Medical Policies

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

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Showing 151– 200 of 340 Results
Title Last Updated Category
Implantable Cardioverter Defibrillator (ICD) Open a PDF 7.01.06 2026-03-13 Heart & Blood Vessels (Cardiovascular)
Inflammatory Markers of Coronary Artery Disease Risk Open a PDF 2.02.15 2026-09-21 Lab Tests (pathology)
Injectable Fillers for Dermal and Laryngeal Conditions Open a PDF 7.01.119 2026-09-21 Miscellaneous
Interfacility Transfer of a Registered Inpatient Open a PDF 11.01.18 2026-03-24 Miscellaneous
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 2026-10-05 Bone & Joints (Orthopedic)
Intradiscal Procedures (Effective 2026-10-15) Open a PDF 7.01.112 2026-07-15 Bone & Joints (Orthopedic)
Intradiscal Procedures Open a PDF 7.01.112 2025-12-31 Bone & Joints (Orthopedic)
Intraocular Lens (IOL) Implants Open a PDF 9.01.14 2025-10-22 Eyes (Ophthalmology)
Intraosseous Basivertebral Nerve Ablation for Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01) Open a PDF 7.01.124 2026-10-05 Bone & Joints (Orthopedic)
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms Open a PDF 2.02.53 2026-03-24 Lab Tests (pathology)
Kidney Transplantation Open a PDF 7.02.04 2026-04-20 Transplants
Lab Testing for Alzheimer’s Disease Open a PDF 2.02.16 2026-06-25 Genetic Disease (Inherited Disease)
Laboratory Testing for the Screening and Management of Prostate Cancer Open a PDF 2.02.48 2026-09-21 Genetic Disease (Inherited Disease)
Laboratory Testing for Transplantation Rejection Open a PDF 2.02.55 2026-07-21 Lab Tests (pathology)
Left Atrial Appendage Closure Devices Open a PDF 7.01.92 2026-09-21 Heart & Blood Vessels (Cardiovascular)
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)
Light and Laser Therapies for Dermatologic Conditions Open a PDF 8.01.21 2025-10-22 Skin (Dermatology)
Limb Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis Open a PDF 1.01.51 2026-09-21 Durable Medical Equipment & Supplies
Liver Transplantation Open a PDF 7.02.07 2025-11-25 Transplants
Lumbar Decompression (Effective 2026-10-15) Open a PDF 7.01.113 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Decompression Open a PDF 7.01.113 2025-10-06 Bone & Joints (Orthopedic)
Lumbar Fusion (Effective 2026-10-15) Open a PDF 7.01.117 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Fusion Open a PDF 7.01.117 2026-01-27 Bone & Joints (Orthopedic)
Lumbar Microdiscectomy (Effective 2026-10-15) Open a PDF 7.01.98 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Microdiscectomy Open a PDF 7.01.98 2025-12-31 Bone & Joints (Orthopedic)
Lung and Lobar Lung Transplant Open a PDF 7.02.10 2026-04-20 Transplants
Lysis of Epidural Adhesions (Effective 2026-10-15) Open a PDF 7.01.73 2026-07-15 Bone & Joints (Orthopedic)
Lysis of Epidural Adhesions Open a PDF 7.01.73 2025-07-11 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 2026-02-13 Radiology (x-rays) & Imaging
Showing 151– 200 of 340 Results

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