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 currently uses InterQual® criteria and anticipates transitioning to MCG™ care guidelines on or after August 1, 2026.

• Powered Upper Extremity Range of Motion Assist Devices - MA-001coming soon Effective date: 7/30/2026
• InterQual^® Transparency
• Clinical Reference Guidelines

The applicable Medicare coverage requirements described above take precedence over CommunityCare medical policies, nationally recognized clinical criteria, and other supporting clinical guidelines.