Payer Guidelines
60 prior authorization guidelines covering 10 payer families across 6 clinical topics
| Payer | Topic | Title | ICD codes | Chunks | |
|---|---|---|---|---|---|
| Aetna | ed hypogonadism | Aetna Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Aetna | hematuria bladder cancer | Aetna Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Aetna | kidney stones hydronephrosis | Aetna Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Aetna | oab incontinence | Aetna Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Aetna | prostate bph cancer | Aetna Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Aetna | uti cystitis management | Aetna Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Anthem BCBS | ed hypogonadism | Anthem BCBS Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Anthem BCBS | hematuria bladder cancer | Anthem BCBS Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Anthem BCBS | kidney stones hydronephrosis | Anthem BCBS Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Anthem BCBS | oab incontinence | Anthem BCBS Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Anthem BCBS | prostate bph cancer | Anthem BCBS Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Anthem BCBS | uti cystitis management | Anthem BCBS Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| CareFirst BCBS | ed hypogonadism | CareFirst BCBS Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| CareFirst BCBS | hematuria bladder cancer | CareFirst BCBS Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| CareFirst BCBS | kidney stones hydronephrosis | CareFirst BCBS Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| CareFirst BCBS | oab incontinence | CareFirst BCBS Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| CareFirst BCBS | prostate bph cancer | CareFirst BCBS Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| CareFirst BCBS | uti cystitis management | CareFirst BCBS Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Cigna | ed hypogonadism | Cigna Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Cigna | hematuria bladder cancer | Cigna Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Cigna | kidney stones hydronephrosis | Cigna Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Cigna | oab incontinence | Cigna Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Cigna | prostate bph cancer | Cigna Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Cigna | uti cystitis management | Cigna Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Highmark | ed hypogonadism | Highmark Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Highmark | hematuria bladder cancer | Highmark Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Highmark | kidney stones hydronephrosis | Highmark Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Highmark | oab incontinence | Highmark Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Highmark | prostate bph cancer | Highmark Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Highmark | uti cystitis management | Highmark Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Humana Choice | ed hypogonadism | Humana Choice Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Humana Choice | hematuria bladder cancer | Humana Choice Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Humana Choice | kidney stones hydronephrosis | Humana Choice Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Humana Choice | oab incontinence | Humana Choice Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Humana Choice | prostate bph cancer | Humana Choice Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Humana Choice | uti cystitis management | Humana Choice Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Medicare | ed hypogonadism | Medicare Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Medicare | hematuria bladder cancer | Medicare Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Medicare | kidney stones hydronephrosis | Medicare Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Medicare | oab incontinence | Medicare Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Medicare | prostate bph cancer | Medicare Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Medicare | uti cystitis management | Medicare Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Sentara Health Plans | ed hypogonadism | Sentara Health Plans Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Sentara Health Plans | hematuria bladder cancer | Sentara Health Plans Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Sentara Health Plans | kidney stones hydronephrosis | Sentara Health Plans Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Sentara Health Plans | oab incontinence | Sentara Health Plans Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Sentara Health Plans | prostate bph cancer | Sentara Health Plans Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Sentara Health Plans | uti cystitis management | Sentara Health Plans Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| Tricare East | ed hypogonadism | Tricare East Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| Tricare East | hematuria bladder cancer | Tricare East Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| Tricare East | kidney stones hydronephrosis | Tricare East Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| Tricare East | oab incontinence | Tricare East Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| Tricare East | prostate bph cancer | Tricare East Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| Tricare East | uti cystitis management | Tricare East Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |
| UHC | ed hypogonadism | UHC Guideline - Erectile Dysfunction & Hypogonadism Workup | N52.9 N52.1 N52.02 N52.31 E29.1 E34.9 +4 more | 5 | View → |
| UHC | hematuria bladder cancer | UHC Guideline - Hematuria Workup & Bladder Cancer Management | R31.0 R31.29 C67.9 C67.2 C68.9 N32.0 +1 more | 5 | View → |
| UHC | kidney stones hydronephrosis | UHC Guideline - Kidney Stones & Hydronephrosis Management | N20.0 N21.0 N13.1 N13.2 N13.30 R10.9 +2 more | 5 | View → |
| UHC | oab incontinence | UHC Guideline - Overactive Bladder & Urinary Incontinence | N32.81 N39.3 N39.41 R33.9 R35.0 R35.1 +3 more | 5 | View → |
| UHC | prostate bph cancer | UHC Guideline - Prostate Conditions — BPH, Cancer, PSA Screening | N40.0 N40.1 N40.2 C61 R97.20 Z12.5 +6 more | 5 | View → |
| UHC | uti cystitis management | UHC Guideline - UTI & Cystitis Management in Complex Urologic Cases | N39.0 N30.10 N30.90 R30.0 | 5 | View → |