|
Amniotic Membrane Grafting/Transplantation (AMG/AMT) for Ophthalmologic Conditions (Effective 2027-01-01)
Open a PDF
9.01.20
|
2027-01-01 |
|
|
Amniotic Membrane Grafting/Transplantation (AMG/AMT) for Ophthalmologic Conditions (Effective 2026-12-15)
Open a PDF
9.01.20
|
2026-09-15 |
|
|
Amniotic Membrane Grafting/Transplantation (AMG/AMT) for Ophthalmologic Conditions (Effective 2026-12-15)
Open a PDF
9.01.20
|
2026-09-15 |
|
|
Management of Dry Eye Syndrome and Meibomian Gland Dysfunction (e.g., LipiFlow)
Open a PDF
9.01.19
|
2025-12-23 |
|
|
Management of Dry Eye Syndrome and Meibomian Gland Dysfunction (e.g., LipiFlow)
Open a PDF
9.01.19
|
2025-12-23 |
|
|
Aqueous Drainage Devices (Stents and Shunts) for Glaucoma
Open a PDF
9.01.18
|
2026-01-27 |
|
|
Aqueous Drainage Devices (Stents and Shunts) for Glaucoma
Open a PDF
9.01.18
|
2026-01-27 |
|
|
Intraocular Lens (IOL) Implants
Open a PDF
9.01.14
|
2026-10-26 |
|
|
Intraocular Lens (IOL) Implants
Open a PDF
9.01.14
|
2026-10-26 |
|
|
Vision Therapy
Open a PDF
9.01.04
|
2025-11-25 |
|
|
Vision Therapy
Open a PDF
9.01.04
|
2025-11-25 |
|
|
Therapies (Speech, Physical and Occupational)
Open a PDF
8.01.24
|
2025-11-25 |
|
|
Therapies (Speech, Physical and Occupational)
Open a PDF
8.01.24
|
2025-11-25 |
|
|
Tibial Nerve Stimulation (TNS) for Voiding Dysfunction
Open a PDF
8.01.22
|
2026-04-20 |
|
|
Tibial Nerve Stimulation (TNS) for Voiding Dysfunction
Open a PDF
8.01.22
|
2026-04-20 |
|
|
Light and Laser Therapies for Dermatologic Conditions
Open a PDF
8.01.21
|
2026-10-26 |
|
|
Light and Laser Therapies for Dermatologic Conditions
Open a PDF
8.01.21
|
2026-10-26 |
|
|
Cardiac Rehabilitation
Open a PDF
8.01.14
|
2026-10-26 |
|
|
Cardiac Rehabilitation
Open a PDF
8.01.14
|
2026-10-26 |
|
|
Prolotherapy
Open a PDF
8.01.10
|
2026-07-15 |
|
|
Prolotherapy
Open a PDF
8.01.10
|
2026-07-15 |
|
|
Photodynamic Therapy for Malignant Disease
Open a PDF
8.01.06
|
2026-04-28 |
|
|
Photodynamic Therapy for Malignant Disease
Open a PDF
8.01.06
|
2026-04-28 |
|
|
Extracorporeal Photochemotherapy/Photopheresis
Open a PDF
8.01.01
|
2026-10-26 |
|
|
Extracorporeal Photochemotherapy/Photopheresis
Open a PDF
8.01.01
|
2026-10-26 |
|
|
Coverage for Ambulatory Surgery Unit (ASU) and Anesthesia for Dental Services (Effective 2027-01-01)
Open a PDF
7.03.01
|
2027-01-01 |
|
|
Coverage for Ambulatory Surgery Unit (ASU) and Anesthesia for Dental Services
Open a PDF
7.03.01
|
2026-07-31 |
|
|
Coverage for Ambulatory Surgery Unit (ASU) and Anesthesia for Dental Services
Open a PDF
7.03.01
|
2026-07-31 |
|
|
Coverage for Ambulatory Surgery Unit (ASU) and Anesthesia for Dental Services - FPO
Open a PDF
7.03.01
|
2026-01-15 |
|
|
Lung and Lobar Lung Transplant
Open a PDF
7.02.10
|
2026-04-20 |
|
|
Lung and Lobar Lung Transplant
Open a PDF
7.02.10
|
2026-04-20 |
|
|
Liver Transplantation
Open a PDF
7.02.07
|
2025-11-25 |
|
|
Liver Transplantation
Open a PDF
7.02.07
|
2025-11-25 |
|
|
Heart & Heart/Lung Transplant
Open a PDF
7.02.06
|
2026-07-21 |
|
|
Heart & Heart/Lung Transplant
Open a PDF
7.02.06
|
2026-07-21 |
|
|
Small Bowel and Multivisceral Transplants in Adults and Children
Open a PDF
7.02.05
|
2026-03-24 |
|
|
Small Bowel and Multivisceral Transplants in Adults and Children
Open a PDF
7.02.05
|
2026-03-24 |
|
|
Kidney Transplantation
Open a PDF
7.02.04
|
2026-04-20 |
|
|
Kidney Transplantation
Open a PDF
7.02.04
|
2026-04-20 |
|
|
Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT)
Open a PDF
7.02.03
|
2026-03-13 |
|
|
Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT)
Open a PDF
7.02.03
|
2026-03-13 |
|
|
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT)
Open a PDF
7.02.02
|
2026-04-22 |
|
|
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT)
Open a PDF
7.02.02
|
2026-04-22 |
|
|
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 |
|
|
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 |
|
|
Sinus Excision/Destruction, Implants, and Repair
Open a PDF
7.01.99
|
2025-12-23 |
|
|
Sinus Excision/Destruction, Implants, and Repair
Open a PDF
7.01.99
|
2025-12-23 |
|
|
Lumbar Microdiscectomy
Open a PDF
7.01.98
|
2026-07-15 |
|
|
Lumbar Microdiscectomy
Open a PDF
7.01.98
|
2026-07-15 |
|
|
Hip Arthroplasty
Open a PDF
7.01.96
|
2026-07-15 |
|
|
Hip Arthroplasty
Open a PDF
7.01.96
|
2026-07-15 |
|
|
Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)
Open a PDF
7.01.95
|
2026-07-15 |
|
|
Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)
Open a PDF
7.01.95
|
2026-07-15 |
|
|
Sacroiliac Joint Fusion or Stabilization
Open a PDF
7.01.93
|
2026-07-15 |
|
|
Sacroiliac Joint Fusion or Stabilization
Open a PDF
7.01.93
|
2026-07-15 |
|
|
Left Atrial Appendage Closure Devices
Open a PDF
7.01.92
|
2026-09-21 |
|
|
Left Atrial Appendage Closure Devices
Open a PDF
7.01.92
|
2026-09-21 |
|
|
Heart Failure Management Devices
Open a PDF
7.01.91
|
2026-03-13 |
|
|
Heart Failure Management Devices
Open a PDF
7.01.91
|
2026-03-13 |
|
|
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)
Open a PDF
7.01.89
|
2027-01-01 |
|
|
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)
Open a PDF
7.01.89
|
2026-07-15 |
|
|
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)
Open a PDF
7.01.89
|
2026-07-15 |
|
|
Balloon Sinus Ostial Dilation for Treatment of Chronic Rhinosinusitis (e.g., Balloon Sinuplasty) (Effective 2027-01-01)
Open a PDF
7.01.85
|
2027-01-01 |
|
|
Balloon Sinus Ostial Dilation for Treatment of Chronic Rhinosinusitis (i.e., Balloon Sinuplasty)
Open a PDF
7.01.85
|
2026-08-25 |
|
|
Balloon Sinus Ostial Dilation for Treatment of Chronic Rhinosinusitis (i.e., Balloon Sinuplasty)
Open a PDF
7.01.85
|
2026-08-25 |
|
|
Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members (Effective 2027-01-01)
Open a PDF
7.01.84
|
2027-01-01 |
|
|
Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members
Open a PDF
7.01.84
|
2026-05-27 |
|
|
Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members
Open a PDF
7.01.84
|
2026-05-27 |
|
|
Artificial Cervical Intervertebral Disc
Open a PDF
7.01.80
|
2026-07-15 |
|
|
Artificial Cervical Intervertebral Disc
Open a PDF
7.01.80
|
2026-07-15 |
|
|
Implantable Bone Conduction Hearing Aids
Open a PDF
7.01.77
|
2026-04-20 |
|
|
Implantable Bone Conduction Hearing Aids
Open a PDF
7.01.77
|
2026-04-20 |
|
|
Metal-on-Metal Total Hip Resurfacing
Open a PDF
7.01.74
|
2026-07-15 |
|
|
Metal-on-Metal Total Hip Resurfacing
Open a PDF
7.01.74
|
2026-07-15 |
|
|
Lysis of Epidural Adhesions
Open a PDF
7.01.73
|
2026-07-15 |
|
|
Lysis of Epidural Adhesions
Open a PDF
7.01.73
|
2026-07-15 |
|
|
Transarterial Radioembolization (TARE) for Hepatic Tumors
Open a PDF
7.01.69
|
2026-02-23 |
|
|
Radioembolization (TARE) for Hepatic Tumors
Open a PDF
7.01.69
|
2026-02-23 |
|
|
Gastric Electrical Stimulation
Open a PDF
7.01.64
|
2026-01-27 |
|
|
Gastric Electrical Stimulation
Open a PDF
7.01.64
|
2026-01-27 |
|
|
Artificial Lumbar Intervertebral Disc
Open a PDF
7.01.63
|
