Medical policies

Below are links to the most up-to-date policies on treatment options for FCHP members. Each policy includes an overview, policy and criteria, an explanation of when services are covered, and any exclusions that apply.

We use InterQual® guidelines for the following criteria:

Effective November 1, 2013

  • Hysterectomy Abdominal
  • Hysterectomy Laparoscopically Assisted Vaginal
  • Hysterectomy Supracervical
  • Hysterectomy Vaginal
  • Neuro Discectomy Anterior Cervical
  • Neuro Laminectomy Cervical
  • Neuro Laminectomy Lumbar
  • Neurosurgery Discectomy Cervical
  • Neurosurgery Disectomy Lumbar
  • Neurosurgery Fusion Cervical
  • Neurosurgery Hemilaminectomy Cervical
  • Neurosurgery Hemilaminectomy Lumbar and Discectomy Foraminotomy
  • Total Joint Replacement Hip
  • Total Joint Replacement Knee

Effective January 1, 2014

  • Inter-Spinous Process Decompression X Stop
  • Lumbar Disc Replacement
  • Neuromuscular Electrical Stimulation
  • Spinal Cord Stimulation
  • Transplants
  • Vagus Nerve Stimulation
  • Weight Loss Surgery

If you do not have access to InterQual® criteria, they can be accessed through McKesson.