-247-1103-No published policy available. Contact health plan for information.
NETRICAREGOVERNMENT-No published policy available. Contact health plan for information.
NEUNIVERSITY OF NEBRASKA (NE)GOVERNMENT-No published policy available. Contact health plan for information.
NEAETNAMEDICAID-No published policy available. Contact health plan for information.
NEMEDICAID IOWA (IA)MEDICAID-No published policy available. Contact health plan for information.
NEMEDICAID NEBRASKA (NE)MEDICAID-No published policy available. Contact health plan for information.
NEUHC - AMERICHOICEMEDICAID-No published policy available. Contact health plan for information.
NECOVENTRYMEDICARE-No published policy available. Contact health plan for information.
NEHUMANAMEDICAREYUU--Visit Link
NEUHC - PACIFICAREMEDICAREYUU--Visit Link
NEXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
NHAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NHANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
NHBAE SYSTEMSCOMMERCIAL-No published policy available. Contact health plan for information.
NHBCBS MASSACHUSETTS (MA)COMMERCIAL-No published policy available. Contact health plan for information.
NHBCBS VERMONT (VT)COMMERCIAL-No published policy available. Contact health plan for information.
NHCIGNACOMMERCIALYYU800-882-4462-Visit Link
NHHARVARD PILGRIMCOMMERCIALYYN800-708-4414-Visit Link
NHNAVITUS - OTHERSCOMMERCIAL-No published policy available. Contact health plan for information.
NHRAYTHEON COMPANYCOMMERCIAL-No published policy available. Contact health plan for information.
NHTUFTS HEALTH PLAN (MA)COMMERCIALYNN617-972-9409-Visit Link
NHUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NHFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
NHNH LOCAL GOVT CENTER/LGC (NH)GOVERNMENT-No published policy available. Contact health plan for information.
NHTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
NHBOSTON MEDICAL CENTERMEDICAID-No published policy available. Contact health plan for information.
NHCENTENEMEDICAID-No published policy available. Contact health plan for information.
NHMEDICAID NEW HAMPSHIRE (NH)MEDICAID-No published policy available. Contact health plan for information.
NHMEDICAID VERMONT (VT)MEDICAID-No published policy available. Contact health plan for information.
NHHUMANAMEDICAREYUU--Visit Link
NHUHC - PACIFICAREMEDICAREYUU--Visit Link
NJAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NJANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
NJBCBS HORIZON (NJ)COMMERCIALYYU800-624-1110877-798-5903Visit Link
NJCIGNACOMMERCIALYYU800-882-4462-Visit Link
NJIBC COMMERCIALCOMMERCIAL-No published policy available. Contact health plan for information.
NJUHC - OXFORDCOMMERCIALYUN800-666-1353-Visit Link
NJUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NJUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
NJFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-664-2583-No published policy available. Contact health plan for information.
NJNJ EMPLOYEE PRES DRUG PLAN (NJ)GOVERNMENT-No published policy available. Contact health plan for information.
NJANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
NJHARMONY HEALTH PLAN OF ILMEDICAID-No published policy available. Contact health plan for information.
NJNJ HEALTHMEDICAID-No published policy available. Contact health plan for information.
NJUHC - AMERICHOICEMEDICAID-No published policy available. Contact health plan for information.
NJAETNAMEDICAREYNU888-968-7241-Visit Link
NJANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
NJBCBS HORIZON (NJ)MEDICARENo published policy available. Contact health plan for information.
NJCAREPOINT HEALTH PLANSMEDICARE-No published policy available. Contact health plan for information.
NJIBC MEDICAREMEDICARE-No published policy available. Contact health plan for information.
NJUHC - PACIFICAREMEDICAREYUU--Visit Link
NMAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NMCIGNACOMMERCIALYYU800-882-4462-Visit Link
NMNM HEALTH CONNECTIONS (NM)COMMERCIALNo published policy available. Contact health plan for information.
NMPRESBYTERIAN HEALTH PLAN (NM)COMMERCIAL-No published policy available. Contact health plan for information.
NMUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NMALBUQUERQUE PUBLIC SCHOOLS (NM)GOVERNMENT-No published policy available. Contact health plan for information.
NMFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-325-8334-No published policy available. Contact health plan for information.
NMNEW MEXICO EMP RISK MGT (NM)GOVERNMENT-No published policy available. Contact health plan for information.
NMNEW MEXICO RETIREE HC AUTH (NM)GOVERNMENT-No published policy available. Contact health plan for information.