2026-07-15 |
|
|
Artificial Lumbar Intervertebral Disc
Open a PDF
7.01.63
|
2026-07-15 |
|
|
Osteochondral Grafting of the Knee
Open a PDF
7.01.59
|
2026-07-15 |
|
|
Osteochondral Grafting of the Knee
Open a PDF
7.01.59
|
2026-07-15 |
|
|
Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices
Open a PDF
7.01.58
|
2026-03-13 |
|
|
Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices
Open a PDF
7.01.58
|
2026-03-13 |
|
|
Blepharoplasty and Brow Ptosis Repair
Open a PDF
7.01.55
|
2026-03-24 |
|
|
Blepharoplasty and Brow Ptosis Repair
Open a PDF
7.01.55
|
2026-03-24 |
|
|
Abdominoplasty, Panniculectomy, and Lipedema Reduction Surgery (Effective 2027-01-01)
Open a PDF
7.01.53
|
2027-01-01 |
|
|
Abdominoplasty, Panniculectomy, and Lipedema Reduction Surgery
Open a PDF
7.01.53
|
2026-05-27 |
|
|
Abdominoplasty, Panniculectomy, and Lipedema Reduction Surgery
Open a PDF
7.01.53
|
2026-05-27 |
|
|
Spinal Cord Stimulation / Dorsal Column Stimulation
Open a PDF
7.01.51
|
2026-07-15 |
|
|
Spinal Cord Stimulation / Dorsal Column Stimulation
Open a PDF
7.01.51
|
2026-07-15 |
|
|
Varicose Vein Treatments
Open a PDF
7.01.47
|
2026-10-26 |
|
|
Varicose Vein Treatments
Open a PDF
7.01.47
|
2026-10-26 |
|
|
Transendoscopic Therapies for Gastroesophageal Reflux Disease (GERD)
Open a PDF
7.01.45
|
2026-03-24 |
|
|
Transendoscopic Therapies for Gastroesophageal Reflux Disease (GERD)
Open a PDF
7.01.45
|
2026-03-24 |
|
|
Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation
Open a PDF
7.01.42
|
2026-07-15 |
|
|
Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation
Open a PDF
7.01.42
|
2026-07-15 |
|
|
Surgical Management of Sleep Disorders
Open a PDF
7.01.41
|
2026-10-23 |
|
|
Surgical Management of Sleep Disorders
Open a PDF
7.01.41
|
2026-10-23 |
|
|
Reduction Mammaplasty (Mammoplasty)
Open a PDF
7.01.39
|
2026-10-06 |
|
|
Reduction Mammaplasty (Mammoplasty)
Open a PDF
7.01.39
|
2026-10-06 |
|
|
Reduction Mammaplasty (Mammoplasty)
Open a PDF
7.01.39
|
2027-01-01 |
|
|
Autologous Chondrocyte Implantation (ACI)
Open a PDF
7.01.38
|
2026-07-15 |
|
|
Autologous Chondrocyte Implantation (ACI)
Open a PDF
7.01.38
|
2026-07-15 |
|
|
Bioengineered Tissue Products for Wound Treatment and Surgical Interventions
Open a PDF
7.01.35
|
2026-10-26 |
|
|
Bioengineered Tissue Products for Wound Treatment and Surgical Interventions
Open a PDF
7.01.35
|
2026-10-26 |
|
|
Bioengineered Tissue Products for Wound Treatment and Surgical Interventions (Effective 2027-01-01)
Open a PDF
7.01.35
|
2027-01-01 |
|
|
Erectile Dysfunction
Open a PDF
7.01.30
|
2026-10-26 |
|
|
Erectile Dysfunction
Open a PDF
7.01.30
|
2026-10-26 |
|
|
Bariatric and Metabolic Surgery
Open a PDF
7.01.29
|
2026-06-16 |
|
|
Bariatric and Metabolic Surgery
Open a PDF
7.01.29
|
2026-06-16 |
|
|
Maze Procedures for Atrial Fibrillation and Flutter
Open a PDF
7.01.27
|
2027-01-01 |
|
|
Maze Procedures for Atrial Fibrillation and Flutter
Open a PDF
7.01.27
|
2026-06-25 |
|
|
MAZE Procedures for Atrial Fibrillation and Flutter
Open a PDF
7.01.27
|
2026-06-25 |
|
|
Cochlear Implants and Auditory Brainstem Implants
Open a PDF
7.01.26
|
2026-04-22 |
|
|
Cochlear Implants and Auditory Brainstem Implants
Open a PDF
7.01.26
|
2026-04-22 |
|
|
Deep Brain Stimulation
Open a PDF
7.01.23
|
2026-04-20 |
|
|
Deep Brain Stimulation
Open a PDF
7.01.23
|
2026-04-20 |
|
|
Bulking Agents for Treatment of Urinary or Fecal Incontinence
Open a PDF
7.01.22
|
2026-03-24 |
|
|
Bulking Agents for Treatment of Urinary or Fecal Incontinence
Open a PDF
7.01.22
|
2026-03-24 |
|
|
Dental and Oral Care under Medical Plans (Effective 2027-01-01)
Open a PDF
7.01.21
|
2027-01-01 |
|
|
Dental and Oral Care under Medical Plans
Open a PDF
7.01.21
|
2026-05-27 |
|
|
Dental and Oral Care under Medical Plans
Open a PDF
7.01.21
|
2026-05-27 |
|
|
Spine Procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.126
|
2026-10-27 |
|
|
Spine Procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.126
|
2026-10-27 |
|
|
Orthopedic Joint Procedures of the Shoulder for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.125
|
2026-10-27 |
|
|
Orthopedic Joint Procedures of the Shoulder for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.125
|
2026-10-27 |
|
|
Intraosseous Basivertebral Nerve Ablation for Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.124
|
2026-10-16 |
|
|
Intraosseous Basivertebral Nerve Ablation for Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.124
|
2026-10-16 |
|
|
Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.123
|
2026-10-27 |
|
|
Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.123
|
2026-10-27 |
|
|
Interventional Pain Management for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.122
|
2026-10-20 |
|
|
Interventional Pain Management for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.122
|
2026-10-20 |
|
|
Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.121
|
2026-10-27 |
|
|
Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01)
Open a PDF
7.01.121
|
2026-10-27 |
|
|
Peroral Endoscopic Myotomy (POEM) Procedures
Open a PDF
7.01.120
|
2026-02-13 |
|
|
Peroral Endoscopic Myotomy (POEM) Procedures
Open a PDF
7.01.120
|
2026-02-13 |
|
|
Injectable Fillers for Dermal and Laryngeal Conditions
Open a PDF
7.01.119
|
2026-09-21 |
|
|
Injectable Fillers for Dermal and Laryngeal Conditions
Open a PDF
7.01.119
|
2026-09-21 |
|
|
Lumbar Fusion
Open a PDF
7.01.117
|
2026-07-15 |
|
|
Lumbar Fusion
Open a PDF
7.01.117
|
2026-07-15 |
|
|
Facet Joint Injections/ Medial Branch Blocks
Open a PDF
7.01.116
|
2026-07-15 |
|
|
Facet Joint Injections/ Medial Branch Blocks
Open a PDF
7.01.116
|
2026-07-15 |
|
|
Epidural Steroid Injections
Open a PDF
7.01.115
|
2026-07-15 |
|
|
Epidural Steroid Injections
Open a PDF
7.01.115
|
2026-07-15 |
|
|
Ventricular Assist Device (VAD) and Total Artificial Heart (TAH)
Open a PDF
7.01.114
|
2026-03-24 |
|
|
Ventricular Assist Device (VAD) and Total Artificial Heart (TAH)
Open a PDF
7.01.114
|
2026-03-24 |
|
|
Lumbar Decompression
Open a PDF
7.01.113
|
2026-07-15 |
|
|
Lumbar Decompression
Open a PDF
7.01.113
|
2026-07-15 |
|
|
Intradiscal Procedures
Open a PDF
7.01.112
|
2026-07-15 |
|
|
Intradiscal Procedures
Open a PDF
7.01.112
|
2026-07-15 |
|
|
Thermal Ablation for Solid Tumor Treatment Policy Number (Effective 2027-01-01)
Open a PDF
7.01.111
|
2027-01-01 |
|
|
Thermal Ablation for Solid Tumor Treatment
Open a PDF
7.01.111
|
2026-08-25 |
|
|
Thermal Ablation for Solid Tumor Treatment
Open a PDF
7.01.111
|
2026-08-25 |
|
|
Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries
Open a PDF
7.01.110
|
2025-12-23 |
|
|
Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries
Open a PDF
7.01.110
|
2025-12-23 |
|
|
Cosmetic and Reconstructive Procedures
Open a PDF
7.01.11
|
2026-09-21 |
|
|
Cosmetic and Reconstructive Procedures
Open a PDF
7.01.11
|
2026-09-21 |
|
|
Transcatheter Heart Valve Procedures (Effective 2027-01-01)
Open a PDF
7.01.109
