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| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2024-UHC-558 | Surgery of the Knee | 7/11/24 | 8/25/24 | Approved | Surgery of the Knee |
| 2024-UHC-1170 | Prostate Surgeries and Interventions | 7/11/24 | 8/25/24 | Approved | Prostate Surgeries and Interventions |
| 2024-UHC-1399 | Glaucoma Surgical Treatment | 7/11/24 | 8/25/24 | Approved | Glaucoma Surgical Treatment |
| 2024-UHC-1400 | Occipital Nerve Injections and Ablations | 7/11/24 | 8/25/24 | Approved | Occipital Nerve Injections and Ablations |
| 2024-UHC-1852 | Macular Degeneration Treatment Procedures | 7/11/24 | 8/25/24 | Approved | Macular Degeneration Treatment Procedures |
| 2024-ABH-2449 | Coordination of Benefits | 7/11/24 | 8/25/24 | Approved | Coordination of Benefits |
| 2024-HBL-2462 | Permanent Implantable Pacemakers | 7/11/24 | 8/25/24 | Approved | Permanent Implantable Pacemakers |
| 2024-UHC-2475 | Prior Authorization Liaison – Chisholm Membership Management Policy | 7/11/24 | 8/25/24 | Approved | Prior Authorization Liaison – Chisholm Membership Management Policy |
| 2024-LHCC-2476 | In Lieu Of Services Remote Patient Monitoring | 7/11/24 | 8/25/24 | Approved | In Lieu Of Services Remote Patient Monitoring |
| 2024-UHC-2477 | LA Amniotic Membrane Transplant | 7/11/24 | 8/25/24 | Approved | LA Amniotic Membrane Transplant |
| 2024-UHC-2478 | LA Closure of Lacrimal Duct by Plug | 7/11/24 | 8/25/24 | Approved | LA Closure of Lacrimal Duct by Plug |
| 2024-UHC-2479 | LA Color Vision Examination Extended Draft Policy | 7/11/24 | 8/25/24 | Approved | LA Color Vision Examination Extended Draft Policy |
| 2024-UHC-2480 | LA Computerized Corneal Topography Draft Policy | 7/11/24 | 8/25/24 | Approved | LA Computerized Corneal Topography Draft Policy |
| 2024-UHC-2481 | LA Corneal Pachymetry Draft Policy | 7/11/24 | 8/25/24 | Approved | LA Corneal Pachymetry Draft Policy |
| 2024-UHC-2482 | LA Deluxe Frames LA Draft Policy | 7/11/24 | 8/25/24 | Approved | LA Deluxe Frames LA Draft Policy |
| 2024-UHC-2483 | LA Extended Ophthalmoscopy Draft Policy | 7/11/24 | 8/25/24 | Approved | LA Extended Ophthalmoscopy Draft Policy |
| 2024-UHC-2484 | LA External Ocular Photography Draft Policy | 7/11/24 | 8/25/24 | Approved | LA External Ocular Photography Draft Policy |
| 2024-HBL-2457 | Cancer Antigen 125 Testing | 7/2/24 | 8/16/24 | Approved | Cancer Antigen 125 Testing |
| 2024-HUM-2465 | Removal Exp&Inv | 7/2/24 | 8/16/24 | Completed | Removal Exp&Inv |
| 2024-HUM-2466 | Removal Gen&MolTest | 7/2/24 | 8/16/24 | Completed | Removal Gen&MolTest |
| 2024-HUM-2467 | Add NonParNonEmerg | 7/2/24 | 8/16/24 | Completed | Add NonParNonEmerg |
| 2024-HUM-2469 | Obstetric Ultrasounds 7510 | 7/2/24 | 8/16/24 | Approved | Obstetric Ultrasounds 7510 |
| 2024-HUM-2471 | Hearing Aid and Cochlear Implants-Age Limits 7474, 7475 | 7/2/24 | 8/16/24 | Approved | Hearing Aid and Cochlear Implants-Age Limits 7474, 7475 |
| 2024-HUM-2472 | CPT New Patient Visits 7502 | 7/2/24 | 8/16/24 | Approved | CPT New Patient Visits 7502 |
| 2024-HUM-2473 | CPT Fluoride 7499 | 7/2/24 | 8/16/24 | Approved | CPT Fluoride 7499 |
| 2024-UHC-559 | Implantable Beta-Emitting Microspheres | 7/2/24 | 8/16/24 | Approved | Implantable Beta-Emitting Microspheres |
| 2024-UHC-582 | Cosmetic and Reconstructive Procedures | 7/2/24 | 8/16/24 | Approved | Cosmetic and Reconstructive Procedures |
| 2024-UHC-958 | Criteria for Medical Necessity & Prior Authorization – PDHC | 7/2/24 | 8/16/24 | Approved | Criteria for Medical Necessity & Prior Authorization – PDHC |
