Medical Policies

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Showing 101– 150 of 360 Results
Title Last Updated Category
Autologous Chondrocyte Implantation (ACI) (Effective 2026-10-15) Open a PDF 7.01.38 2026-07-15 Bone & Joints (Orthopedic)
Autologous Chondrocyte Implantation (ACI) Open a PDF 7.01.38 2026-07-15 Bone & Joints (Orthopedic)
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty (Effective 2026-10-15) Open a PDF 6.01.17 2026-07-15 Bone & Joints (Orthopedic)
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty Open a PDF 6.01.17 2026-07-15 Bone & Joints (Orthopedic)
Magnetic Resonance Imaging (MRI) of the Prostate (Effective 2026-10-15) Open a PDF 6.01.46 2026-07-15 Radiology (x-rays) & Imaging
Magnetic Resonance Imaging (MRI) of the Prostate Open a PDF 6.01.46 2026-07-15 Radiology (x-rays) & Imaging
Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) (Effective 2026-10-15) Open a PDF 6.01.34 2026-07-15 Radiology (x-rays) & Imaging
Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) Open a PDF 6.01.34 2026-07-15 Radiology (x-rays) & Imaging
Positron Emission Tomography (PET) - Non-Oncologic Applications (Effective 2026-10-15) Open a PDF 6.01.07 2026-07-15 Radiology (x-rays) & Imaging
Positron Emission Tomography (PET) Oncologic Applications (Effective 2026-10-15) Open a PDF 6.01.29 2026-07-15 Radiology (x-rays) & Imaging
Positron Emission Tomography (PET) Oncologic Applications Open a PDF 6.01.29 2026-07-15 Radiology (x-rays) & Imaging
Positron Emission Tomography (PET) - Non-Oncologic Applications Open a PDF 6.01.07 2026-07-15 Radiology (x-rays) & Imaging
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD) (Effective 2026-10-15) Open a PDF 7.01.89 2026-07-15 Digestive System (Gastroenterology)
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD) Open a PDF 7.01.89 2026-07-15 Digestive System (Gastroenterology)
Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) Devices (Effective 2026-10-15) Open a PDF 1.01.06 2026-07-15 Sleep Medicine
Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure (Effective 2026-10-15) Open a PDF 1.01.57 2026-07-15 Sleep Medicine
MAZE Procedures for Atrial Fibrillation and Flutter Open a PDF 7.01.27 2026-06-25 Heart & Blood Vessels (Cardiovascular)
Applied Behavior Analysis Open a PDF 3.01.11 2026-06-25 Behavioral Health (Psychiatry/Psychology)
Lab Testing for Alzheimer’s Disease Open a PDF 2.02.16 2026-06-25 Genetic Disease (Inherited Disease)
Home Automatic External Defibrillators (AEDs) and Wearable Cardioverter Defibrillators (WCDs) Open a PDF 1.01.42 2026-06-25 Heart & Blood Vessels (Cardiovascular)
Cryotherapy (Cold Therapy) Devices Open a PDF 1.01.21 2026-06-25 Bone & Joints (Orthopedic)
Bariatric and Metabolic Surgery Open a PDF 7.01.29 2026-06-16 Digestive System (Gastroenterology)
Cranial and Auricular Neuromodulation Open a PDF 1.01.58 2026-05-27 Durable Medical Equipment & Supplies
Electromagnetic and Pulsed Field Stimulation Open a PDF 1.01.59 2026-05-27 Durable Medical Equipment & Supplies
Implantable and Invasive Neuromodulation Systems Open a PDF 1.01.60 2026-05-27 Durable Medical Equipment & Supplies
Non-Invasive Surface Electrical Stimulation for Pain and Rehabilitation Open a PDF 1.01.61 2026-05-27 Durable Medical Equipment & Supplies
Transcatheter Heart Valve Procedures Open a PDF 7.01.109 2026-05-27 Heart & Blood Vessels (Cardiovascular)
Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members Open a PDF 7.01.84 2026-05-27 Miscellaneous
Abdominoplasty, Panniculectomy, and Lipedema Reduction Surgery Open a PDF 7.01.53 2026-05-27 Cosmetic / Reconstructive Surgery
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy Open a PDF 7.01.103 2026-05-27 Nervous Systems (Neurology)
Dental and Oral Care under Medical Plans Open a PDF 7.01.21 2026-05-27 Dental
Genetic Testing for Cardiac Ion Channelopathies Open a PDF 2.02.38 2026-05-27 Genetic Disease (Inherited Disease)
Evoked Potentials Open a PDF 2.01.27 2026-05-27 Nervous Systems (Neurology)
Orthotics Open a PDF 1.01.25 2026-05-15 Bone & Joints (Orthopedic)
External Prosthetic Devices Open a PDF 1.01.18 2026-05-15 Miscellaneous
New/Emerging Technology and Services Code List Open a PDF 11.01.27 2026-04-30 Miscellaneous
Photodynamic Therapy for Malignant Disease Open a PDF 8.01.06 2026-04-28 Cancer Treatment (Oncology)
Neuropsychological and Psychological Testing Open a PDF 3.01.24 2026-04-28 Behavioral Health (Psychiatry/Psychology)
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) Open a PDF 7.02.02 2026-04-22 Transplants
Cochlear Implants and Auditory Brainstem Implants Open a PDF 7.01.26 2026-04-22 Ear, Nose & Throat (Otorhinolaryngology)
Tumor-Treatment Fields Therapy Open a PDF 6.01.45 2026-04-20 Cancer Treatment (Oncology)
Level of Care Criteria for Inpatient, Residential, Partial Hospital, and Intensive Outpatient Mental Health Services for Adults and Children Open a PDF 3.01.21 2026-04-20 Behavioral Health (Psychiatry/Psychology)
Kidney Transplantation Open a PDF 7.02.04 2026-04-20 Transplants
Lung and Lobar Lung Transplant Open a PDF 7.02.10 2026-04-20 Transplants
Genetic Assay of Tumor Tissue to Determine Prognosis and Treatment of Breast Cancer Open a PDF 2.02.27 2026-04-20 Genetic Disease (Inherited Disease)
Implantable Bone Conduction Hearing Aids Open a PDF 7.01.77 2026-04-20 Ear, Nose & Throat (Otorhinolaryngology)
Tibial Nerve Stimulation (TNS) for Voiding Dysfunction Open a PDF 8.01.22 2026-04-20 Nervous Systems (Neurology)
Deep Brain Stimulation Open a PDF 7.01.23 2026-04-20 Nervous Systems (Neurology)
Continuing Day Treatment Programs Open a PDF 3.01.20 2026-04-20 Behavioral Health (Psychiatry/Psychology)
Showing 101– 150 of 360 Results

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