Durable Medical Equipment (DME) Clinical Guidelines for Medical Necessity
Effective Nov 1, 2020
2,954 active EviCore by Evernorth policies in Backwork, grouped by policy type. Each policy page shows the codes the policy lists and links to the payer’s own copy.
Summary of the payer’s published policy. Not a coverage determination — confirm with EviCore by Evernorth before submitting.
Free account. Policy pages stay open to everyone.
801–850 of 2,954, by type and title
Effective Nov 1, 2020
Effective Nov 2, 2020
Effective Jan 1, 2021
Effective Nov 15, 2024
Effective Oct 27, 2025
Effective Jul 1, 2024
Effective Jul 1, 2025
Effective Aug 1, 2023
Effective Oct 27, 2025
Effective Sep 1, 2024
Effective Aug 1, 2025
Effective Aug 1, 2023
Effective Apr 1, 2021
Effective Jan 1, 2019
Effective Mar 1, 2023
Effective Jun 1, 2019
Effective May 1, 2020
Effective Mar 1, 2022
Effective Mar 1, 2020
Effective Feb 1, 2023
Effective Jul 1, 2019
Effective Jan 1, 2019
Effective Feb 1, 2022
Effective Mar 15, 2021
Effective Jul 1, 2025
Effective Mar 1, 2022
Effective Feb 1, 2023
Effective Mar 9, 2018
Effective Apr 1, 2021
Effective May 1, 2020
Effective Aug 15, 2018
Effective Oct 1, 2025
Effective Oct 1, 2022
Effective Apr 1, 2022
Effective Dec 1, 2023
Effective Apr 1, 2019
Effective Apr 1, 2022
Effective Apr 1, 2023
Effective May 1, 2021
Effective May 1, 2020
Effective Jun 1, 2025
Effective Jun 1, 2024