By continuing to the Medicare Advantage Medical Policy Manual, you understand and agree to the following terms and conditions:
Medicare Advantage Medical Policy Manual Terms and Conditions
Description
The Medicare Advantage Medical Policy Manual contains approved Medical Policies. Medical Policies are developed using applicable Centers for Medicare & Medicaid Services (CMS) guidelines, when available. Please see the Introduction to the Medicare Advantage Medical Policy Manual for a full description of the policy development process.
Use
Our Plans and any of their affiliated or subsidiary companies use Medicare Advantage Medical Policies as guidelines for coverage determinations for Medicare Advantage members. The applicable Medicare Advantage Medical Policy is the policy that is in effect at the time of service.
Conflict with Plan Documents
In the event of a conflict between Medicare Advantage Medical Policy and any Plan document under which a member is entitled to Covered Services, the Plan document will govern. Plan documents include, but are not limited to, Evidence of Coverage (EOC) summaries and other coverage documents prepared by a Plan.
Restrictions and Limitations
- Medicare Advantage Medical Policies DO NOT determine the schedule of benefits. Rather, Medical Policies are used in the process of determining medical necessity for specific services.
- Medicare Advantage Medical Policies are interpreted and applied at the sole discretion of the Plan.
- Medicare Advantage Medical Policy application is subject to state and federal laws and specific instructions from Centers for Medicare & Medicaid Services (CMS).
- Medicare Advantage Medical Policies DO NOT constitute medical advice and DO NOT guarantee any results or outcomes. You should discuss any health care questions related to these Medical Policies with your health care provider.
- Current Procedural Terminology (CPT®) codes and descriptions are the property of the American Medical Association with all rights reserved.
- Medicare Advantage Medical Policies are the property of our Plans and their affiliated or subsidiary companies, but may be used for purposes related to the health care of a Medicare Advantage Plan member. You are strictly prohibited from using Medicare Advantage Medical Policies for purposes not related to the health care of a Plan member, including but not limited to commercial use.
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