| 2024-UHC-960 | Criteria for Medical Necessity & Prior Authorization - Private Duty Nursing (PDN)/Extended Home Health (EHH) | 7/2/24 | 8/16/24 | Approved | Criteria for Medical Necessity & Prior Authorization - Private Duty Nursing (PDN)/Extended Home Health (EHH) |
| 2024-LHCC-1114 | Urodynamic Testing | 7/2/24 | 8/16/24 | Approved | Urodynamic Testing |
| 2024-LHCC-1381 | Bronchial Thermoplasty | 7/2/24 | 8/16/24 | Approved | Bronchial Thermoplasty |
| 2024-LHCC-1389 | Endometrial Ablaation | 7/2/24 | 8/16/24 | Approved | Endometrial Ablaation |
| 2024-LHCC-1944 | Laser Therapy for Skin Conditions | 7/2/24 | 8/16/24 | Approved | Laser Therapy for Skin Conditions |
| 2024-LHCC-1946 | Low-Frequency | 7/2/24 | 8/16/24 | Approved | Low Frequency |
| 2024-LHCC-2226 | Concert Genetic Testing Aortopathies and Connective | 7/2/24 | 8/16/24 | Approved | Concert Genetic Testing Aortopathies and Connective |
| 2024-LHCC-2231 | Concert Genetic Testing Gastroenterologic Disorders | 7/2/24 | 8/16/24 | Approved | Concert Genetic Testing Gastroenterologic Disorders |
| 2024-LHCC-2232 | Concert Genetic Testing General Approach to Genetic | 7/2/24 | 8/16/24 | Approved | Concert Genetic Testing General Approach to Genetic |
| 2024-LHCC-2233 | Concert Genetic Testing Hearing Loss | 7/2/24 | 8/16/24 | Approved | Concert Genetic Testing Hearing Loss |
| 2024-LHCC-2235 | Concert Genetic Testing Kidney Disorders | 7/2/24 | 8/16/24 | Approved | Concert Genetic Testing Kidney Disorders |
| 2024-LHCC-2241 | Concert Genetic Oncology Cancer Screening | 7/2/24 | 8/16/24 | Approved | Concert Genetic Oncology Cancer Screening |
| 2024-LHCC-2269 | Concert Genetic Testing Hereditary Cancer | 7/2/24 | 8/16/24 | Approved | Concert Genetic Testing Hereditary Cancer |
| 2024-HBL-2433 | Behavioral Health Peer to Peer Discussion Changes | 7/2/24 | 8/16/24 | Approved | Behavioral Health Peer to Peer Discussion Changes |
| 2024-HBL-2452 | Home Enteral Nutrition | 7/2/24 | 8/16/24 | Approved | Home Enteral Nutrition |
| 2024-HBL-2454 | Carrier Screening | 7/2/24 | 8/16/24 | Approved | Carrier Screening |
| 2024-HBL-2456 | Prefabricated External Infant Ear Molding Systems | 7/2/24 | 8/16/24 | Approved | Prefabricated External Infant Ear Molding Systems |
| 2024-UHC-559 | Implantable Beta Emitting Microspheres Treatment | 7/2/24 | 8/16/24 | Approved | Implantable Beta Emitting Microspheres Treatment |
| 2024-UHC-582 | Cosmetic and Reconstructive Procedures | 7/2/24 | 8/16/24 | Approved | Cosmetic and Reconstructive Procedures |
| 2024-UHC-958 | Criteria for Medical Necessity Review PDHC Policy | 7/2/24 | 8/16/24 | Approved | Criteria for Medical Necessity Review PDHC Policy |
| 2024-UHC-960 | Criteria for Medical Necessity Review PDN Policy Update | 7/2/24 | 8/16/24 | Approved | Criteria for Medical Necessity Review PDN Policy Update |
| 2024-HBL-1009 | Advanced Imaging of the Heart | 6/28/24 | 8/12/24 | Approved | Advanced Imaging of the Heart |
| 2024-HBL-1253 | High Frequency Chest Compression Devices for Airway Clearance | 6/28/24 | 8/12/24 | Approved | High Frequency Chest Compression Devices for Airway Clearance |
| 2024-HBL-1257 | Compression Devices for Lymphedema | 6/28/24 | 8/12/24 | Approved | Compression Devices for Lymphedema |
| 2024-HUM-1532 | Assertive Community Treatment (ACT/FACT) | 6/28/24 | 8/12/24 | Approved | Assertive Community Treatment (ACT/FACT) |
| 2024-HBL-1780 | Foot Care Services | 6/28/24 | 8/12/24 | Approved | Foot Care Services |
| 2024-UHC-1811 | Integration of Physical Health and Behavorial Health Through Whole Person Care | 6/28/24 | 8/12/24 | Approved | Integration of Physical Health and Behavorial Health Through Whole Person Care |
| 2024-LHCC-1908 | Community Brief Crisis Support | 6/28/24 | 8/12/24 | Approved | Community Brief Crisis Support |
