InterQual® Ambulatory Care Planning Criteria

Identify when imaging studies, procedures, DME, MDx tests, specialty pharmacy medications, and specialty referral consultations are appropriate.

Promote Clinical Quality and Cost-Effective Allocation of Medical Resources

InterQual® Ambulatory Care Planning Criteria help identify when imaging studies, procedures, durable medical equipment, molecular diagnostic tests, specialty pharmacy medications, and specialty referral consultations are appropriate. The criteria can be applied prospectively or retrospectively to manage utilization and identify differences in practice patterns.

The criteria feature extensive informational notes and references that support clinical recommendations and offer guidance to the reviewer in a timely manner. The intuitive Q&A format, available in all Care Planning Criteria, supports efficient review workflows. In addition, the best evidence-based recommendation is suggested within a single workflow where appropriate, according to the clinical scenario presented (e.g., MRI being superior to CT of the head in cases of evaluation for primary brain tumor), thereby allowing you to drive more value from your criteria investment.

InterQual Ambulatory Care Planning Criteria are available for:

  • Durable Medical Equipment
  • Imaging
  • Molecular Diagnostics
  • Procedures
  • Specialty Referral
  • Specialty Rx (Oncology and Non-Oncology)
  • Retrospective Monitoring

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Industry Content by InterQual®

Content from the Centers for Medicare and Medicaid Services (CMS) and others is converted into our easy-to-use Q&A format to support consistent application of third-party content and improve review workflow and efficiency.


An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions.

InterQual® Interactive Medical Review Options

Our Interactive desktop and cloud applications provide access to the InterQual Criteria and help streamline the medical review process.