InterQual Criteria
INTERQUAL musculoskeletal services management
InterQual® aligns payers and providers with actionable, evidence-based clinical intelligence to support appropriate care and foster optimal utilization of resources.
When we receive a request for authorization or prior approval, our utilization review clinicians use InterQual® criteria to determine if the services and level of care are clinically indicated. If the criteria are met, the request is approved; if the criteria are not met, the request is reviewed by a physician.
For additional informational see
InterQual Musculoskeletal Services Management #220
InterQual Musculoskeletal Services Management CPT and HCPCS Codes #221
We encourage providers to use InterQual® criteria to submit prior authorization requests for the procedures listed in InterQual Musculoskeletal Services Management CPT and HCPCS Codes #221. Use of InterQual® is recommended because they provide us with the information, we will need to expedite your request.