| 2024-LHCC-1910 | Implantable Intrathecal or Epidural Pain Pump | 6/28/24 | 8/12/24 | Approved | Implantable Intrathecal or Epidural Pain Pump |
| 2024-HBL-2532 | Gastric Electrical Stimulation | 6/28/24 | 8/12/24 | Approved | Gastric Electrical Stimulation |
| 2024-UHC-1941 | Louisiana ABA Policy | 6/28/24 | 8/12/24 | Approved | Louisiana ABA Policy |
| 2024-ABH-2385 | UB 04 Reminder | 6/28/24 | 8/12/24 | Approved | UB 04 Reminder |
| 2024-HBL-2394 | Approval LT for CMBM | 6/28/24 | 8/12/24 | Approved | Approval LT for CMBM |
| 2024-UHC-2435 | Diagnosis Code Requirement Policy, Professional and Facility | 6/28/24 | 8/12/24 | Approved | Diagnosis Code Requirement Policy, Professional and Facility |
| 2024-HBL-2444 | Anatomical Modifiers STATE | 6/28/24 | 8/12/24 | Approved | Anatomical Modifiers STATE |
| 2024-UHC-2446 | Healthy First Steps Covered Services Policy | 6/28/24 | 8/12/24 | Approved | Healthy First Steps Covered Services Policy |
| 2024-UHC-2447 | LA Healthy First Steps Maternity Case Mgmt | 6/28/24 | 8/12/24 | Approved | LA Healthy First Steps Maternity Case Mgmt |
| 2024-UHC-2448 | Healthy First Steps Identification and Risk Strat of High Risk Members for Maternity CM | 6/28/24 | 8/12/24 | Approved | Healthy First Steps Identification and Risk Strat of High Risk Members for Maternity CM |
| 2024-LHCC-2450 | Pharmacy Prior Authorization and Medical Necessity | 6/28/24 | 8/12/24 | Approved | Pharmacy Prior Authorization and Medical Necessity |
| 2024-HBL-2461 | Cardiac Resynchronization Therapy | 6/28/24 | 8/12/24 | Approved | Cardiac Resynchronization Therapy |
| 2024-LDH-12 | MCO Manual > Part 10: Provider Services >Provider Issue Resolution>Claim Reconsideration, Appeal, and Arbitration | 6/27/24 | 8/11/24 | Pending | Claim Reconsideration, Appeal, and Arbitration |
| 2024-LHCC-1886 | Sacroiliac Joint Infusion | 6/14/24 | 7/29/24 | Approved | Sacroiliac Joint Infusion |
| 2024-LHCC-1887 | Shoulder Arthroplasty | 6/14/24 | 7/29/24 | Approved | Shoulder Arthroplasty |
| 2024-LHCC-1888 | Spine Surgery Other | 6/14/24 | 7/29/24 | Approved | Spine Surgery Other |
| 2024-LHCC-1889 | Shoulder Arthroscopy | 6/14/24 | 7/29/24 | Approved | Shoulder Arthroscopy |
| 2024-LHCC-1890 | Thoracic Spine Surgery | 6/14/24 | 7/29/24 | Approved | Thoracic Spine Surgery |
| 2024-ACLA-2155 | Co-Surgeon | 6/14/24 | 7/29/24 | Approved | Co-Surgeon |
| 2024-LHCC-2184 | Organizational Assessment and Reassessment | 6/14/24 | 7/29/24 | Complete | Organizational Assessment and Reassessment |
| 2024-ACLA-2247 | Bundling (Status B P T) reimbursement policy | 6/14/24 | 7/29/24 | Approved | Bundling (Status B P T) reimbursement policy |
| 2024-ABH-2337 | Reimbursement Payment Policy for Clinical Editing | 6/14/24 | 7/29/24 | Approved | Reimbursement Payment Policy for Clinical Editing |
| 2024-ABH-2383 | Prenatal Services | 6/14/24 | 7/29/24 | Approved | Prenatal Services |
| 2024-HBL-2397 | Intraocular Telescope | 6/14/24 | 7/29/24 | Approved | Intraocular Telescope |
| 2024-HUM-2407 | Newborn | 6/14/24 | 7/29/24 | Approved | Newborn |
| 2024-HUM-2409 | CPT-Radiology Specialty Ultrasounds | 6/14/24 | 7/29/24 | Approved | CPT-Radiology Specialty Ultrasounds |
| 2024-HUM-2423 | CPT EKG Date | 6/14/24 | 7/29/24 | Approved | CPT EKG Date |
| 2024-HUM-2424 | CPT EKG Date | 6/14/24 | 7/29/24 | Approved | CPT EKG Date |
| 2024-ACLA-2437 | Diagnosis Procedure Age Guidelines | 6/14/24 | 7/29/24 | Approved | Diagnosis Procedure Age Guidelines |
| 2024-HUM-2439 | PAL Code Removal-PhyOccSpTherapy | 6/14/24 | 7/29/24 | Complete | PAL Code Removal-PhyOccSpTherapy |
