Medical Policies

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By accessing our medical policies, you signify your agreement to our Terms of Use. Learn more about how medical policies are developedOpen a PDFand about experimental & investigational procedures .

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Showing 251– 300 of 347 Results
Title Last Updated Category
External Prosthetic Devices Open a PDF 1.01.18 2026-05-15 Miscellaneous
Experimental or Investigational Services Open a PDF 11.01.03 2026-08-07 Miscellaneous
Evoked Potentials Open a PDF 2.01.27 2026-05-27 Nervous Systems (Neurology)
Erectile Dysfunction Open a PDF 7.01.30 2025-10-22 Urinary System (Genitourinary)
Epidural Steroid Injections (Effective 2026-10-15) Open a PDF 7.01.115 2026-07-15 Bone & Joints (Orthopedic)
Epidural Steroid Injections Open a PDF 7.01.115 2026-07-15 Bone & Joints (Orthopedic)
Enteral Nutrition Open a PDF 10.01.03 2026-02-23 Food (Nutrition)
Endometrial Ablation Open a PDF 4.01.01 2026-02-23 Women's Health (Obstetrics & Gynecology)
Emergency Care Services Open a PDF 10.01.12 2026-03-24 Miscellaneous
Electromagnetic Navigation Bronchoscopy Open a PDF 6.01.40 2026-01-27 Lungs (Respiratory)
Electromagnetic and Pulsed Field Stimulation Open a PDF 1.01.59 2026-05-27 Durable Medical Equipment & Supplies
Durable Medical Equipment (DME) and Devices, Standard and Non-Standard Open a PDF 1.01.00 2026-08-25 Durable Medical Equipment & Supplies
Disability Determination for Extension of Benefits after Coverage Termination Open a PDF 10.01.11 2026-08-25 Miscellaneous
Dental Inlays and Onlays Open a PDF 13.01.03 2026-07-21 Dental
Dental Implants Open a PDF 13.01.01 2026-07-21 Dental
Dental Crowns and Veneers Open a PDF 13.01.02 2026-07-21 Dental
Dental and Oral Care under Medical Plans Open a PDF 7.01.21 2026-05-27 Dental
Deep Brain Stimulation Open a PDF 7.01.23 2026-04-20 Nervous Systems (Neurology)
Cryotherapy (Cold Therapy) Devices Open a PDF 1.01.21 2026-06-25 Bone & Joints (Orthopedic)
Cranial Orthotics Open a PDF 1.01.32 2025-11-14 Children's Health (Pediatrics)
Cranial and Auricular Neuromodulation Open a PDF 1.01.58 2026-05-27 Durable Medical Equipment & Supplies
Coverage for Dependents with Disabilities Open a PDF 10.01.08 2025-11-25 Miscellaneous
Coverage for Ambulatory Surgery Unit (ASU) and Anesthesia for Dental Services Open a PDF 7.03.01 2026-07-31 Anesthesiology
Cosmetic and Reconstructive Procedures Open a PDF 7.01.11 2026-09-21 Cosmetic / Reconstructive Surgery
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
Continuous Passive Motion Device (CPM) in the Home Setting Open a PDF 1.01.02 2025-10-22 Durable Medical Equipment & Supplies
Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes Open a PDF 1.01.30 2025-12-23 Diabetes (Endocrinology)
Continuing Day Treatment Programs Open a PDF 3.01.20 2026-04-20 Behavioral Health (Psychiatry/Psychology)
Computed Tomography (CT) for Coronary Calcium Scoring Open a PDF 6.01.13 2026-02-13 Radiology (x-rays) & Imaging
Comfort, Convenience, or Custodial Services Open a PDF 11.01.11 2025-12-23 Miscellaneous
Colorectal Cancer Screening and Surveillance Open a PDF 2.01.51 2026-09-21 Digestive System (Gastroenterology)
Cochlear Implants and Auditory Brainstem Implants Open a PDF 7.01.26 2026-04-22 Ear, Nose & Throat (Otorhinolaryngology)
Clinical Trials Open a PDF 11.01.10 2026-09-21 Miscellaneous
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) Open a PDF 2.02.56 2026-02-23 Lab Tests (pathology)
Chromosomal Microarray (CMA) Analysis for Prenatal Evaluation and Evaluation of Patients with Developmental Delay/ Intellectual Disability or Autism Spectrum Disorder Open a PDF 2.02.42 2025-11-25 Genetic Disease (Inherited Disease)
Chiropractic Care Open a PDF 10.01.02 2026-07-21 Chiropractic
Showing 251– 300 of 347 Results

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