NMPUBLIC SCHOOL INSR AUTH - PSIA(NM)GOVERNMENT-No published policy available. Contact health plan for information.
NMTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
NMUNIV OF NEW MEXICO (NM)GOVERNMENT-No published policy available. Contact health plan for information.
NMMEDICAID NEW MEXICO (NM)MEDICAID-No published policy available. Contact health plan for information.
NMMOLINA HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
NMUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
NMANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
NMHUMANAMEDICAREYUU--Visit Link
NMMOLINA HEALTH CAREMEDICARE-No published policy available. Contact health plan for information.
NMPRESBYTERIAN HEALTH PLAN (NM)MEDICARE-No published policy available. Contact health plan for information.
NMUHC - PACIFICAREMEDICAREYUU--Visit Link
NVAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NVANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
NVCIGNACOMMERCIALYYU800-882-4462-Visit Link
NVHOMETOWN HEALTH PLAN (NV)COMMERCIAL-No published policy available. Contact health plan for information.
NVMGMCOMMERCIAL-No published policy available. Contact health plan for information.
NVNEVADA HEALTH CO - OP (NV)COMMERCIAL-No published policy available. Contact health plan for information.
NVSIERRA HEALTHCOMMERCIALYUU702-243-8499-Visit Link
NVUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
NVUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
NVFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
NVTEACHERS HEALTH TRUST (NV)GOVERNMENT-No published policy available. Contact health plan for information.
NVTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
NVANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
NVMEDICAID NEVADA (NV)MEDICAID-No published policy available. Contact health plan for information.
NVUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
NVCAREMOREMEDICARE-No published policy available. Contact health plan for information.
NVHOMETOWN HEALTH PLAN (NV)MEDICARE-No published policy available. Contact health plan for information.
NVHUMANAMEDICAREYUU--Visit Link
NVSIERRA HEALTHMEDICARE-No published policy available. Contact health plan for information.
NVUHC - PACIFICAREMEDICAREYUU--Visit Link
NYAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
NYEXCELLUS - THIRD PARTYCOMMERCIALYUU800-363-4658-No published policy available. Contact health plan for information.
NYHIPCOMMERCIAL-No published policy available. Contact health plan for information.
NYINDEPENDENT HEALTH (NY)COMMERCIAL-No published policy available. Contact health plan for information.
NYUHC - OXFORDCOMMERCIALYUN800-666-1353-Visit Link
NYUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
NYANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
NYCAPITAL PHYSICIANS HEALTH PLAN - (CDPHP)MEDICAID-No published policy available. Contact health plan for information.
NYFIDELIS CARE NEW YORK (NY)MEDICAID-No published policy available. Contact health plan for information.
NYHEALTH FIRST (NY)MEDICAID-No published policy available. Contact health plan for information.
NYHIPMEDICAIDYYN866-215-2928844-296-4440Visit Link
NYMEDICAID NEW YORK (NY)MEDICAID-No published policy available. Contact health plan for information.
NYMETRO PLUS HEALTH PLAN (NY)MEDICAID-No published policy available. Contact health plan for information.
NYUHC - AMERICHOICEMEDICAID-No published policy available. Contact health plan for information.
NYANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
NYEXCELLUSMEDICAREYUU800-363-4658-No published policy available. Contact health plan for information.
NYHEALTH FIRST (NY)MEDICARE-No published policy available. Contact health plan for information.
NYHIPMEDICARE-No published policy available. Contact health plan for information.
NYINDEPENDENT HEALTH (NY)MEDICARE-No published policy available. Contact health plan for information.
NYUHC - PACIFICAREMEDICAREYUU--Visit Link
OHAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
OHANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
OHCARESOURCECOMMERCIALYUN800-488-0134888-752-0012Visit Link
OHCIGNACOMMERCIALYYU800-882-4462-Visit Link
OHHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
OHMEDICAL MUTUTAL OF OHIOCOMMERCIALYYN877-321-6664-No published policy available. Contact health plan for information.
OHUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
OHFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
OHOHIO STATE EMP BENEFIT PLAN (OH)GOVERNMENT-No published policy available. Contact health plan for information.
OHPUBLIC EES RETIREMENT (OH)GOVERNMENT-No published policy available. Contact health plan for information.
OHCARESOURCEMEDICAIDYUN800-488-0134888-752-0012Visit Link
