Internal Coverage Criteria for Medicare Part B Drugs

When reviewing a prior authorization request, Devoted Health uses InterQual™ clinical criteria for the services and procedures listed in our Services reviewed using InterQual criteria policy.

To learn more about InterQual's criteria, see:

• InterQual’s detailed coverage criteria (you'll need to create an Optum One Healthcare ID account)
• InterQual’s clinical development process

For cases when coverage criteria are not fully spelled out in these resources, we created internal coverage criteria based on current evidence in widely used treatment guidelines or in publicly available clinical literature.