|
2027-01-01 |
|
|
Transcatheter Heart Valve Procedures
Open a PDF
7.01.109
|
2026-05-27 |
|
|
Transcatheter Heart Valve Procedures
Open a PDF
7.01.109
|
2026-05-27 |
|
|
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 |
|
|
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 |
|
|
Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) (Effective 2027-01-01)
Open a PDF
7.01.104
|
2027-01-01 |
|
|
Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH)
Open a PDF
7.01.104
|
2026-08-04 |
|
|
Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH)
Open a PDF
7.01.104
|
2026-08-04 |
|
|
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (Effective 2027-01-01)
Open a PDF
7.01.103
|
2027-01-01 |
|
|
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy
Open a PDF
7.01.103
|
2026-05-27 |
|
|
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy
Open a PDF
7.01.103
|
2026-05-27 |
|
|
Balloon Dilation of the Eustachian Tube (BDET)
Open a PDF
7.01.101
|
2027-01-01 |
|
|
Balloon Dilation of the Eustachian Tube (BDET)
Open a PDF
7.01.101
|
2026-07-21 |
|
|
Balloon Dilation of the Eustachian Tube
Open a PDF
7.01.101
|
2026-07-21 |
|
|
Pain Management Techniques for Knee Pain
Open a PDF
7.01.100
|
2026-07-21 |
|
|
Pain Management Techniques for Knee Pain
Open a PDF
7.01.100
|
2026-07-21 |
|
|
Sacral Nerve Stimulation
Open a PDF
7.01.10
|
2025-12-16 |
|
|
Sacral Nerve Stimulation
Open a PDF
7.01.10
|
2025-12-16 |
|
|
Implantable Cardioverter Defibrillator (ICD)
Open a PDF
7.01.06
|
2026-03-13 |
|
|
Implantable Cardioverter Defibrillator (ICD)
Open a PDF
7.01.06
|
2026-03-13 |
|
|
Vagus Nerve Stimulation and Vagus Nerve Blocking Therapy (Effective 2027-01-01)
Open a PDF
7.01.05
|
2027-01-01 |
|
|
Vagus Nerve Stimulation and Vagus Nerve Blocking Therapy
Open a PDF
7.01.05
|
2026-08-25 |
|
|
Vagus Nerve Stimulation and Vagus Nerve Blocking Therapy
Open a PDF
7.01.05
|
2026-08-25 |
|
|
Focal Therapies for Prostate Cancer Treatment (Effective 2027-01-01)
Open a PDF
7.01.01
|
2027-01-01 |
|
|
Focal Therapies for Prostate Cancer Treatment
Open a PDF
7.01.01
|
2026-08-25 |
|
|
Focal Therapies for Prostate Cancer Treatment
Open a PDF
7.01.01
|
2026-08-25 |
|
|
Positron Emission Tomography (PET) – Head Imaging
Open a PDF
6.01.47
|
2026-02-13 |
|
|
Positron Emission Tomography (PET) – Head Imaging
Open a PDF
6.01.47
|
2026-02-13 |
|
|
Magnetic Resonance Imaging (MRI) of the Prostate
Open a PDF
6.01.46
|
2026-07-15 |
|
|
Magnetic Resonance Imaging (MRI) of the Prostate
Open a PDF
6.01.46
|
2026-07-15 |
|
|
Tumor-Treatment Fields Therapy
Open a PDF
6.01.45
|
2026-04-20 |
|
|
Tumor-Treatment Fields Therapy
Open a PDF
6.01.45
|
2026-04-20 |
|
|
Radiopharmaceuticals for the Treatment of Cancer
Open a PDF
6.01.44
|
2026-09-21 |
|
|
Radiopharmaceuticals for the Treatment of Cancer
Open a PDF
6.01.44
|
2026-09-21 |
|
|
Electromagnetic Navigation Bronchoscopy
Open a PDF
6.01.40
|
2026-01-27 |
|
|
Electromagnetic Navigation Bronchoscopy
Open a PDF
6.01.40
|
2026-01-27 |
|
|
CT (Computed Tomography) Perfusion Imaging of the Brain
Open a PDF
6.01.37
|
2024-04-15 |
|
|
Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)
Open a PDF
6.01.34
|
2026-07-15 |
|
|
Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)
Open a PDF
6.01.34
|
2026-07-15 |
|
|
Brachytherapy After Breast-Conserving Surgery
Open a PDF
6.01.30
|
2025-11-25 |
|
|
Brachytherapy After Breast-Conserving Surgery
Open a PDF
6.01.30
|
2025-11-25 |
|
|
Positron Emission Tomography (PET) Oncologic Applications
Open a PDF
6.01.29
|
2026-07-15 |
|
|
Positron Emission Tomography (PET) Oncologic Applications
Open a PDF
6.01.29
|
2026-07-15 |
|
|
Capsule Endoscopy
Open a PDF
6.01.27
|
2026-10-26 |
|
|
Capsule Endoscopy
Open a PDF
6.01.27
|
2026-10-26 |
|
|
Low-Dose Computed Tomography (LDCT) for Lung Cancer Screening
Open a PDF
6.01.19
|
2024-04-15 |
|
|
Low-Dose Computed Tomography (LDCT) for Lung Cancer Screening
Open a PDF
6.01.19
|
2024-04-15 |
|
|
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty
Open a PDF
6.01.17
|
2026-07-15 |
|
|
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty
Open a PDF
6.01.17
|
2026-07-15 |
|
|
Brachytherapy or Radioactive Seed Implantation for Prostate Cancer
Open a PDF
6.01.16
|
2025-12-31 |
|
|
Brachytherapy or Radioactive Seed Implantation for Prostate Cancer
Open a PDF
6.01.16
|
2025-12-31 |
|
|
Computed Tomography (CT) for Coronary Calcium Scoring
Open a PDF
6.01.13
|
2026-02-13 |
|
|
Computed Tomography (CT) for Coronary Calcium Scoring
Open a PDF
6.01.13
|
2026-02-13 |
|
|
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy
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6.01.12
|
2025-11-14 |
|
|
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy
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6.01.12
|
2025-11-14 |
|
|
Proton Beam Radiation Therapy
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6.01.11
|
2026-08-25 |
|
|
Proton Beam Radiation Therapy
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6.01.11
|
2026-08-25 |
|
|
Positron Emission Tomography (PET) - Non-Oncologic Applications
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6.01.07
|
2026-07-15 |
|
|
Positron Emission Tomography (PET) - Non-Oncologic Applications
Open a PDF
6.01.07
|
2026-07-15 |
|
|
Bone Densitometry/Bone Density Studies (Effective 2027-01-01)
Open a PDF
6.01.05
|
2027-01-01 |
|
|
Bone Densitometry/Bone Density Studies
Open a PDF
6.01.05
|
2026-08-25 |
|
|
Bone Densitometry/Bone Density Studies
Open a PDF
6.01.05
|
2026-08-25 |
|
|
Magnetic Resonance Spectroscopy (MRS)
Open a PDF
6.01.03
|
2026-02-13 |
|
|
Magnetic Resonance Spectroscopy (MRS)
Open a PDF
6.01.03
|
2026-02-13 |
|
|
Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome
Open a PDF
4.01.10
|
2026-09-21 |
|
|
Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome
Open a PDF
4.01.10
|
2026-09-21 |
|
|
Assisted Reproductive Technologies
Open a PDF
4.01.05
|
2026-01-15 |
|
|
Assisted Reproductive Technologies
Open a PDF
4.01.05
|
2026-01-15 |
|
|
Prenatal Genetic Testing
Open a PDF
4.01.03
|
2026-03-17 |
|
|
Prenatal Genetic Testing
Open a PDF
4.01.03
|
2026-03-17 |
|
|
Endometrial Ablation
Open a PDF
4.01.01
|
2026-02-23 |
|
|
Endometrial Ablation
Open a PDF
4.01.01
|
2026-02-23 |
|
|
Neuropsychological and Psychological Testing
Open a PDF
3.01.24
|
2026-04-28 |
|
|
Neuropsychological and Psychological Testing
Open a PDF
3.01.24
|
2026-04-28 |
|
|
Gender Affirming Behavioral Health and Medical Services (Effective 2027-01-01)
Open a PDF
3.01.22
|
2027-01-01 |
|
|
Gender Affirming Behavioral Health and Medical Services
Open a PDF
3.01.22
|
2026-08-25 |
|
|
Gender Affirming Behavioral Health and Medical Services
Open a PDF
3.01.22
|
2026-08-25 |
|
|
Level of Care Criteria for Inpatient, Residential, Partial Hospital, and Intensive Outpatient Mental Health Services for Adults and Children
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3.01.21
|
2026-04-20 |
|
|
