Internal Coverage Criteria for Medical Services

When reviewing a prior authorization request, Devoted Health uses InterQual™ clinical criteria for the services and procedures listed in this policy: Services reviewed using InterQual criteria (PDF)

See InterQual’s detailed coverage criteria. (Note: you'll need to create an Optum One Healthcare ID account to access the criteria.)

Learn about InterQual’s development process (PDF)

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.