MP226/E Bachmann

Description

Bachmann MP226/E CPU Processor Module

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INSTRUCTIONS FOR USE: Company Medicare Medical Policies serve as guidance for the administration of planbenefits and do not constitute medical advice nor a guarantee of coverage. Company Medicare Medical Policiesare reviewed annually to guide the coverage or non-coverage decision-making process for services or proceduresin accordance with member benefit contracts (otherwise known as Evidence of Coverage or EOCs) and Centers ofMedicare and Medicaid Services (CMS) policies, manuals, and other CMS rules and regulations. In the absence of aCMS coverage determination or specific regulation for a requested service, item or procedure, Company policycriteria or applicable utilization management vendor criteria may be applied. These are based upon published,peer-reviewed scientific evidence and evidence-based clinical practice guidelines that are available as of the lastpolicy update. Coverage decisions are made on the basis of individualized determinations of medical necessity andthe experimental or investigational character of the treatment in the individual case. In cases where medicalnecessity is not established by policy for specific treatment modalities, evidence not previously consideredregarding the efficacy of the modality that is presented shall be given consideration to determine if the policyrepresents current standards of care.The Company reserves the right to determine the application of Medicare Medical Policies and make revisions tothese policies at any time. Any conflict or variance between the EOC and Company Medical Policy will be resolvedin favor of the EOC.SCOPE: Providence Health Plan, Providence Health Assurance, and
MEDICARE COVERAGE CRITERIAIMPORTANT NOTE: More than one Centers for Medicare and Medicaid Services (CMS) reference may applyto the same health care service, such as when more than one coverage policy is available (e.g., both an NCDand LCD exist). All references listed should be considered for coverage decision-making. The Company usesthe most current version of a Medicare reference available at the time of publication; however, thesewebsites are not maintained by the Company, so Medicare references and their corresponding hyperlinksmay change at any time. If there is a conflict between the Company Medicare Medical Policy and CMSguidance, the CMS guidance will govern.

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