| 2024-HUM-2440 | PAL Code Removal-Surgery | 6/14/24 | 7/29/24 | Complete | PAL Code Removal-Surgery |
| 2024-HUM-2441 | PAL Code Removal-Transplant-0494T, 0495T, 0496T | 6/14/24 | 7/29/24 | Complete | PAL Code Removal-Transplant-0494T, 0495T, 0496T |
| 2024-HBL-2451 | Occip and Spheno Ganglion Nerve Block Thx for Tx of Headache and Neuralgia | 6/14/24 | 7/29/24 | Approved | Occip and Spheno Ganglion Nerve Block Thx for Tx of Headache and Neuralgia |
| 2024-UHC-1395 | Motorized Spinal Traction | 6/14/24 | 7/29/24 | Approved | Motorized Spinal Traction |
| 2024-LHCC-1430 | Record Keeping and Documentation Standards: Physical Medicine | 6/14/24 | 7/29/24 | Approved | Record Keeping and Documentation Standards: Physical Medicine |
| 2024-LHCC-1711 | Sympathetic Nerve Block | 6/14/24 | 7/29/24 | Approved | Sympathetic Nerve Block |
| 2024-LHCC-1750 | Sacroiliac Joint Injections – NIA | 6/14/24 | 7/29/24 | Approved | Sacroiliac Joint Injections – NIA |
| 2024-LHCC-1751 | Spinal Cord Stimulation – NIA | 6/14/24 | 7/29/24 | Approved | Spinal Cord Stimulation – NIA |
| 2024-LHCC-1752 | Epidural Spine Injections | 6/14/24 | 7/29/24 | Approved | Epidural Spine Injections |
| 2024-LHCC-1753 | Implantable Infusion Pump Insertion | 6/14/24 | 7/29/24 | Approved | Implantable Infusion Pump Insertion |
| 2024-LHCC-1754 | Epidural Spine Injection Trial Intrathecal Hybrid | 6/14/24 | 7/29/24 | Approved | Epidural Spine Injection Trial Intrathecal Hybrid |
| 2024-LHCC-1755 | Facet Injection or Blocks – NIA | 6/14/24 | 7/29/24 | Approved | Facet Injection or Blocks – NIA |
| 2024-LHCC-1756 | Facet Joint Denervation | 6/14/24 | 7/29/24 | Approved | Facet Joint Denervation |
| 2024-UHC-1798 | Case Management Process | 6/14/24 | 7/29/24 | Complete | Case Management Process |
| 2024-UHC-1805 | Transition of Care Coordination | 6/14/24 | 7/29/24 | Complete | Transition of Care Coordination |
| 2024-LHCC-1878 | Cervical Spine Surgery | 6/14/24 | 7/29/24 | Approved | Cervical Spine Surgery |
| 2024-LHCC-1879 | Deformity Surgery | 6/14/24 | 7/29/24 | Approved | Deformity Surgery |
| 2024-LHCC-1880 | Hip Arthroplasty | 6/14/24 | 7/29/24 | Approved | Hip Arthroplasty |
| 2024-LHCC-1881 | Hip Arthroscopy | 6/14/24 | 7/29/24 | Approved | Hip Arthroscopy |
| 2024-LHCC-1882 | Knee Arthroplasty | 6/14/24 | 7/29/24 | Approved | Knee Arthroplasty |
| 2024-LHCC-1883 | Lumbar Artificial Disc Replacement | 6/14/24 | 7/29/24 | Approved | Lumbar Artificial Disc Replacement |
| 2024-LHCC-1884 | Lumbar Spine Surgery | 6/14/24 | 7/29/24 | Approved | Lumbar Spine Surgery |
| 2024-LHCC-1885 | Knee Arthroscopy | 6/14/24 | 7/29/24 | Approved | Knee Arthroscopy |
| 2024-LHCC-329 | Adverse Determinations | 6/14/24 | 7/29/24 | Approved | Adverse Determinations |
| 2024-UHC-521 | Gastrointestinal Motility Disorders Diagnosis and Treatment | 6/14/24 | 7/29/24 | Approved | Gastrointestinal Motility Disorders Diagnosis and Treatment |
| 2024-LHCC-682 | Active Procedures in Physical Medicine | 6/14/24 | 7/29/24 | Approved | Active Procedures in Physical Medicine |
| 2024-LHCC-683 | Chiro Infant Care Policy 2020 | 6/14/24 | 7/29/24 | Approved | Chiro Infant Care Policy 2020 |
| 2024-LHCC-685 | Experimental, Unproven, or Investigational Services | 6/14/24 | 7/29/24 | Approved | Experimental, Unproven, or Investigational Services |
| 2024-LHCC-687 | Measurable Progressive Improvement | 6/14/24 | 7/29/24 | Approved | Measurable Progressive Improvement |
| 2024-LHCC-689 | Outpatient Habilitative PT and OT Therapy | 6/14/24 | 7/29/24 | Approved | Outpatient Habilitative PT and OT Therapy |
| 2024-LHCC-690 | Outpatient Habilitative and Rehabilitative Speech Therapy | 6/14/24 | 7/29/24 | Approved | Outpatient Habilitative and Rehabilitative Speech Therapy |