OHCENTENEMEDICAID-No published policy available. Contact health plan for information.
OHMEDICAID OHIO (OH)MEDICAID-No published policy available. Contact health plan for information.
OHMOLINA HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
OHPROMEDICA / PARAMOUNT HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
OHUHC - UNISON HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
OHAETNAMEDICAREYNU888-968-7241-Visit Link
OHANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
OHHUMANAMEDICAREYUU--Visit Link
OHUHC - PACIFICAREMEDICAREYUU--Visit Link
OKAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
OKANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
OKAT AND TCOMMERCIAL-No published policy available. Contact health plan for information.
OKCATALYSTCOMMERCIAL-No published policy available. Contact health plan for information.
OKCIGNACOMMERCIALYYU800-882-4462-Visit Link
OKCOMMUNITY CARE MHCCOMMERCIAL-No published policy available. Contact health plan for information.
OKHCA INCCOMMERCIAL-No published policy available. Contact health plan for information.
OKUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
OKUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
OKUNIVERSAL AMERICANCOMMERCIAL-No published policy available. Contact health plan for information.
OKWALMARTCOMMERCIAL-No published policy available. Contact health plan for information.
OKFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-672-2378-No published policy available. Contact health plan for information.
OKGOVRNMNT EMPLOYEE HOSP ASSC/GEHAGOVERNMENT-No published policy available. Contact health plan for information.
OKOK STATE EDUCAT EE/HLTCHCE(OK)GOVERNMENT-No published policy available. Contact health plan for information.
OKTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
OKMEDICAID OKLAHOMA (OK)MEDICAID-No published policy available. Contact health plan for information.
OKCOMMUNITY CARE MHCMEDICARE-No published policy available. Contact health plan for information.
OKHUMANAMEDICAREYUU--Visit Link
OKUHC - PACIFICAREMEDICAREYUU--Visit Link
OKUNIVERSAL AMERICANMEDICARE-No published policy available. Contact health plan for information.
ORAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
ORCIGNACOMMERCIALYYU800-882-4462-Visit Link
ORODS HEALTH PLANSCOMMERCIALYYN503-243-3968503-243-3964No published policy available. Contact health plan for information.
ORPACIFICSOURCE (OR)COMMERCIAL-No published policy available. Contact health plan for information.
ORPREMERACOMMERCIAL-No published policy available. Contact health plan for information.
ORPROVIDENCE HEALTH SYSTEMSCOMMERCIAL-No published policy available. Contact health plan for information.
ORTHE REGENCE GROUPCOMMERCIAL-No published policy available. Contact health plan for information.
ORUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
ORUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
ORFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-824-8563-No published policy available. Contact health plan for information.
ORMARION POLK COMM HLTH PLAN (OR)MEDICAID-No published policy available. Contact health plan for information.
ORMEDICAID OREGON (OR)MEDICAIDYNU800-642-8635-No published policy available. Contact health plan for information.
ORPACIFICSOURCE (OR)MEDICAID-No published policy available. Contact health plan for information.
ORATRIO HEALTH PLAN (OR)MEDICARE-No published policy available. Contact health plan for information.
ORCARE OREGON (OR)MEDICARE-No published policy available. Contact health plan for information.
ORHEALTH NETMEDICAREYYU--Visit Link
ORPACIFICSOURCE (OR)MEDICARE-No published policy available. Contact health plan for information.
ORPROVIDENCE HEALTH SYSTEMSMEDICARE-No published policy available. Contact health plan for information.
ORTHE REGENCE GROUPMEDICARE-No published policy available. Contact health plan for information.
ORUHC - PACIFICAREMEDICAREYUU--Visit Link
PAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
PABLUE CROSS CAPITAL (PA)COMMERCIALYYU--Visit Link
PAGEISINGERCOMMERCIALYYU800-544-3907-Visit Link
PAHIGHMARKCOMMERCIALYYU800-547-3627-No published policy available. Contact health plan for information.
PAIBC COMMERCIALCOMMERCIALYYU--Visit Link
PAUPMC (PA)COMMERCIAL-No published policy available. Contact health plan for information.
PAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-862-3648-No published policy available. Contact health plan for information.
PAAMERIHEALTH/MERCYMEDICAID-No published policy available. Contact health plan for information.
PAGATEWAY HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
PAGEISINGERMEDICAIDYYU800-544-3907-Visit Link
PAHEALTH PARTNERS OF (PA)MEDICAID-No published policy available. Contact health plan for information.
