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MPDocType
Title
MPPolicyNumber
MPNotificationIssuedDate
MPEffectiveDate
MPReissuedDate
MPArchiveNotifEffDate
MPSALogCreatedOn
MPPolicyChangeTypeslt
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MPSiteActivityRemovedDate
News & Announcements
Preventive Coverage of Clesrovimab (Enflonsia) for Commercial Members (Retroactively Effective 08/04/2025)
9/23/2025
Updated Policies
Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests
00.01.24m
9/8/2025
9/8/2025
Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated Policies
Cochlear Implantation
11.01.02s
9/8/2025
9/8/2025
Medical Necessity Criteria
Updated Policies
In Vivo Allergy Sensitivity Testing
07.00.05j
9/8/2025
9/8/2025
Medical Necessity Criteria
Updated Policies
Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
07.03.09w
9/22/2025
9/22/2025
Medical Necessity Criteria;Medical Coding
Updated Policies
Intraoperative Neurophysiological Monitoring (INM)
07.03.14s
9/22/2025
9/22/2025
Medical Necessity Criteria;Medical Coding
Updated Policies
Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
08.01.29m
9/22/2025
9/22/2025
Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Reissue Policies
Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
11.08.04i
7/11/2022
9/3/2025
9/3/2025
Reissue Policies
Upper Limb Prostheses
05.00.72h
4/1/2025
9/3/2025
9/3/2025
Reissue Policies
Otoplasty or Non-Surgical External Ear Molding
11.01.01j
9/8/2018
9/3/2025
9/3/2025
Reissue Policies
Auricular Prostheses
05.00.82
5/20/2024
9/3/2025
9/3/2025
Reissue Policies
Abatacept (Orencia®) for Injection for Intravenous Use
08.00.62q
9/23/2024
9/3/2025
9/3/2025
Reissue Policies
Sebelipase alfa (Kanuma®)
08.01.28e
9/26/2022
9/3/2025
9/3/2025
Reissue Policies
Lifileucel (Amtagvi™)
08.02.22
10/21/2024
9/3/2025
9/3/2025
Reissue Policies
Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis
11.03.16
1/20/2025
9/3/2025
9/3/2025
Reissue Policies
Catheter Ablation of Cardiac Arrhythmias
11.02.06r
1/1/2025
9/3/2025
9/3/2025
Reissue Policies
Bone Mineral Density (BMD) Testing
09.00.04o
1/2/2024
9/3/2025
9/3/2025
Reissue Policies
Nadofaragene Firadenovec-vncg (Adstiladrin®)
08.02.11b
10/21/2024
9/3/2025
9/3/2025
Reissue Policies
Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
06.02.43b
2/1/2017
9/3/2025
9/30/2025
Archived Policies
Fetal Fibronectin Enzyme (fFN) Immunoassay
06.02.04d
9/5/2025 9:00 AM
10/6/2025
9/5/2025
Archived Policies
Laboratory-Based Vestibular Function Testing
07.03.24b
9/5/2025 9:00 AM
10/6/2025
9/5/2025
Archived Policies
Smell and Taste Dysfunction Testing
07.11.01c
9/5/2025 9:00 AM
10/6/2025
9/5/2025
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