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Molinalogo

Marketplace Benefit Interpretation Policies

For Codification, please click here (for Marketplace only)

For Clinical Policies, please click here (all LOBs)

For PA Lookup Tool, please click here

Abortions Pregnancy Termination

Acquired Brain Injury Services

Allergy Testing and Injections

Ambulance Transportation

Attention Deficit Hyperactivity Disorder

Autism Spectrum Disorder

Bariatric Surgery

Biofeedback and Neurofeedback

Cardiac Pacemakers and Defibrillators

Cardiac Rehabilitation Services

Clinical Trials

Cognitive Rehabilitation

Complementary Alternative Medicine

Continuity of Care and Transition of Care

download Continuity of Care and Transition of Care

Cosmetic, Reconstructive or Plastic Surgery

Dental Care and Oral Surgery

Diabetic Management Services

Diagnostic and Radiology Services

Dialysis Services

Durable Medical Equipment, Prosthetics and Medical Supplies

download Durable Medical Equipment, Prosthetics and Medical Supplies

Emergency and Urgent Services

Experimental and Investigational Services

Family Planning

Foot Care and Podiatry Services

Gender Affirming Care

Genetic Testing

Hearing Services

Home Health Care

Home Infusion Therapy

Hospice Services

Immunizations and Vaccinations

Inpatient Hospital Services

Maternity and Newborn Care

Medications and Off-Label Drugs

Member Initiated Second Opinion

Outpatient Hospital Services

Pain Management

Parenteral Enteral and Oral Nutritional Therapy

Physician Services

Post Mastectomy Surgery

Preventive Care Services

Rehabilitation and Habilitation Services

Residential Care

Services and Complications Related to Non-Covered Services

Services While Confined Incarcerated

Sexual Dysfunction

Shoes and Foot Orthotics

Skilled Nursing Facility

Substance Use Disorder

Telemedicine Telehealth Services and Virtual Visits

Transplantation Services

Vision Care and Services

Wheelchairs and Accessories