PAKEYSTONE MERCYMEDICAID-No published policy available. Contact health plan for information.
PAMEDICAID PENNSYLVANIA (PA)MEDICAID-No published policy available. Contact health plan for information.
PAUPMC (PA)MEDICAID-No published policy available. Contact health plan for information.
PACOVENTRYMEDICARE-No published policy available. Contact health plan for information.
PAGATEWAY HEALTH PLANMEDICARE-No published policy available. Contact health plan for information.
PAGEISINGERMEDICARENNU800-544-3907-Visit Link
PAHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
PAIBC MEDICAREMEDICAREYYU--Visit Link
PAUPMC (PA)MEDICARE-No published policy available. Contact health plan for information.
RIAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
RIANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
RIBCBS MASSACHUSETTS (MA)COMMERCIAL-No published policy available. Contact health plan for information.
RIBCBS RHODE ISLAND (RI)COMMERCIAL-No published policy available. Contact health plan for information.
RICIGNACOMMERCIALYYU800-882-4462-Visit Link
RIGENERAL DYNAMICS (VA)COMMERCIAL-No published policy available. Contact health plan for information.
RIHARVARD PILGRIMCOMMERCIAL-No published policy available. Contact health plan for information.
RINATL MEDICAL HLTH WORKERS COMPCOMMERCIAL-No published policy available. Contact health plan for information.
RITUFTS HEALTH PLAN (MA)COMMERCIALYNN617-972-9409-Visit Link
RIUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
RIUNITED NETWORKS OF AMERICACOMMERCIAL-No published policy available. Contact health plan for information.
RICTY OF PROVIDENCE (RI)GOVERNMENT-No published policy available. Contact health plan for information.
RIFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU401-272-5670-No published policy available. Contact health plan for information.
RISTATE OF RHODE ISLAND EMP (RI)GOVERNMENT-No published policy available. Contact health plan for information.
RIMEDICAID MASSACHUSETTS (MA)MEDICAID-No published policy available. Contact health plan for information.
RIMEDICAID RHODE ISLAND (RI)MEDICAID-No published policy available. Contact health plan for information.
RINEIGHBORHOOD HEALTH PLAN OF RIMEDICAID-No published policy available. Contact health plan for information.
RIUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
RIBCBS RHODE ISLAND (RI)MEDICARENNU800-635-2477401-272-8885Visit Link
RIUHC - PACIFICAREMEDICAREYUU--Visit Link
SCAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
SCANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
SCBCBS SOUTH CAROLINA (SC)COMMERCIALYNU--Visit Link
SCCIGNACOMMERCIALYYU800-882-4462-Visit Link
SCCONSUMERS CHOICE HLTH INS (SC)COMMERCIAL-No published policy available. Contact health plan for information.
SCUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
SCFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU803-264-3100-No published policy available. Contact health plan for information.
SCSOUTH CAROLINA PEBA (SC)GOVERNMENT-No published policy available. Contact health plan for information.
SCTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
SCCENTENEMEDICAID-No published policy available. Contact health plan for information.
SCMEDICAID SOUTH CAROLINA (SC)MEDICAID-No published policy available. Contact health plan for information.
SCMOLINA HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
SCSELECT HEALTH OF SCMEDICAIDYYU888-559-1010843-764-1988No published policy available. Contact health plan for information.
SCWELLCAREMEDICAIDYNU866-270-5223-Visit Link
SCHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
SCHUMANAMEDICAREYUU--Visit Link
SCNMHC EGWPMEDICARE-No published policy available. Contact health plan for information.
SCSOUTH CAROLINA PEBA (SC)MEDICARE-No published policy available. Contact health plan for information.
SCUHC - PACIFICAREMEDICAREYUU--Visit Link
SCXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
SDANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
SDAVERA HEALTHCOMMERCIAL-No published policy available. Contact health plan for information.
SDBCBS MINNESOTA (MN)COMMERCIAL-No published policy available. Contact health plan for information.
SDBCBS NEBRASKA (NE)COMMERCIAL-No published policy available. Contact health plan for information.
SDBCBS NORTH DAKOTA (ND)COMMERCIAL-No published policy available. Contact health plan for information.
SDCIGNACOMMERCIALYYU800-882-4462-Visit Link
SDDAKOTACARECOMMERCIAL-No published policy available. Contact health plan for information.
SDMEDICACOMMERCIALYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
SDSANFORD HEALTH PLANCOMMERCIAL-No published policy available. Contact health plan for information.
SDUHC - INNOVIANTCOMMERCIAL-No published policy available. Contact health plan for information.
SDUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
SDWELLMARKCOMMERCIAL-No published policy available. Contact health plan for information.
SDWELLS FARGO CORP/NORWESTCOMMERCIAL-No published policy available. Contact health plan for information.
SDFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-552-3993-No published policy available. Contact health plan for information.
SDTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
SDMEDICAID IOWA (IA)MEDICAID-No published policy available. Contact health plan for information.
SDMEDICAID MISSOURI (MO)MEDICAID-No published policy available. Contact health plan for information.
SDMEDICAID SOUTH DAKOTA (SD)MEDICAIDYUY605-773-3495-Visit Link
SDCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
SDHUMANAMEDICAREYUU--Visit Link
SDMEDICAMEDICAREYYN800-458-5512952-992-3556No published policy available. Contact health plan for information.
TNAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
TNANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
TNBCBS ALABAMA (AL)COMMERCIAL-No published policy available. Contact health plan for information.
TNBCBS TENNESSEE (TN)COMMERCIAL-No published policy available. Contact health plan for information.
TNCIGNACOMMERCIALYYU800-882-4462-Visit Link
TNHCA INCCOMMERCIAL-No published policy available. Contact health plan for information.
TNHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
TNUHC - RIVER VALLEYCOMMERCIALYUU800-747-1446
888-242-9078
-No published policy available. Contact health plan for information.
TNUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
TNFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-228-2096-No published policy available. Contact health plan for information.
TNSTATE OF TN EMPLOYEES (TN)GOVERNMENT-No published policy available. Contact health plan for information.
TNTENNESSEE COVERRX (TN)GOVERNMENT-No published policy available. Contact health plan for information.
TNTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
TNMEDICAID TENNESSEE (TN)MEDICAID-No published policy available. Contact health plan for information.
TNANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
TNBCBS TENNESSEE (TN)MEDICARE-No published policy available. Contact health plan for information.
TNHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
TNHUMANAMEDICAREYUU--Visit Link
TNUHC - PACIFICAREMEDICAREYUU--Visit Link
TXAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
TXANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
TXCIGNACOMMERCIALYYU800-882-4462-Visit Link
TXHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
TXUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
TXFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-441-9188-No published policy available. Contact health plan for information.
TXTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
TXTRS - CAREGOVERNMENT-No published policy available. Contact health plan for information.
TXANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
TXCENTENEMEDICAID-No published policy available. Contact health plan for information.
TXMOLINA HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
TXUHC - UNITED HEALTHCARE LEGACYMEDICAID-No published policy available. Contact health plan for information.
TXAETNAMEDICAREYNU888-968-7241-Visit Link
TXANTHEM / WELLPOINTMEDICARE-No published policy available. Contact health plan for information.
TXHEALTH SPRINGMEDICARE-No published policy available. Contact health plan for information.
TXHUMANAMEDICAREYUU--Visit Link
TXUHC - PACIFICAREMEDICAREYUU--Visit Link
TXUNIVERSAL AMERICANMEDICARE-No published policy available. Contact health plan for information.
TXWELLCAREMEDICAREYNU608-221-8616-Visit Link
TXXL HEALTHMEDICARE-No published policy available. Contact health plan for information.
UTAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
UTCIGNACOMMERCIALYYU800-882-4462-Visit Link
UTCOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
UTHUMANA - THIRD PARTYCOMMERCIALYUU--Visit Link
UTSELECT HEALTHCOMMERCIAL-No published policy available. Contact health plan for information.
UTTHE REGENCE GROUPCOMMERCIAL-No published policy available. Contact health plan for information.
UTUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
UTFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-228-8263-No published policy available. Contact health plan for information.
UTPEHP/PUBLIC EMP HEALTH PLAN (UT)GOVERNMENT-No published policy available. Contact health plan for information.
UTTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
UTMEDICAID UTAH (UT)MEDICAID-No published policy available. Contact health plan for information.
UTMOLINA HEALTH CAREMEDICAID-No published policy available. Contact health plan for information.
