Medical Policies

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Showing 151– 200 of 358 Results
Title Last Updated Category
Germline Genetic Testing for Hereditary Cancers Open a PDF 2.02.60 2026-04-20 Genetic Disease (Inherited Disease)
Bone Growth Stimulators Open a PDF 1.01.53 2026-04-20 Bone & Joints (Orthopedic)
Vitrectomy Chair/ Face-Down Positioning System Open a PDF 1.01.52 2026-04-20 Durable Medical Equipment & Supplies
Pharmacogenetics Open a PDF 2.02.30 2026-04-14 Genetic Disease (Inherited Disease)
Pancreas Transplant: (Pancreas Transplant Alone, Pancreas Transplant after Kidney Transplant, Simultaneous Pancreas Kidney Transplant): Islet Cell Transplant Open a PDF 7.02.01 2026-03-24 Transplants
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms Open a PDF 2.02.53 2026-03-24 Lab Tests (pathology)
Interfacility Transfer of a Registered Inpatient Open a PDF 11.01.18 2026-03-24 Miscellaneous
Ambulance: Air Open a PDF 11.01.06 2026-03-24 Miscellaneous
Emergency Care Services Open a PDF 10.01.12 2026-03-24 Miscellaneous
Ambulance: Land/Ground Open a PDF 10.01.07 2026-03-24 Miscellaneous
Small Bowel and Multivisceral Transplants in Adults and Children Open a PDF 7.02.05 2026-03-24 Transplants
Ventricular Assist Device (VAD) and Total Artificial Heart (TAH) Open a PDF 7.01.114 2026-03-24 Heart & Blood Vessels (Cardiovascular)
Blepharoplasty and Brow Ptosis Repair Open a PDF 7.01.55 2026-03-24 Cosmetic / Reconstructive Surgery
Transendoscopic Therapies for Gastroesophageal Reflux Disease (GERD) Open a PDF 7.01.45 2026-03-24 Digestive System (Gastroenterology)
Bulking Agents for Treatment of Urinary or Fecal Incontinence Open a PDF 7.01.22 2026-03-24 Urinary System (Genitourinary)
Pelvic Floor Electrical Stimulation as a Treatment for Urinary or Fecal Incontinence Open a PDF 1.01.19 2026-03-24 Urinary System (Genitourinary)
Gender Reassignment/Gender Affirming Surgery and Treatments for Medicaid Managed Care Plan (MMCP) and Health and Recovery Plan (HARP) Members Open a PDF 7.01.105 2026-03-20 Miscellaneous
Prenatal Genetic Testing Open a PDF 4.01.03 2026-03-17 Genetic Disease (Inherited Disease)
Heart Failure Management Devices Open a PDF 7.01.91 2026-03-13 Heart & Blood Vessels (Cardiovascular)
Implantable Cardioverter Defibrillator (ICD) Open a PDF 7.01.06 2026-03-13 Heart & Blood Vessels (Cardiovascular)
Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices Open a PDF 7.01.58 2026-03-13 Heart & Blood Vessels (Cardiovascular)
Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT) Open a PDF 7.02.03 2026-03-13 Transplants
Standing Devices and Gait Trainers Open a PDF 1.01.46 2026-02-23 Durable Medical Equipment & Supplies
Total Parenteral Nutrition (TPN) or Hyperalimentation Open a PDF 11.01.04 2026-02-23 Food (Nutrition)
Enteral Nutrition Open a PDF 10.01.03 2026-02-23 Food (Nutrition)
Radioembolization (TARE) for Hepatic Tumors Open a PDF 7.01.69 2026-02-23 Radiation Treatment
Endometrial Ablation Open a PDF 4.01.01 2026-02-23 Women's Health (Obstetrics & Gynecology)
Treatment of Gambling Disorder and Other Repetitive Behaviors Open a PDF 3.01.19 2026-02-23 Behavioral Health (Psychiatry/Psychology)
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) Open a PDF 2.02.56 2026-02-23 Lab Tests (pathology)
Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers Open a PDF 2.02.51 2026-02-23 Genetic Disease (Inherited Disease)
Specialty Enclosure Bed Systems Open a PDF 1.01.56 2026-02-13 Durable Medical Equipment & Supplies
Positron Emission Tomography (PET) – Head Imaging Open a PDF 6.01.47 2026-02-13 Radiology (x-rays) & Imaging
Peroral Endoscopic Myotomy (POEM) Procedures Open a PDF 7.01.120 2026-02-13 Digestive System (Gastroenterology)
Temporomandibular Joint Disorders (TMJD) Open a PDF 11.01.17 2026-02-13 Bone & Joints (Orthopedic)
Magnetic Resonance Spectroscopy (MRS) Open a PDF 6.01.03 2026-02-13 Radiology (x-rays) & Imaging
Computed Tomography (CT) for Coronary Calcium Scoring Open a PDF 6.01.13 2026-02-13 Radiology (x-rays) & Imaging
Sleep Studies Open a PDF 2.01.28 2026-01-27 Sleep Medicine
Surgical Management of Sleep Disorders Open a PDF 7.01.41 2026-01-27 Sleep Medicine
Electromagnetic Navigation Bronchoscopy Open a PDF 6.01.40 2026-01-27 Lungs (Respiratory)
Platelet Rich Plasma and Growth Factor Treatments Open a PDF 2.01.24 2026-01-27 Skin (Dermatology)
Bioimpedance Devices for Detection and Management of Breast Cancer Related Lymphedema Open a PDF 2.01.52 2026-01-27 Miscellaneous
Out-of-Network Services Open a PDF 11.01.13 2026-01-27 Miscellaneous
Aqueous Drainage Devices (Stents and Shunts) for Glaucoma Open a PDF 9.01.18 2026-01-27 Eyes (Ophthalmology)
Gastric Electrical Stimulation Open a PDF 7.01.64 2026-01-27 Digestive System (Gastroenterology)
Powered Compression Devices/Lymphedema Pumps Open a PDF 1.01.17 2026-01-15 Durable Medical Equipment & Supplies
Assisted Reproductive Technologies Open a PDF 4.01.05 2026-01-15 Women's Health (Obstetrics & Gynecology)
Brachytherapy or Radioactive Seed Implantation for Prostate Cancer Open a PDF 6.01.16 2025-12-31 Radiation Treatment
Showing 151– 200 of 358 Results

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