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Clinical Criteria for Surgical Procedures

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​View or download clinical criteria by surgical procedure type.

  • Blepharoplasty
  • Dermabrasions & Chemical Peels
  • Gastric Bypass​
  • Macromastia- Reduction Mammoplasty
  • Panniculectomy/Abdominoplasty
  • ​Penile Implants
  • Prostate Rectal Spacers​​​
  • Rhinoplasty and other Nasal Surgeries​​​
  • Transcervical Radiofrequency Ablation
  • Transplant- Initial
  • Transplant- Renewal

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Related Webpages

  • Clinical Criteria for Laboratory Testing

  • Clinical Criteria for Drugs and Injectables Requiring Preauthorization

  • Preauthorization Information

Related Documents

  • Colon Cancer Screening Updated 2021
  • Lung Cancer Screening Updates 2022 
  • Out-of-State Inpatient Admissions Criteria
  • Professional Services Codes Requiring Preauthorization ​
  • Gender-Affirming Treatments- Expanded Coverage​
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Maryland Department of Health
201 W. Preston Street, Baltimore, MD 21201
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