UTSELECT HEALTHMEDICAID-No published policy available. Contact health plan for information.
UTUNIVERSITY OF UTAH (UT)MEDICAID-No published policy available. Contact health plan for information.
UTCOVENTRYMEDICARE-No published policy available. Contact health plan for information.
UTHUMANAMEDICAREYUU--Visit Link
UTMOLINA HEALTH CAREMEDICARE-No published policy available. Contact health plan for information.
UTSELECT HEALTHMEDICARE-No published policy available. Contact health plan for information.
UTTHE REGENCE GROUPMEDICARE-No published policy available. Contact health plan for information.
UTUHC - PACIFICAREMEDICAREYUU--Visit Link
VAAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
VAANTHEM / WELLPOINTCOMMERCIALYUN800-533-1120-Visit Link
VABCBS NORTH CAROLINA (NC)COMMERCIAL-No published policy available. Contact health plan for information.
VACAREMORECOMMERCIAL-No published policy available. Contact health plan for information.
VACIGNACOMMERCIALYYU800-882-4462-Visit Link
VACOVENTRYCOMMERCIAL-No published policy available. Contact health plan for information.
VAHCA INCCOMMERCIAL-No published policy available. Contact health plan for information.
VAUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
VAUNIONS - NATIONALCOMMERCIAL-No published policy available. Contact health plan for information.
VACOMMONWEALTH OF VIRGINIA (VA)GOVERNMENT-No published policy available. Contact health plan for information.
VAFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-860-2156800-732-8318No published policy available. Contact health plan for information.
VATRICAREGOVERNMENT-No published policy available. Contact health plan for information.
VAANTHEM / WELLPOINTMEDICAID-No published policy available. Contact health plan for information.
VACOVENTRYMEDICAID-No published policy available. Contact health plan for information.
VAMEDICAID VIRGINIA (VA)MEDICAID-No published policy available. Contact health plan for information.
VAVIRGINIA PREMIER HEALTH PLANMEDICAID-No published policy available. Contact health plan for information.
VAAETNAMEDICAREYNU888-968-7241-Visit Link
VACAREMOREMEDICARE-No published policy available. Contact health plan for information.
VAHUMANAMEDICAREYUU--Visit Link
VAUHC - PACIFICAREMEDICAREYUU--Visit Link
VTAETNACOMMERCIALYNU888-632-3862888-267-3277Visit Link
VTANTHEM / WELLPOINTCOMMERCIAL-No published policy available. Contact health plan for information.
VTBCBS MASSACHUSETTS (MA)COMMERCIALNo published policy available. Contact health plan for information.
VTBCBS VERMONT (VT)COMMERCIALYNN--Visit Link
VTCBA/EBPACOMMERCIAL-No published policy available. Contact health plan for information.
VTCIGNACOMMERCIALYYU800-882-4462-Visit Link
VTEXCELLUS - THIRD PARTYCOMMERCIAL-No published policy available. Contact health plan for information.
VTGENERAL ELECTRIC COMPANYCOMMERCIAL-No published policy available. Contact health plan for information.
VTIBM CORPORATIONCOMMERCIAL-No published policy available. Contact health plan for information.
VTMVP (NY)COMMERCIAL-No published policy available. Contact health plan for information.
VTRESTATCOMMERCIAL-No published policy available. Contact health plan for information.
VTUHC - UNITED HEALTHCARE LEGACYCOMMERCIALYUU877-842-3210-Visit Link
VTFEDERAL EMPLOYEES HEALTH BENEFITGOVERNMENTYNU800-922-8778-No published policy available. Contact health plan for information.
VTSTATE OF VERMONT EMPLOYEES (VT)GOVERNMENT-No published policy available. Contact health plan for information.
VTTRICAREGOVERNMENT-No published policy available. Contact health plan for information.
VTFIDELIS CARE NEW YORK (NY)MEDICAID-No published policy available. Contact health plan for information.
VTMEDICAID VERMONT (VT)MEDICAIDYNY844-679-5366-No published policy available. Contact health plan for information.
VTMVP (NY)MEDICARE-No published policy available. Contact health plan for information.
VTNEW ENGLAND JOINT ENTERPMEDICARE-No published policy available. Contact health plan for information.
VTUHC - PACIFICAREMEDICAREYUU--Visit Link
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*Not a guarantee of coverage under any specific plan. Coverage criteria are subject to change. Each payer may have multiple plans with different coverage. This information may not be complete or error-free and should be considered a guide only. To confirm coverage and frequency limits in individual cases, or for more information on any particular plan, you (or the patient) should contact the payer directly. This material was compiled based on publicly available information provided by Policy Reporter. Policy Reporter and its affiliates do not guarantee the accuracy or completeness of its service, data, or any content therein.

