Central Health Clinical Criteria
Medical Policies
Ambulance Services - Medical Transportation
Autologous Chondrocyte Implantation
Continuity of Care and Transition of Care
Hospital Stay Requirements for Skilled Nursing Facility Admission (MA)
Investigational or Experimental Services and Clinical Trials
Knee Arthroplasty (Total or Partial)
Pulsed Dye Laser Therapy for Port Wine Stain
Sacroiliac Joint Pain Management
Short Stay Admissions and Outpatient Hospital Observation
Site of Service Utilization Review
Skilled Nursing Facility Services
Temporomandibular Joint (TMJ) Disorders
Tumor Treating Fields (Optune®)
Step Theorapy
Colony Stimulating Factors Long Acting
Colony Stimulating Factors – Short Acting
Hyaluronate Injections for Osteoarthritis of the Knee
Medical Pharmacy Policies
Abecma - idecabtagene vicleucel
Alpha-1-Proteinase Inhibitors: Aralast/Prolastin/Zemaira/Glassia
Breyanzi - lisocabtagene maraleucel
Cabenuva - cabotegravir and rilpivirine
Cresemba - isavuconazonium sulfate
Duchenne Muscular Dystrophy (DMD)
Emend - fosaprepitant dimeglumine
Fyarro - sirolimus albumin-bound
Intravenous Immune Globulins (IVIG)
Intravitreal Injections/Implants
Lupron Depot-Lupron Depot-Ped Eligard-Fensolvi-Camcevi - leuprolide
Luxturna - voretigene neparvovec
Mepsevii - vestronidase alfa-vjbk
Nexviazyme - avalglucosidase alfa-ngpt
Nulibry - fosdenopterin hydrobromide
Padcev - enfortumab vedotin-ejfv
Pepaxto - melphalan flufenamide
Pulmonary Arterial Hypertension
Subcutaneous Immune Globulins (SCIG)
Tecartus - brexucabtagene autoleucel
Vyvgart - efgartigimod alfa-fcab
Yescarta - axicabtagene ciloleucel
Zilretta - triamcinolone acetonide
Zolgensma - onasemnogene abeparvovec-xioi
Zynlonta - loncastuximab tesirine
Zynteglo (betibeglongene autotemcel)
MCG Registration and Sign-in
For additional clinical criteria please register by entering your name and email address. The same email address associated with your Central Health plan.
For Apollo Criteria please click the link below:
https://hsmso.apollomanagedcare.com