| 2024-LHCC-691 | Passive Treatment | 6/14/24 | 7/29/24 | Approved | Passive Treatment |
| 2024-LHCC-694 | Record Keeping and Documentation Standards Chiropractic Care | 6/14/24 | 7/29/24 | Approved | Record Keeping and Documentation Standards Chiropractic Care |
| 2024-LHCC-715 | Cervical Spine CT | 6/14/24 | 7/29/24 | Approved | Cervical Spine CT |
| 2024-LHCC-716 | Cervical Spine MRI | 6/14/24 | 7/29/24 | Approved | Cervical Spine MRI |
| 2024-LHCC-717 | Chest (Thorax) CT | 6/14/24 | 7/29/24 | Approved | Chest (Thorax) CT |
| 2024-LHCC-735 | Low Dose CT for Lung Cancer Screening | 6/14/24 | 7/29/24 | Approved | Low Dose CT for Lung Cancer Screening |
| 2024-LHCC-740 | Lumbar Spine CT | 6/14/24 | 7/29/24 | Approved | Lumbar Spine CT |
| 2024-LHCC-741 | Lumbar Spine MRI | 6/14/24 | 7/29/24 | Approved | Lumbar Spine MRI |
| 2024-LHCC-758 | Thoracic Spine CT | 6/14/24 | 7/29/24 | Approved | Thoracic Spine CT |
| 2024-LHCC-759 | Thoracic Spine MRI | 6/14/24 | 7/29/24 | Approved | Thoracic Spine MRI |
| 2024-ABH-822 | ABH Provider Manual | 6/14/24 | 7/29/24 | Approved | ABH Provider Manual |
| 2024-UHC-1342 | Pectus Deformity Repair | 6/14/24 | 7/29/24 | Approved | Pectus Deformity Repair |
| 2024-LDH-11 | MCO Manual > Part 4: Services >Professional Services > Cardiovascular Services > Invasive Coronary Angiography and Percutaneous Coronary Intervention (Effective Date = 7/22/2024) | 6/6/24 | 7/21/24 | Pending | Invasive Coronary Angiography and Percutaneous Coronary Intervention |
| 2024-LDH-8 | MCO Manual > Part 4: Services > Pharmacy > Lock-In Program | 5/16/24 | 6/30/24 | Pending | Lock-In Program |
| 2024-LDH-9 | MCO Manual > Part 10: Provider Services > Provider Issue Resolution>Provider Issue Escalation and Resolution | 5/16/24 | 6/30/24 | Pending | Provider Issue Resolution |
| 2024-LDH-10 | MCO Manual > Part 4: Services > In Lieu of Services > Behavioral Health Services > Visions of Hope Community Services | 5/16/24 | 6/30/24 | Pending | Visions of Hope ILOS |
| 2024-LHCC-1933 | Personal Care Services (PCS) | 5/29/24 | 7/13/24 | Approved | Personal Care Services (PCS) |
| 2024-LHCC-1960 | Dually Diagnosed Continuous Improvement | 5/29/24 | 7/13/24 | Approved | Dually Diagnosed Continuous Improvement |
| 2024-HUM-2367 | RSV Admin Codes CPT 7249 | 5/29/24 | 7/13/24 | Approved | RSV Admin Codes CPT 7249 |
| 2024-HUM-2368 | Tobacco Cessation CPT 7243 | 5/29/24 | 7/13/24 | Approved | Tobacco Cessation CPT 7243 |
| 2024-HBL-2399 | Member Returned Mail Undeliverable Policy and Procedure | 5/29/24 | 7/13/24 | Approved | Member Returned Mail Undeliverable Policy and Procedure |
| 2024-HUM-2400 | Anesthesia | 5/29/24 | 7/13/24 | Approved | Anesthesia |
| 2024-HUM-2401 | Anesthesia-Maternity Related CPT | 5/29/24 | 7/13/24 | Approved | Anesthesia-Maternity Related CPT |
| 2024-HUM-2402 | Mammography | 5/29/24 | 7/13/24 | Approved | Mammography |
| 2024-HUM-2404 | ArterialDiseaseRehab | 5/29/24 | 7/13/24 | Approved | ArterialDiseaseRehab |
| 2024-HUM-2406 | CorrectCoding-Inconsistent DoB | 5/29/24 | 7/13/24 | Approved | CorrectCoding-Inconsistent DoB |
| 2024-HUM-2408 | Modifiers 54,55,56 | 5/29/24 | 7/13/24 | Approved | Modifiers 54,55,56 |
| 2024-HUM-2410 | Drug Testing | 5/29/24 | 7/13/24 | Approved | Drug Testing |
| 2024-HUM-2412 | EMGlobalPeriod | 5/29/24 | 7/13/24 | Approved | EMGlobalPeriod |
| 2024-HUM-2413 | Anesthesia-MedDirection, Modifier QK | 5/29/24 | 7/13/24 | Approved | Anesthesia-MedDirection, Modifier QK |
| 2024-HUM-2414 | Modifiers-Nebulizers | 5/29/24 | 7/13/24 | Approved | Modifiers-Nebulizers |
