MediGold follows Medicare coverage guidelines and regularly updates its policy guidelines to comply with changes in the Center for Medicare & Medicare Services (CMS) policy. MediGold encourages physicians and other healthcare professionals to keep current with any CMS policy changes and/or billing requirements by frequently referring to the guidelines published annually by CMS or your local carrier website. Physicians and other healthcare professionals can sign up for regular distributions for policy or regulatory changes directly from CMS and/or your local carrier. You can find this at:

A list of services that are subject to notification/prior authorization requirements can be found at

Providers are responsible for submission of accurate claims to MediGold. Policy guidelines are intended to ensure that coverage decisions are made accurately based on the code or codes that correctly describe the health care services provided. MediGold policy guidelines use Current Procedural Terminology (CPT®), CMS or other commonly accepted coding guidelines. For more details see our Provider Administrative Manual at:

For various claims forms, see the Claims section of our Forms page on this website:

If you have a question on a claim, please call Provider Services at: 800-991-9907 or access our Provider Portal at:

Updated 01/2020