Level of Care Criteria for Inpatient, Residential, Partial Hospital, and Intensive Outpatient Mental Health Services for Adults and Children
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3.01.21
|
2026-04-20 |
|
|
Continuing Day Treatment Programs
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3.01.20
|
2026-04-20 |
|
|
Continuing Day Treatment Programs
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3.01.20
|
2026-04-20 |
|
|
Treatment of Gambling Disorder and Other Repetitive Behaviors
Open a PDF
3.01.19
|
2026-02-23 |
|
|
Treatment of Gambling Disorder and Other Repetitive Behaviors
Open a PDF
3.01.19
|
2026-02-23 |
|
|
Partial Hospitalization for Substance Use Disorders (Effective 2027-01-01)
Open a PDF
3.01.18
|
2027-01-01 |
|
|
Partial Hospitalization for Substance Use Disorders
Open a PDF
3.01.18
|
2026-08-25 |
|
|
Partial Hospitalization for Substance Use Disorders
Open a PDF
3.01.18
|
2026-08-25 |
|
|
Applied Behavior Analysis
Open a PDF
3.01.11
|
2027-01-01 |
|
|
Applied Behavior Analysis
Open a PDF
3.01.11
|
2026-06-25 |
|
|
Applied Behavioral Analysis
Open a PDF
3.01.11
|
2026-06-25 |
|
|
Transcranial Magnetic Stimulation and Cranial Electrotherapy Stimulation
Open a PDF
3.01.09
|
2026-09-17 |
|
|
Transcranial Magnetic Stimulation and Cranial Electrotherapy Stimulation
Open a PDF
3.01.09
|
2026-09-17 |
|
|
Genetic Testing for Thoracic Aortic Aneurysms/ Dissections and Connective Tissue Related Disorders
Open a PDF
2.02.61
|
2026-09-21 |
|
|
Genetic Testing for Thoracic Aortic Aneurysms/ Dissections and Connective Tissue Related Disorders
Open a PDF
2.02.61
|
2026-09-21 |
|
|
Germline Genetic Testing for Hereditary Cancers
Open a PDF
2.02.60
|
2026-04-20 |
|
|
Germline Genetic Testing for Hereditary Cancers
Open a PDF
2.02.60
|
2026-04-20 |
|
|
Molecular Testing in the Management of Pulmonary Nodules
Open a PDF
2.02.58
|
2026-10-26 |
|
|
Molecular Testing in the Management of Pulmonary Nodules
Open a PDF
2.02.58
|
2026-10-25 |
|
|
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy)
Open a PDF
2.02.56
|
2026-02-23 |
|
|
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy)
Open a PDF
2.02.56
|
2026-02-23 |
|
|
Laboratory Testing for Transplantation Rejection
Open a PDF
2.02.55
|
2026-07-21 |
|
|
Laboratory Testing for Transplantation Rejection
Open a PDF
2.02.55
|
2026-07-21 |
|
|
Measurable Residual Disease (MRD) Assessment Testing
Open a PDF
2.02.54
|
2026-08-25 |
|
|
Measurable Residual Disease (MRD) Assessment Testing
Open a PDF
2.02.54
|
2026-08-25 |
|
|
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms
Open a PDF
2.02.53
|
2026-03-24 |
|
|
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms
Open a PDF
2.02.53
|
2026-03-24 |
|
|
Gene Expression Profiling for Cutaneous Melanoma
Open a PDF
2.02.52
|
2025-10-22 |
|
|
Gene Expression Profiling for Cutaneous Melanoma
Open a PDF
2.02.52
|
2025-10-22 |
|
|
Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers
Open a PDF
2.02.51
|
2026-02-23 |
|
|
Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers
Open a PDF
2.02.51
|
2026-02-23 |
|
|
Urine Drug Testing
Open a PDF
2.02.50
|
2026-10-26 |
|
|
Urine Drug Testing
Open a PDF
2.02.50
|
2026-10-26 |
|
|
Molecular Marker Testing of the Thyroid
Open a PDF
2.02.49
|
2025-11-25 |
|
|
Molecular Marker Testing of the Thyroid
Open a PDF
2.02.49
|
2025-11-25 |
|
|
Laboratory Testing for the Screening and Management of Prostate Cancer
Open a PDF
2.02.48
|
2026-09-21 |
|
|
Laboratory Testing for the Screening and Management of Prostate Cancer
Open a PDF
2.02.48
|
2026-09-21 |
|
|
Testing for the Use of Biologic Therapeutics for the Treatment of Inflammatory Disorders
Open a PDF
2.02.47
|
2025-11-25 |
|
|
Testing for the Use of Biologic Therapeutics for the Treatment of Inflammatory Disorders
Open a PDF
2.02.47
|
2025-11-25 |
|
|
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
Open a PDF
2.02.46
|
2026-09-21 |
|
|
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
Open a PDF
2.02.46
|
2026-09-21 |
|
|
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 |
|
|
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 |
|
|
Predictive Testing for Pancreatic Cancer
Open a PDF
2.02.39
|
2025-12-23 |
|
|
Predictive Testing for Pancreatic Cancer
Open a PDF
2.02.39
|
2025-12-23 |
|
|
Genetic Testing for Cardiac Ion Channelopathies (Effective 2027-01-01)
Open a PDF
2.02.38
|
2027-01-01 |
|
|
Genetic Testing for Cardiac Ion Channelopathies
Open a PDF
2.02.38
|
2026-05-27 |
|
|
Genetic Testing for Cardiac Ion Channelopathies
Open a PDF
2.02.38
|
2026-05-27 |
|
|
Pharmacogenetics
Open a PDF
2.02.30
|
2026-04-14 |
|
|
Pharmacogenetics
Open a PDF
2.02.30
|
2026-04-14 |
|
|
Genetic Assay of Tumor Tissue to Determine Prognosis and Treatment of Breast Cancer
Open a PDF
2.02.27
|
2026-04-20 |
|
|
Genetic Assay of Tumor Tissue to Determine Prognosis and Treatment of Breast Cancer
Open a PDF
2.02.27
|
2026-04-20 |
|
|
Non-Invasive Prenatal Testing
Open a PDF
2.02.25
|
2026-08-25 |
|
|
Non-Invasive Prenatal Testing
Open a PDF
2.02.25
|
2026-08-25 |
|
|
Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease
Open a PDF
2.02.19
|
2025-11-25 |
|
|
Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease
Open a PDF
2.02.19
|
2025-11-25 |
|
|
Genetic Testing for Cystic Fibrosis
Open a PDF
2.02.17
|
2026-07-21 |
|
|
Genetic Testing for Cystic Fibrosis
Open a PDF
2.02.17
|
2026-07-21 |
|
|
Lab Testing for Alzheimer’s Disease
Open a PDF
2.02.16
|
2026-06-25 |
|
|
Lab Testing for Alzheimer’s Disease
Open a PDF
2.02.16
|
2026-06-25 |
|
|
Inflammatory Markers of Coronary Artery Disease Risk
Open a PDF
2.02.15
|
2026-09-21 |
|
|
Inflammatory Markers of Coronary Artery Disease Risk
Open a PDF
2.02.15
|
2026-09-21 |
|
|
Urinary Tumor Markers for Bladder and Urothelial Cancers
Open a PDF
2.02.12
|
2027-01-01 |
|
|
Urinary Tumor Markers for Bladder and Urothelial Cancers
Open a PDF
2.02.12
|
2026-07-21 |
|
|
Urinary Tumor Markers for Bladder and Urothelial Cancers
Open a PDF
2.02.12
|
2026-07-21 |
|
|
Genetic Testing for Inherited Disorders
Open a PDF
2.02.03
|
2025-12-23 |
|
|
Genetic Testing for Inherited Disorders
Open a PDF
2.02.03
|
2025-12-23 |
|
|
Bioimpedance Devices for Detection and Management of Breast Cancer Related Lymphedema
Open a PDF
2.01.52
|
2026-01-27 |
|
|
Bioimpedance Devices for Detection and Management of Breast Cancer Related Lymphedema
Open a PDF
2.01.52
|
2026-01-27 |
|
|
Colorectal Cancer Screening and Surveillance
Open a PDF
2.01.51
|
2026-09-21 |
|
|
Colorectal Cancer Screening and Surveillance
Open a PDF
2.01.51
|
2026-09-21 |
|
|
Fecal Microbiota Transplantation
Open a PDF
2.01.48
|
2026-09-21 |
|
|
Fecal Microbiota Transplantation
Open a PDF
2.01.48
|
2026-09-21 |
|
|
Microvolt T-Wave Alternans
Open a PDF
2.01.45
|
2018-05-07 |
|
|
Microvolt T-Wave Alternans
Open a PDF
2.01.45
|
2018-05-07 |
|
|
Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds
Open a PDF
2.01.31
|
2027-01-01 |
|
|
Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds
Open a PDF
2.01.31
|
2026-09-01 |
|
|
Extracorporeal Shock Wave Therapy (ESWT) for Muscoloskeletal Conditions and Soft Tissue Wounds
Open a PDF
2.01.31
|
2026-09-01 |
|
|
Sleep Studies
Open a PDF
2.01.28
|
2026-01-27 |
|
|
Sleep Studies
Open a PDF
2.01.28
|
2026-01-27 |
|
|
Evoked Potentials (Effective 2027-01-01)
Open a PDF
2.01.27
|
2027-01-01 |
|
|
Evoked Potentials
Open a PDF
2.01.27
|
2026-05-27 |
|
|
Evoked Potentials
Open a PDF
2.01.27
|
2026-05-27 |
|
|
Platelet Rich Plasma and Growth Factor Treatments
Open a PDF
2.01.24
|
2026-01-27 |
|
|
Platelet Rich Plasma and Growth Factor Treatments
Open a PDF
2.01.24
|
2026-01-27 |
|
|
Allergy Testing
Open a PDF
2.01.10
|
2027-01-01 |
|
|
Allergy Testing
Open a PDF
2.01.10
|
2026-07-21 |
|
|
Allergy Testing
Open a PDF
2.01.10
|
2026-07-21 |
|
|
Hyperbaric Oxygen Therapy (HBOT)
Open a PDF
2.01.07
|
2027-01-01 |
|
|
Hyperbaric Oxygen Therapy (HBOT)
Open a PDF
2.01.07
|
2026-07-21 |
|
|
Hyperbaric Oxygen Therapy (HBOT)
Open a PDF
2.01.07
|
2026-07-21 |
|
|
Cardiac Event Monitors
Open a PDF
2.01.03
|
2026-07-21 |
|
|
Cardiac Event Monitors
Open a PDF
2.01.03
|
2026-07-21 |
|
|
Periodontal Maintenance
Open a PDF
13.01.05
|
2026-07-21 |
|
|
Periodontal Maintenance
Open a PDF
13.01.05
|
2026-07-21 |
|
|
Periodontal Scaling and Root Planing
Open a PDF
13.01.04
|
2026-07-21 |
|
|
Periodontal Scaling and Root Planing
Open a PDF
13.01.04
|
2026-07-21 |
|
|
Dental Inlays and Onlays
Open a PDF
13.01.03
|
2026-07-21 |
|
|
Dental Inlays and Onlays
Open a PDF
13.01.03
|
2026-07-21 |
|
|
Dental Crowns and Veneers
Open a PDF
13.01.02
|
2026-07-21 |
|
|
Dental Crowns and Veneers
Open a PDF
13.01.02
|
2026-07-21 |
|
|
Dental Implants
Open a PDF
13.01.01
|
2026-07-21 |
|
|
Dental Implants
Open a PDF
13.01.01
|
2026-07-21 |
|
|
March Connection
Open a PDF
12.8.9
|
3/8/18 |
|
|
Private Rooms
Open a PDF
12.01.06
|
2025-11-25 |
|
|
Private Rooms
Open a PDF
12.01.06
|
2025-11-25 |
|
|
New/Emerging Technology and Services Code List
Open a PDF
11.01.27
|
2026-10-26 |
|
|
New/Emerging Technology and Services Code List
Open a PDF
11.01.27
|
2026-10-26 |
|
|
New/Emerging Technology & Services
Open a PDF
11.01.27
|
2025-11-25 |
|
|
New/Emerging Technology & Services
Open a PDF
11.01.27
|
2025-11-25 |
|
|
Home Birth by Certified Nurse Midwives
Open a PDF
11.01.23
|
2026-10-30 |
|
|
Home Birth by Certified Nurse Midwives
Open a PDF
11.01.23
|
2026-10-30 |
|
|
Skilled Nursing Facility Care / Level of Care Criteria
Open a PDF
11.01.21
|
2027-01-01 |
|
|
Skilled Nursing Facility Care / Level of Care Criteria
Open a PDF
11.01.21
|
2026-07-21 |
|
|
Skilled Nursing Facility Care / Level of Care Criteria
Open a PDF
11.01.21
|
2026-07-21 |
|
|
Interfacility Transfer of a Registered Inpatient
Open a PDF
11.01.18
|
2026-03-24 |
|
|
Interfacility Transfer of a Registered Inpatient
Open a PDF
11.01.18
|
2026-03-24 |
|
|
Temporomandibular Joint Disorders (TMJD)
Open a PDF
11.01.17
|
2026-02-13 |
|
|
Temporomandibular Joint Disorders (TMJD)
Open a PDF
11.01.17
|
2026-02-13 |
|
|
Medically Necessary Services
Open a PDF
11.01.15
|
2026-10-26 |
|
|
Medically Necessary Services
Open a PDF
11.01.15
|
2026-10-26 |
|
|
Out-of-Network Services
Open a PDF
11.01.14
|
2026-01-27 |
|
|
Out-of-Network Services
Open a PDF
11.01.13
|
2026-01-27 |
|
|
Comfort, Convenience, or Custodial Services
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11.01.11
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2025-12-23 |
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Comfort, Convenience, or Custodial Services
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11.01.11
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2025-12-23 |
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Clinical Trials
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11.01.10
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2026-09-21 |
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Clinical Trials
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11.01.10
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2026-09-21 |
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Medical Response to Contamination from Terrorist Attacks (Effective 2027-01-01)
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11.01.09
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2027-01-01 |
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Medical Response to Contamination from Terrorist Attacks
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11.01.09
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2026-08-25 |
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Medical Response to Contamination from Terrorist Attacks
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11.01.09
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2026-08-25 |
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Ambulance Air
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11.01.06
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2026-03-24 |
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Ambulance: Air
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11.01.06
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2026-03-24 |
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Total Parenteral Nutrition (TPN) or Hyperalimentation
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11.01.04
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2026-02-23 |
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Total Parenteral Nutrition (TPN) or Hyperalimentation
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11.01.04
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2026-02-23 |
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Experimental or Investigational Services
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11.01.03
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2026-08-07 |
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Experimental or Investigational Services
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11.01.03
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2026-08-07 |
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Emergency Care Services
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10.01.12
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2026-03-24 |
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Emergency Care Services
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10.01.12
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2026-03-24 |
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Disability Determination for Extension of Benefits After Coverage Termination (Effective 2027-01-01)
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10.01.11
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2027-01-01 |
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Disability Determination For Extension of Benefits After Coverage Termination
