Clinical Guidelines and Policies 

For Medicare beneficiaries, Molina Healthcare uses policies from the Centers for Medicare and Medicaid Services (CMS) to make clinical decisions. When CMS policies are not available, Molina Healthcare may use the following guidelines and policies to make decisions:

  • Molina Clinical Policy
  • In select markets, Molina contracts with a vendor to make decisions about cardiology, oncology, and radiation oncology services. To leave Molina Healthcare's website and access the vendor policies, click here.
  • Additional Third-party Guidelines – To access additional third-party guidelines Molina Healthcare uses to make decisions, click here.

Register to access additional third-party guidelines

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