Understand HMSA medical necessity and level of care criteria, including clinical guidelines used to determine appropriate treatment settings and authorize behavioral health services.

Learn about nebulizers—how they work, covered medications, and when they’re used—to help manage respiratory conditions effectively.

Learn how to determine the correct onset date for HMSA durable medical equipment claims, including accident, condition, and post‑surgery guidelines and billing requirements.

Learn about Blue Distinction Centers for Transplants, including approved facilities for HMSA members and resources for current transplant center listings.

View HMSA’s Outpatient Surgical Procedure-Related Group (PRG) List, including CPT codes, procedure descriptions, and group assignments used to determine outpatient surgical reimbursement.

Overview of patient safety initiatives at HMSA, including programs, policies, and efforts to reduce medical errors and improve quality of care.

Explore physical medicine and therapy codes for 2026, including covered services, coding requirements, and billing guidelines for accurate claims submission.

List of procedures appropriate for office settings, including eligible services for coverage and guidance on when precertification is required for higher levels of care.

Learn HMSA's outpatient treatment policy, including eligible procedures, precertification requirements, exceptions, and patient financial responsibility.

Overview of HMSA medical precertification requirements, including services that require approval, provider responsibilities, and the process for submitting and reviewing precertification requests.