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10.01.11
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2026-08-25 |
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Disability Determination for Extension of Benefits after Coverage Termination
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10.01.11
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2026-08-25 |
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Second Medical and Surgical Opinions (Effective 2027-01-01)
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10.01.10
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2027-01-01 |
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Second Medical and Surgical Opinions
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10.01.10
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2026-08-25 |
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Second Medical and Surgical Opinions
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10.01.10
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2026-08-25 |
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Coverage for Dependents with Disabilities
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10.01.08
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2025-11-25 |
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Coverage for Dependents with Disabilities
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10.01.08
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2025-11-25 |
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Ambulance: Land/Ground
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10.01.07
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2026-03-24 |
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Ambulance: Land/Ground
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10.01.07
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2026-03-24 |
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Enteral Nutrition
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10.01.03
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2026-02-23 |
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Enteral Nutrition
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10.01.03
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2026-02-23 |
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Chiropractic Care
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10.01.02
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2026-10-26 |
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Chiropractic Care
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10.01.02
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2026-10-26 |
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Chiropractic Care
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10.01.02
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2027-01-01 |
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Chiropractic Care
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10.01.02
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2021-07-13 |
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Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy (Effective 2027-01-01)
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10.01.01
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2027-01-01 |
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Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy
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10.01.01
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2026-08-25 |
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Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy
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10.01.01
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2026-08-25 |
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Specialized Neuromodulation for Specific Conditions
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1.01.62
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2026-08-24 |
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Specialized Neuromodulation for Specific Conditions
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1.01.62
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2026-08-24 |
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Specialized Neuromodulation for Specific Conditions (Effective 2027-01-01)
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1.01.62
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2027-01-01 |
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Non-Invasive Surface Electrical Stimulation for Pain and Rehabilitation (Effective 2027-01-01)
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1.01.61
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2027-01-01 |
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Non-Invasive Surface Electrical Stimulation for Pain and Rehabilitation
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1.01.61
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2026-05-27 |
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Non-Invasive Surface Electrical Stimulation for Pain and Rehabilitation
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1.01.61
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2026-05-27 |
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Implantable and Invasive Neuromodulation Systems (Effective 2027-01-01)
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1.01.60
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2027-01-01 |
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Implantable and Invasive Neuromodulation Systems
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1.01.60
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2026-05-27 |
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Implantable and Invasive Neuromodulation Systems
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1.01.60
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2026-05-27 |
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Electromagnetic and Pulsed Field Stimulation (Effective 2027-01-01)
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1.01.59
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2027-01-01 |
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Electromagnetic and Pulsed Field Stimulation
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1.01.59
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2026-05-27 |
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Electromagnetic and Pulsed Field Stimulation
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1.01.59
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2026-05-27 |
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Cranial and Auricular Neuromodulation (Effective 2027-01-01)
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1.01.58