| 2024-HUM-2416 | CPT-EvalMngtSrvs-New Patient | 5/29/24 | 7/13/24 | Approved | CPT-EvalMngtSrvs-New Patient |
| 2024-HUM-2417 | CPT-EvalMngtSrvs-After hours | 5/29/24 | 7/13/24 | Approved | CPT-EvalMngtSrvs-After hours |
| 2024-HUM-2421 | CPT-Medicine-Chiro | 5/29/24 | 7/13/24 | Approved | CPT-Medicine-Chiro |
| 2024-HUM-2425 | Diabetes Training | 5/29/24 | 7/13/24 | Approved | Diabetes Training |
| 2024-HUM-2426 | Cystourethroscopy | 5/29/24 | 7/13/24 | Approved | Cystourethroscopy |
| 2024-UHC-585 | Chelation Therapy | 5/29/24 | 7/13/24 | Approved | Chelation Therapy |
| 2024-ACLA-815 | Vitamin D Policy | 5/29/24 | 7/13/24 | Approved | Vitamin D Policy |
| 2024-ACLA-818 | Prior Authorizations Services List | 5/29/24 | 7/13/24 | Completed | Prior Authorizations Services List |
| 2024-LHCC-922 | Fraud, Waste, and Abuse Plan | 5/29/24 | 7/13/24 | Approved | Fraud, Waste, and Abuse Plan |
| 2024-LHCC-1227 | Skin and Soft Tissue Substitutes for Chronic Wounds | 5/29/24 | 7/13/24 | Approved | Skin and Soft Tissue Substitutes for Chronic Wounds |
| 2024-LHCC-1284 | Preventive Health and Clinical Practice | 5/29/24 | 7/13/24 | Approved | Preventive Health and Clinical Practice |
| 2024-UHC-1340 | Gynecomastia Surgery | 5/29/24 | 7/13/24 | Approved | Gynecomastia Surgery |
| 2024-LHCC-1356 | Lung Transplantation | 5/29/24 | 7/13/24 | Approved | Lung Transplantation |
| 2024-LHCC-1385 | Implantable Wireless PAP Monitoring | 5/29/24 | 7/13/24 | Approved | Implantable Wireless PAP Monitoring |
| 2024-LHCC-1386 | Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins | 5/29/24 | 7/13/24 | Approved | Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins |
| 2024-LHCC-1388 | Code Edting Overview | 5/29/24 | 7/13/24 | Completed | Code Edting Overview |
| 2024-UHC-1393 | Panniculectomy and Body Contouring Procedures | 5/29/24 | 7/13/24 | Approved | Panniculectomy and Body Contouring Procedures |
| 2024-UHC-1401 | Manipulative Therapy | 5/29/24 | 7/13/24 | Approved | Manipulative Therapy |
| 2024-LHCC-1403 | Continuity and Coordination of Medical Care | 5/29/24 | 7/13/24 | Approved | Continuity and Coordination of Medical Care |
| 2024-LHCC-1527 | Nerve Blocks and Neurolysis for Pain Management | 5/29/24 | 7/13/24 | Approved | Nerve Blocks and Neurolysis for Pain Management |
| 2024-LHCC-1703 | Pediatric Kidney Transplant | 5/29/24 | 7/13/24 | Approved | Pediatric Kidney Transplant |
| 2024-LHCC-1745 | Donor Lymphocyte Infusion | 5/29/24 | 7/13/24 | Approved | Donor Lymphocyte Infusion |
| 2024-LHCC-1838 | Intensity-Modulated Radiotherapy | 5/29/24 | 7/13/24 | Approved | Intensity-Modulated Radiotherapy |
| 2024-LHCC-1912 | Multi-Systemic Therapy (MST) | 5/29/24 | 7/13/24 | Approved | Multi-Systemic Therapy (MST) |
| 2024-LHCC-1916 | Individual Placement and Support | 5/29/24 | 7/13/24 | Approved | Individual Placement and Support |
| 2024-LHCC-111 | Functional Family Therapy - Child Welfare | 5/9/24 | 6/23/24 | Approved | Functional Family Therapy - Child Welfare |
| 2024-UHC-217 | Omnibus Codes | 5/9/24 | 6/23/24 | Approved | Omnibus Codes |
| 2024-UHC-492 | Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins | 5/9/24 | 6/23/24 | Approved | Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins |
| 2024-UHC-555 | Orthognathic (Jaw) Surgery | 5/9/24 | 6/23/24 | Approved | Orthognathic (Jaw) Surgery |
| 2024-UHC-825 | Cardiac Event Monitoring | 5/9/24 | 6/23/24 | Approved | Cardiac Event Monitoring |
| 2024-HBL-1208 | Cosmetic and Reconstr Serv of Trunk and Groin | 5/9/24 | 6/23/24 | Approved | Cosmetic and Reconstr Serv of Trunk and Groin |
| 2024-LHCC-1216 | Bariatric Surgery | 5/9/24 | 6/23/24 | Approved | Bariatric Surgery |
