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Medicare Clinical Policy Bulletins (CPBs)

For our New York Medicare (Wellcare By Fidelis Care) members, we provide transparent access to medical Clinical Policy Bulletins (CPBs) which detail the services and procedures coded as medically necessary, cosmetic, or experimental.

Please note that the current policy list is not exhaustive, but rather a collection of policies that individuals have expressed an interest in viewing. Amendments, modifications, supplements to these posted policies and/or additional policies may be posted in the near future. 

If you have any questions regarding these policies, please contact a Fidelis Care representative.


Member Portal

Log in or register to make payments, print ID cards, choose or change a PCP, and much more.

Clinical Policies

Clinical Policies (A-Z)
Clinical Policy: AHCT for Sickle Cell Anemia
  • Reference Number: MC.CP.MP.108
  • PDF Publish Date: 2/1/2024

Clinical Policy: Applied Behavior Analysis (ABA)
  • Reference Number: CP.FC.BH.301.04
  • PDF Publish Date: 8/1/2023

Clinical Policy: Donor Lymphocyte Infusion
  • Reference Number: MC.CP.MP.101
  • PDF Publish Date: 2/1/2024

Clinical Policy: Facility-Based Sleep Studies for Obstructive Sleep Apnea
  • Reference Number: MC.CP.MP.248
  • PDF Publish Date: 1/1/2024

Clinical Policy: Implantable Wireless PAP Monitoring
  • Reference Number: MC.CP.MP.160
  • PDF Publish Date: 1/1/2024

Clinical Policy: Lung Transplantation
  • Reference Number: MC.CP.MP.57
  • PDF Publish Date: 2/1/2024

Clinical Policy: Out-of-Network
  • Reference Number: CP.FC.20
  • PDF Publish Date: 1/1/2024

Clinical Policy: Pancreas Transplantation
  • Reference Number: MC.CP.MP.246
  • PDF Publish Date: 1/1/2024

Clinical Policy: Short Inpatient Hospital Stay (Medicare)
  • Reference Number: MC.CP.FC.182
  • PDF Publish Date: 12/1/2023

Clinical Policy: Skilled Nursing Facility Leveling
  • Reference Number: CC.PP.206
  • PDF Publish Date: 4/1/2024

Clinical Policy: State CP Process
  • Reference Number: CP.FC.40
  • PDF Publish Date: 12/1/2023

Clinical Policy: Transfer Policy
  • Reference Number: CP.FC.03
  • PDF Publish Date: 8/1/2023


About MCG Health

Centene has partnered with MCG Health, part of the Hearst Health network, to provide unbiased clinical guidance for patient-centered care decisions. MCG uses artificial intelligence and technology solutions, in tandem with objective clinical expertise, to streamline solutions and provide instant access to necessary documentation.


Wellcare by Fidelis Care shares information about services that require authorization. Clinical guidelines that Wellcare by Fidelis Care uses to determine the medical necessity of services that require authorization in our Medicare lines of business can be viewed by clicking on the above Clinical Policies (A-Z) section on this web page. If a policy does not exist in the above section, additional guidelines can be accessed by members in the Member Portal and providers in the Provider Portal. New users who are current members and providers of Wellcare By Fidelis Care can request log-in credentials by clicking those links.

Prospective members and providers who do not have the ability to create a portal account with Wellcare By Fidelis Care can also request access to specific guidelines by sending an email to with the subject line “Requesting Guideline Access for Clinical Policies” and include your name and if you are a prospective member or provider.

Access Wellcare By Fidelis Care MCG Guidelines (By clicking this link, you will leave the Fidelis Care website.)

Your Information is Protected

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule applies to all forms of your protected health information, whether electronic, written, or oral. 

To learn more about HIPAA and your privacy rights, visit the U.S. Department of Health and Human Services
(By clicking this link, you will leave the Fidelis Care website.)

Authorization to Use and Disclose Health Information (PDF)

Revocation of Authorization to Use and/or Disclose Health Information (PDF)




Additional Information

Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

From October 1 to March 31, you can call us at [1-800-247-1447 (TTY: 711)] 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends and on federal holidays.

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Last Updated 4.9.2024