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2027-01-01 |
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Cranial and Auricular Neuromodulation
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1.01.58
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2026-05-27 |
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Cranial and Auricular Neuromodulation
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1.01.58
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2026-05-27 |
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Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure
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1.01.57
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2027-01-01 |
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Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure
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1.01.57
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2026-07-15 |
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Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure
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1.01.57
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2026-07-15 |
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Specialty Enclosure Bed Systems
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1.01.56
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2026-02-13 |
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Specialty Enclosure Bed Systems
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1.01.56
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2026-02-13 |
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Bone Growth Stimulators
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1.01.53
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2026-04-20 |
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Bone Growth Stimulators
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1.01.53
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2026-04-20 |
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Vitrectomy Chair/ Face-Down Positioning System
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1.01.52
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2026-04-20 |
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Vitrectomy Chair/ Face-Down Positioning System
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1.01.52
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2026-04-20 |
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Limb Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis
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1.01.51
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2026-09-21 |
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Limb Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis
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1.01.51
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2026-09-21 |
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Standing Devices and Gait Trainers
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1.01.46
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2026-02-23 |
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Standing Devices and Gait Trainers
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1.01.46
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2026-02-23 |
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Home Automatic External Defibrillators (AEDs) and Wearable Cardioverter Defibrillators (WCDs)
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1.01.42
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2026-06-25 |
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Home Automatic External Defibrillators (AEDs) and Wearable Cardioverter Defibrillators (WCDs)
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1.01.42
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2026-06-25 |
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Foot Orthotics
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1.01.41
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2027-01-01 |
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Foot Orthotics
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1.01.41
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2026-07-21 |
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Foot Orthotics
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1.01.41
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2026-07-21 |
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Negative Pressure Wound Therapy (Vacuum-Assisted Closure)
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1.01.38
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2026-09-21 |
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Cranial Orthotics
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1.01.32
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2026-10-26 |
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Cranial Orthotics
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1.01.32
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2026-10-26 |
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Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes
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1.01.30
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2025-12-23 |
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Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes
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1.01.30
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2025-12-23 |
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Orthotics
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1.01.25
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2026-05-15 |
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Orthotics
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1.01.25
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2026-05-15 |
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Cryotherapy (Cold Therapy) Devices
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1.01.21
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2027-01-01 |
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Cryotherapy (Cold Therapy) Devices
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1.01.21
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2026-06-25 |
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Cryotherapy (Cold Therapy) Devices
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1.01.21
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2026-06-25 |
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Pelvic Floor Electrical Stimulation as a Treatment for Urinary or Fecal Incontinence
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1.01.19
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2026-03-24 |