| 2024-HBL-1301 | Sacroilac Joint Fusion | 5/9/24 | 6/23/24 | Approved | Sacroilac Joint Fusion |
| 2024-UHC-1432 | Pediatric Gait Trainers and Standing Systems | 5/9/24 | 6/23/24 | Approved | Pediatric Gait Trainers and Standing Systems |
| 2024-UHC-1523 | Facet Joint and Medial Branch Block Injections for Spinal Pain | 5/9/24 | 6/23/24 | Approved | Facet Joint and Medial Branch Block Injections for Spinal Pain |
| 2024-HBL-1778 | Outpatient Glycated Hemoglobin and Protein Testing | 5/9/24 | 6/23/24 | Approved | Outpatient Glycated Hemoglobin and Protein Testing |
| 2024-UHC-1848 | Mobility Devices, Options and Accessories | 5/9/24 | 6/23/24 | Approved | Mobility Devices, Options and Accessories |
| 2024-LHCC-1907 | Hyperhidrousis Treatments | 5/9/24 | 6/23/24 | Approved | Hyperhidrousis Treatments |
| 2024-LHCC-1919 | Cardiovascular Services | 5/9/24 | 6/23/24 | Approved | Cardiovascular Services |
| 2024-LHCC-2153 | Pharmacy Lock-In Program | 5/9/24 | 6/23/24 | Approved | Pharmacy Lock-In Program |
| 2024-ABH-2382 | Utilization Management System Controls | 5/9/24 | 6/23/24 | Approved | Utilization Management System Controls |
| 2024-ABH-2390 | Chiropractic In Lieu of Services ILO | 5/9/24 | 6/23/24 | Approved | Chiropractic In Lieu of Services ILO |
| 2024-ABH-2391 | Gender Affirming Care Policy | 5/9/24 | 6/23/24 | Approved | Gender Affirming Care Policy |
| 2024-HBL-2392 | Wireless Cap for the Eval of Suspect Gastric Intestinal Motility Dis | 5/9/24 | 6/23/24 | Approved | Wireless Cap for the Eval of Suspect Gastric Intestinal Motility Dis |
| 2024-HBL-2395 | External Insulin Pumps | 5/9/24 | 6/23/24 | Approved | External Insulin Pumps |
| 2024-HBL-2396 | Vestibular Function Testing | 5/9/24 | 6/23/24 | Approved | Vestibular Function Testing |
| 2024-UHC-222 | Skin and Soft Tissue Substitutes | 4/30/24 | 6/14/24 | Approved | Skin and Soft Tissue Substitutes |
| 2024-HBL-1058 | Whole Genome Sequ. Whole Exome Sequ. Gene Panels and Molecular Prof | 4/30/24 | 6/14/24 | Approved | Whole Genome Sequ. Whole Exome Sequ. Gene Panels and Molecular Prof |
| 2024-LHCC-1190 | PCP Auto-Assignment PP | 4/30/24 | 6/14/24 | Approved | PCP Auto-Assignment PP |
| 2024-HBL-1222 | Mandibular/Maxillary (Orthognathic) Surgery | 4/30/24 | 6/14/24 | Approved | Mandibular/Maxillary (Orthognathic) Surgery |
| 2024-HBL-1245 | Myoelectric Upper Extremity Prosthetic Devices | 4/30/24 | 6/14/24 | Approved | Myoelectric Upper Extremity Prosthetic Devices |
| 2024-HBL-1257 | Compression Devices for Lymphedema | 4/30/24 | 6/14/24 | Approved | Compression Devices for Lymphedema |
| 2024-HUM-1428 | Preauthorization and Notification List | 4/30/24 | 6/14/24 | Completed | Preauthorization and Notification List |
| 2024-HUM-1826 | Revenue Codes for Outpatient Services | 4/30/24 | 6/14/24 | Approved | Revenue Codes for Outpatient Services |
| 2024-ABH-1900 | Physical Safety for Field Based Colleagues | 4/30/24 | 6/14/24 | Completed | Physical Safety for Field Based Colleagues |
| 2024-UHC-1928 | Transanal Endoscopic Microsurgery | 4/30/24 | 6/14/24 | Approved | Transanal Endoscopic Microsurgery |
| 2024-LHCC-1938 | Continuity & Coordination Between Medical and Behavioral Health Care | 4/30/24 | 6/14/24 | Completed | Continuity & Coordination Between Medical and Behavioral Health Care |
| 2024-UHC-2277 | Risk Strat NCM 012 | 4/30/24 | 6/14/24 | Approved | Risk Strat NCM 012 |
| 2024-ABH-2366 | AMA XXXX Supplement Oxygen and Oxygen Supplies | 4/30/24 | 6/14/24 | Approved | AMA XXXX Supplement Oxygen and Oxygen Supplies |
| 2024-LHCC-2372 | Member Reassignment | 4/30/24 | 6/14/24 | Approved | Member Reassignment |