The information above reflects coverage only for approved indications of FreeStyle Libre Pro, and is not intended to give complete CGM coverage information. FreeStyle Libre Pro is NOT indicated for pediatric or gestational patients.

For the “T1 (type 1 patients)” and “T2 (type 2 patients)” categories:

  • Y (yes) = Plan includes coverage in at least some cases
  • N (no) = Plan does not include coverage
  • U (unknown) = Contact the plan for information

§For the “Prior authorization required” category:

  • Y (yes) = Plan requires prior authorization for at least some cases
  • N (no) = Plan does not require prior authorization
  • U (unknown) = Contact the plan for information

Professional CGM Workflow & Associated Billing Codes

Step
1

PRE-WORK

PATIENT SELECTION

HCP prescribes pro-CGM

Patient in office*

VERIFY INSURANCE BENEFITS

(Submit prior authorization if required)

SCHEDULE VISIT

Step
2

PROCEDURE CPT
95250

  • Performed by physician or office staff under supervision, per state scope of practice

BEGIN ASSESSMENT

  • Insert sensor
  • Educate patient

Patient in office*

DATA COLLECTION

(Must collect at least 72 hours of device data to bill CPT 95250)

ASSESSMENT COMPLETE

  • Remove sensor
  • Download data
  • Generate reports

Patient in office*

Step
3

INTERPRETATION CPT
95251

  • Performed by physician or office staff under supervision, per state scope of practice

HCP INTERPRETS & REPORTS

With/without patient in office*

Step
4

INFORMED
DECISION-MAKING

HCP TREATMENT RECOMMENDATION & PATIENT CONSULTATION

  • Share evaluation results
  • Discuss therapy options

Patient in office*

Notes:

  • 95250 and 95251 can only be reported once monthly per patient and require a minimum of 72 hours of data. Payers are not obligated to cover monthly.
  • E/M can only be billed separately on the same day when a significant and separately identifiable service took place above and beyond the services associated with CGM.
  • Use modifier "-25" with E/M code when billing 95250 and 95251 on the same day.

Individual plans vary. Always verify coverage and frequency limits directly with the payer. It is the physician's responsibility to ensure appropriate code selection.

*Billing of CPT 95250 and 95251 does not preclude the use of Evaluation and Management codes. Add modifier “-25” to the E/M code if a separate face-to-face office visit above and beyond the CGM service is performed, medically necessary, and documented.

Reimbursement

CY 2016 National Payments for CPT® Codes 95250 and 95251

Definition

95250

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording

(Do not repeat more than once per month.)

Medicare physician
fee schedule1,2
Medicare allowable

$159.69

Private payer3
Median billed

$303

Definition

95251

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report

Medicare physician
fee schedule1,2
Medicare allowable

$44.04

Private payer3
Median billed

$87

Medicare rates are not geographically adjusted and do not show the impact of the 2% sequestration.
Physician fee schedule rates represent the non-facility allowed rates.

References: 1. Determining Medicare Payments PPRRVU16_V0122.xlsx https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/ 2. January 2016 Web Addendum B.12.14.15.xlsx https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/ 3. PMIC Medical Fees in the United States 2016. Numbers provided are the 50th percentile of the Usual and Customary (UCR) charges. Note: These are charges and not actual reimbursed amounts. Private payer paid rates are confidential.

CPT code definitions sourced from American Medical Association CPT Code Book 2016.
CPT is a registered trademark of the American Medical Association.

Access reimbursement support

Professional CGM Reimbursement Guide

Abbott Diabetes Care Reimbursement Customer Support

Call 877-549-9181
between 8 am-8 pm ET, Monday-Friday

Have a sales representative provide more information

* Coverage is limited to patients for whom professional CGM is medically necessary. Individual plan coverage may vary. Always verify coverage criteria and frequency directly with the payer.

† Medicare does not have a NCD for professional CGM. Most local contractors do not have a policy limiting professional CGM. To determine coverage, check with the local Medicare administrative contractor.

References: 1. Data on file. Analysis by Policy Reporter. 2. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx, accessed Aug, 2016

ADC-05533 Ver 1.0 10/17

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