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Pelvic Floor Electrical Stimulation as a Treatment for Urinary or Fecal Incontinence
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1.01.19
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2026-03-24 |
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External Prosthetic Devices
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1.01.18
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2026-10-29 |
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External Prosthetic Devices
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1.01.18
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2026-10-29 |
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Powered Compression Devices/Lymphedema Pumps
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1.01.17
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2026-01-15 |
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Powered Compression Devices/Lymphedema Pumps
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1.01.17
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2026-01-15 |
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Wheelchairs and Power Operated Vehicles (POVs) (Effective 2027-01-01)
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1.01.16
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2027-01-01 |
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Wheelchairs and Power Operated Vehicles (POVs)
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1.01.16
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2026-08-25 |
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Wheelchairs and Power Operated Vehicles (POVs)
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1.01.16
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2026-08-25 |
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Airway Clearance Devices
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1.01.15
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2025-12-16 |
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Airway Clearance Devices
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1.01.15
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2025-12-16 |
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Patient Lifts
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1.01.08
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2027-01-01 |
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Patient Lifts (Effective 2026-11-16)
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1.01.08
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2026-09-14 |
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Patient Lifts (Effective 2026-11-16)
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1.01.08
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2026-09-14 |
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Patient Lifts (e.g., Hoyer, Saralift, Seat Lift, Chair Mechanisms, and Ceiling Lifts)
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1.01.08
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2026-09-14 |
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Patient Lifts (e.g., Hoyer, Saralift, Seat Lift, Chair Mechanisms, and Ceiling Lifts)
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1.01.08
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2026-09-14 |
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Medical Management Obstructive Sleep Apnea (OSA)
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1.01.07
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2026-10-26 |
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Medical Management Obstructive Sleep Apnea (OSA)
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1.01.07
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2026-10-26 |
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Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) Devices
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1.01.06
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2027-01-01 |
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Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) Devices
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1.01.06
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2026-07-15 |
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Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) Devices
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1.01.06
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2026-07-15 |
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Augmentative and Alternative Communication Systems (e.g., Speech Generating Devices) (Effective 2027-01-01)
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1.01.03
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2027-01-01 |
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Augmentative and Alternative Communication Systems (e.g., Speech-generating Devices)
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1.01.03
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2026-08-25 |
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Augmentative and Alternative Communication Systems (e.g., Speech-generating Devices)
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1.01.03
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2026-08-25 |
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Continuous Passive Motion Device (CPM) in the Home Setting
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1.01.02
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2026-10-26 |
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Continuous Passive Motion Device in the Home Setting
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1.01.02
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2026-10-26 |
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Durable Medical Equipment (DME) and Devices, Standard and Non-Standard (Effective 2027-01-01)
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1.01.00
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2027-01-01 |
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Durable Medical Equipment (DME) and Devices, Standard and Non-Standard
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1.01.00
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2026-08-25 |
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Durable Medical Equipment (DME) and Devices, Standard and Non-Standard
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1.01.00
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2026-08-25 |
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Negative Pressure Wound Therapy (Vacuum-Assisted Closure)
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01.01.38
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2026-09-21 |
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