This Clinical Guideline has been developed in accord with medical necessity criteria contained in Hawaii's Patients' Bill of Rights and Responsibilities Act (Hawaii Revised Statutes §432E-1.4), generally accepted standards of medical practice. If a treating physician disagrees with NIA's determination as to medical necessity in a given case, the physician may request that HMSA reconsider the application of the medical necessity criteria to the case at issue in light of any supporting documentation.
Florida Blue Medicare requests have specific guidelines for services rendered in state. For these services, please use one of the following links:
L33282 - CTA Chest Heart and Coronary Arteries (A57061)
L33382 - Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions (A57654)
L33594 - Manipulation Under Anesthesia (MUA) (A57766)
L33618 - Major Joint Replacement Hip and Knee (A57765)
L33814 - Destruction of Paravertebral Facet Joint Nerve (A57639)
L33906 - Epidural (A56651)
L33930 - Paravertebral Facet Joint Blocks (A57787)
L34372 - Magnetic Resonance Angiography (MRA) (A57779)
L38396 - Cardiology Non-emergent Outpatient Stress Testing (A56952)
Physical Medicine Solutions
to view NIA’s Physical Medicine guidelines.
Magellan adopted the use of
for its Physical Medicine product. View
for accessing MCG Guidelines®.
Please select a Health Plan