Medical Technology/Coverage Guidelines
AvMed keeps pace with changes that provide Practitioners with new developments in technology through our Medical Technology Assessment Committee (MTAC). The technologies presented are comprised of medical and behavioral health procedures, pharmaceuticals, devices, and new applications of existing technologies for inclusion in benefit plans. The MTAC includes Board Certified physicians with varied specialties. A new technology or a new development in technology is presented to the MTAC by unbiased Specialists who are experienced in the technology. Prior technology determinations are also revisited as the scientific evidence and/or the medical literature change. In addition, the MTAC is provided with information for review from appropriate government regulatory bodies, such as the FDA and CMS. Relevant scientific evidence from varied sources and professional organizations such as the American Medical Association and scientific journals, such as PubMed are also used to assist in making a determination on the technology.
The variables used to make a determination for approval include:
• A safe and efficient technology;
• An improvement of health outcomes;
• Potential benefits outweigh potential negative effects and
• The technology’s comparison to those of established alternatives
The complete approved coverage guidelines can be found below. At any time, Practitioners may ask for consideration of a new technology. For these requests or any other question regarding medical technologies, please contact AvMed’s Provider Service Center at 1-800-452-8633.
Medical Necessity Coverage Criteria For Medicare Advantage Members