Medical criteria accessible through this site serve as a guide for evaluating the medical necessity of services. They are intended to promote objectivity and consistency in the medical necessity decision-making process and are necessarily general in approach. They do not constitute or serve as a substitute for the exercise of independent medical judgment in enrollee specific matters and do not constitute or serve as a substitute for medical treatment or advice. Therefore, medical discretion must be exercised in their application. Benefits are available to enrollees only for covered services specified in the enrollee’s benefit plan document. Please call the Customer Service telephone number listed on the back of the enrollee’s identification card for the applicable pre-certification or prior authorization requirements of the enrollee’s plan. The criteria apply to PPO enrollees only when the employer group has contracted with PreferredOne for Medical Management services.