Medicare Part B MAC & Commercial Policy Support.
Nolvium cross-references patient clinical charts against active CMS Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), Local Coverage Articles (LCAs), and selected commercial payer policies.
Scheduled Policy Maintenance Protocol
“Nolvium performs scheduled policy reviews at least quarterly and monitors CMS and MAC coverage-document changes throughout the year. Critical revisions are prioritized for review within 48–72 hours.”
Supported Medicare Administrative Contractors (MACs)
Supported Orthopedic Procedures
Knee Arthroscopy & Meniscectomy
Meniscal tears, mechanical locking, refractory conservative care criteria.
Arthroscopic Rotator Cuff Repair
Full & partial tear indications, physical therapy & injection trial documentation.
Lumbar Discectomy or Laminotomy
Radiculopathy, neurological deficits, conservative care duration thresholds.
Major Joint Injection / Aspiration
Including selected hyaluronic-acid (HA) viscous supplementation workflows.
Total Knee Arthroplasty (TKA)
Radiographic joint space narrowing, functional deficit & non-surgical trial evidence.
Shoulder Capsulorrhaphy / Labral Repair
Instability, Bankart lesions, labral tear medical necessity criteria.
Selected Commercial Payer Support
* Commercial plans may have different documentation requirements, exclusions, authorization rules, definitions, and appeal processes than Medicare Part B.
Need policy verification for your jurisdiction?
Our team can verify if your target CPT codes and regional MAC policies are actively supported.