Clinical Care Guidelines 

AlohaCare provides online access to the AlohaCare review guidelines used to determine medical necessity for outpatient prior authorizations, and inpatient hospitalization requests.

Click here to access the MCG website for Guideline Transparency Portal (CGT).

The following is available:

• AlohaCare Medical Policies
• MCG guidelines for Ambulatory Care
• MCG guidelines for Behavioral Health
• MCG guidelines for General Recovery Care
• MCG guidelines for Home Care
• MCG guidelines for Inpatient and Surgical Care
• MCG guidelines for Recovery Facility Care

We will continue to use Medicare Jurisdiction D for Durable Medical Equipment guidelines. Click here to access the Noridian LCD website.

Medical Policies

• Bone Hearing Device 
• Gender Identity Services and Affirming Procedures
• Hearing Services and Devices for Children
• Incontinence Supplies
• Medical Nutrition Therapy
• Nutritional Support
• Pediatric Nutrition
• Urine Drug Testing
• Vision 

Pharmaceutical Medical Policies

• Alpha-1 Proteinase Inhibitors
• Atezolizumab (Tecentriq)
• Bevacizumab for Non-Ophthalmologic Indications
• Biologics and Immunologics
• Cantharidin (Ycanth)
• Colony-Stimulating Factors (CSFs)
• Denosumab (Prolia, Xgeva)
• Eculizumab (Soliris) & Ravulizumab (Ultomiris)
• Efgartigimod (Vyvgart)
• Erythropoietic Agents
• Hyaluronic Acids
• Infliximab
• Nplate (romiplotism)
• Ocrelizumab (Ocrevus)
• Pegaspargase (Oncaspar)
• Pegloticase (Krystexxa)
• Pembrolizumab (Keytruda)
• Pertuzumab (Perjeta)
• Pertuzumab-trastuzumab-hyaluronidase-zzxf (Phesgo)
• Ramucirumab (Cyramza)
• Vutrisiran (Amvutra)
• Respiratory Interleukins
• Retinal Vascular Disease Agents
• Rituximab
• Trastuzumab

Click here to see the Retired Policies.