| Updated Policies | Glofitamab-gxbm (Columvi) | 08.02.07b | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria | | |
| Updated Policies | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18q | | 9/9/2024 | | | 9/9/2024 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | 09.00.42d | | 9/9/2024 | | | 9/9/2024 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Ground Ambulance Services (Emergency and Nonemergency) (Independence) | 12.04.02k | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria | | |
| Updated Policies | Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) | 08.00.69d | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Vedolizumab (Entyvio®) for Injection for Intravenous Use | 08.01.18i | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant) | 11.07.01y | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria | | |
| Updated Policies | Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy | 11.08.19r | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria | | |
| Updated Policies | Transcatheter Cardiac Valve Procedures | 11.02.25i | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Retifanlimab-dlwr (Zynyz®) | 08.02.05b | | 9/9/2024 | | | 9/9/2024 | Medical Necessity Criteria | | |
| Updated Policies | Knee Orthoses | 05.00.47s | 8/13/2024 10:00 AM | 9/13/2024 | | | 9/13/2024 | Medical Necessity Criteria | | |
| Updated Policies | Surgical Procedures of the Eyelid and Brow | 11.05.02k | 6/18/2024 11:00 AM | 9/16/2024 | | | 9/16/2024 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Reissue Policies | Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD) | 14.00.03a | | 1/1/2024 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms | 11.02.10p | | 1/1/2022 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators) | 11.14.06j | | 1/10/2021 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Bioimpedance for the Detection of Lymphedema | 07.06.03b | | 12/29/2014 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Low-Level Laser Therapy | 07.00.14h | | 1/2/2024 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Osteochondral Allograft Transplantation (Independence Administrators) | 11.14.12f | | 1/10/2021 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Osteochondral Autograft Transplantation (Independence Administrators) | 11.14.09h | | 1/10/2021 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Foot Orthotics and Other Podiatric Appliances | 05.00.35f | | 5/4/2020 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06j | | 10/1/2018 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Surgical Treatment of Femoroacetabular Impingement (Independence Administrators) | 11.14.23d | | 1/10/2021 | 9/4/2024 | | 9/4/2024 | | | |
| Reissue Policies | Breast Pumps | 05.00.76h | | 1/2/2024 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Off-label Coverage for Prescription Drugs and/or Biologics | 08.00.15f | | 5/4/2020 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Enzyme Replacement for the Treatment of Gaucher's Disease | 08.00.51l | | 1/1/2024 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Treatments for Complex Regional Pain Syndrome (CRPS) | 08.00.57r | | 4/1/2024 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Cast and Splint Applications and Associated Supplies | 00.10.15d | | 12/21/2020 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Modifiers XE, XS, XP, XU, and 59 | 03.00.08f | | 1/31/2022 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20s | | 7/1/2024 | 9/18/2024 | | 9/18/2024 | | | |
| Reissue Policies | Inclisiran (Leqvio®) | 08.01.91 | | 1/2/2024 | 9/18/2024 | | 9/18/2024 | | | |
| Archived Policies | Implantation of Intrastromal Corneal Ring Segments (ICRS) | 11.05.11c | 9/6/2024 3:00 PM | 10/7/2024 | | | 9/6/2024 | | | |
