Commercial

Medical Policy

Name	MPDispTitle	MPPolicyNumber	Policy Category	Title	MPPolicyPageName	ID	MPTitle	MPPolicyNumberwithoutversion	MPNotificationIssuedDate	MPattachmentdataPub	MPEffectiveDate
ed45e8da-d433-430e-a79b-90af295c4509	ReimbursementforComponentsofComprehensiveLaboratoryPanels00.01.61b	00.01.61b	Administrative (00)	Reimbursement for Components of Comprehensive Laboratory Panels	ed45e8da-d433-430e-a79b-90af295c4509	7833	Reimbursement for Components of Comprehensive Laboratory Panels	00.01.61	10/31/2025 2:00 PM	{"7834": {"Id":7834,"MPAttachmentLetter":"A","Title":"CPT Codes","MPPolicyAttachmentInternalSourceId":10142,"PolicyAttachmentPageName":"837d1a62-960e-46a8-88d8-02bf471a72a8"},}	2/1/2026
f6af7214-a8af-4bcc-b042-19c5a8fa0f5f	ReimbursementForAdvancedPracticeProviderServices00.10.45	00.10.45	Administrative (00)	Reimbursement For Advanced Practice Provider Services	f6af7214-a8af-4bcc-b042-19c5a8fa0f5f	7837	Reimbursement For Advanced Practice Provider Services	00.10.45	10/31/2025 2:00 PM		2/1/2026
ec1e4d4e-dbbf-437c-b1d0-97ac0cb3ff48	MultipleProcedurePaymentReduction(MPPR)GuidelinesforTransvaginalandTransabdominalUltrasounds00.01.72	00.01.72	Administrative (00)	Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal Ultrasounds	ec1e4d4e-dbbf-437c-b1d0-97ac0cb3ff48	7917	Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal Ultrasounds	00.01.72	12/2/2025 2:00 PM		3/2/2026
6bb63241-4ed2-4c32-a044-f50d59304c38	ReimbursementforCertainEvaluationandManagement(E/M)Services00.01.69c	00.01.69c	Administrative (00)	Reimbursement for Certain Evaluation and Management (E/M) Services	6bb63241-4ed2-4c32-a044-f50d59304c38	7918	Reimbursement for Certain Evaluation and Management (E/M) Services	00.01.69	12/2/2025 2:00 PM		3/2/2026
9ff056f7-b73b-438b-9dd5-e70dd2fdd7ec	ReimbursementofSurgicalPathologyServicesforProstateBiopsy00.01.73	00.01.73	Administrative (00)	Reimbursement of Surgical Pathology Services for Prostate Biopsy	9ff056f7-b73b-438b-9dd5-e70dd2fdd7ec	7919	Reimbursement of Surgical Pathology Services for Prostate Biopsy	00.01.73	12/2/2025 2:00 PM		3/2/2026
10568152-7c5d-4c3a-938d-f948bd08aa91	BariatricSurgery11.03.02x	11.03.02x	Surgery (11)	Bariatric Surgery	10568152-7c5d-4c3a-938d-f948bd08aa91	7946	Bariatric Surgery	11.03.02	12/16/2025 12:00 PM	{"7947": {"Id":7947,"MPAttachmentLetter":"B","Title":"Tanner Staging System Criteria for Adolescents","MPPolicyAttachmentInternalSourceId":10120,"PolicyAttachmentPageName":"3b3ad159-67dc-4597-8faf-eb54ece762aa"},"7948": {"Id":7948,"MPAttachmentLetter":"A","Title":"Body Mass Index (BMI) Charts","MPPolicyAttachmentInternalSourceId":10121,"PolicyAttachmentPageName":"4bb94b7f-0ddf-4113-8063-bfa9f2d1692c"},}	3/17/2026
a5ddac99-22dc-4de1-9545-eac36c4d7d94	Intravenous(IV)IronPreparations08.02.29a	08.02.29a	Pharmacy (08)	Intravenous (IV) Iron Preparations	a5ddac99-22dc-4de1-9545-eac36c4d7d94	7965	Intravenous (IV) Iron Preparations	08.02.29	12/23/2025 9:00 AM		3/23/2026
a1c7bace-247c-4b43-83e7-6eb9ce94d26d	DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplasty11.16.01m	11.16.01m	Surgery (11)	Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty	a1c7bace-247c-4b43-83e7-6eb9ce94d26d	7969	Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty	11.16.01	12/26/2025 9:00 AM		3/30/2026

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