InterQual® authorization criteria

For some services, Priority Health has adopted InterQual® criteria to determine DME and service authorizations.

InterQual® offers evidence-based clinical decision support criteria developed by McKesson and used across the health care industry. They allow providers to use a standardized approach to assess each patient's unique situation and recommend the most appropriate care.

Requirements with no previous medical policy

Prostatectomy, Radical

Tonsillectomy


Priority Health medical policies transitioned to InterQual

Breast Related Procedures - 91545

Cardioverter Defibrillators - 91410

Cranial Helmets - 91504

Electrophysiology Testing & Catheter Ablation for Cardiac Arrhythmias - 91314

Gastroparesis Testing and Treatment - 91572

Hearing Augmentation - 91544

Obstructive Sleep Apnea - 91333

Noninvasive Airway Assistive Devices - General IQ

Noninvasive Airway Assistive Devices - Senior IQ

Orthognathic Surgery - 91273

Sexual Dysfunction & Impotence - 91160

Stimulation Therapy and Devices - 91468

Transcatheter Heart Valve Procedures - 91597