| 2024-LHCC-2373 | Provider Facing Policy for Member Moves | 4/30/24 | 6/14/24 | Approved | Provider Facing Policy for Member Moves |
| 2024-ABH-2376 | Concurrent Review Observation Care | 4/30/24 | 6/14/24 | Approved | Concurrent Review Observation Care |
| 2024-ABH-2377 | Common Hospital Observation | 4/30/24 | 6/14/24 | Approved | Common Hospital Observation |
| 2024-ABH-2385 | UB 04 Reminder | 4/30/24 | 6/14/24 | Approved | UB 04 Reminder |
| 2024-ABH-2387 | Biological Safety for Field Based Colleagues | 4/30/24 | 6/14/24 | Completed | Biological Safety for Field Based Colleagues |
| 2024-HBL-2388 | Sacral Nerve Stim and Percut or Implant Tib Nerve Stim Urin and Fecal Incont Urin Ret | 4/30/24 | 6/14/24 | Approved | Sacral Nerve Stim and Percut or Implant Tib Nerve Stim Urin and Fecal Incont Urin Ret |
| 2024-ACLA-268 | Care and BH Providers | 4/16/24 | 5/31/24 | Approved | Care and BH Providers |
| 2024-LHCC-423 | EPSDT | 4/16/24 | 5/31/24 | Approved | EPSDT |
| 2024-UHC-474 | Rhinoplasty and Other Nasal Procedures | 4/16/24 | 5/31/24 | Approved | Rhinoplasty and Other Nasal Procedures |
| 2024-UHC-490 | Cardiovascular Disease Risk Tests | 4/16/24 | 5/31/24 | Approved | Cardiovascular Disease Risk Tests |
| 2024-UHC-785 | Hearing Aids and Devices including wearable, bone-anchored and semi-implantable | 4/16/24 | 5/31/24 | Approved | Hearing Aids and Devices including wearable, bone-anchored and semi-implantable |
| 2024-UHC-1170 | Prostate Surgeries and Interventions | 4/16/24 | 5/31/24 | Approved | Prostate Surgeries and Interventions |
| 2024-ACLA-1183 | Personal Care Services | 4/16/24 | 5/31/24 | Completed | Personal Care Services |
| 2024-LHCC-1275 | Oxygen Use and Concentrators | 4/16/24 | 5/31/24 | Approved | Oxygen Use and Concentrators |
| 2024-UHC-1394 | Transpupillary Thermotherapy | 4/16/24 | 5/31/24 | Approved | Transpupillary Thermotherapy |
| 2024-HUM-1668 | Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy | 4/16/24 | 5/31/24 | Approved | Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy |
| 2024-LHCC-1913 | Pharmacy Claims Processing | 4/16/24 | 5/31/24 | Approved | Pharmacy Claims Processing |
| 2024-LHCC-2321 | Pharmacy Program | 4/16/24 | 5/31/24 | Completed | Pharmacy Program |
| 2024-ABH-2362 | AMA XXXX Home Health and Extended Home Health | 4/16/24 | 5/31/24 | Approved | AMA XXXX Home Health and Extended Home Health |
| 2024-ABH-2363 | AMA XXXX Hospice | 4/16/24 | 5/31/24 | Approved | AMA XXXX Hospice |
| 2024-ABH-2370 | Dynamo Web Portals Data Security Breach Notification Amend | 4/16/24 | 5/31/24 | Completed | Dynamo Web Portals Data Security Breach Notification Amend |
| 2024-HUM-2371 | Lactation Support Policy | 4/16/24 | 5/31/24 | Approved | Lactation Support Policy |
| 2024-UHC-2374 | LA New Housecalls | 4/16/24 | 5/31/24 | Approved | LA New Housecalls |
| 2024-LDH-7 | MCO Manual > Part 4: Services > Pharmacy > Preferred Drug List | 4/11/24 | 5/26/24 | Completed | Preferred Drug List |
| 2024-LDH-6 | MCO Manual > Part 4: Services > MCO Covered Services > Behavioral Health Services | 4/11/24 | 5/26/24 | Completed | Behavioral Health Covered Services |
| 2024-LDH-5 | MCO Manual > Part 8: Encounters | 4/11/24 | 5/26/24 | Completed | Split-Billing for Encounters |
| 2024-LDH-4 | MCO Manual > Part 13: Quality > Performance Improvement Projects | 4/11/24 | 5/26/24 | Completed | Quality Performance Improvement Projects |
| 2024-LDH-3 | MCO Manual > Part 13: Quality > Performance Improvement Projects > Quality Monitoring Reviews for Behavioral Health Providers | 4/11/24 | 5/26/24 | Completed | Quality Monitoring Reviews for Behavioral Health Providers |
| 2024-LDH-2 | MCO Manual > Part 4: Services > Pharmacy | 4/11/24 | 5/26/24 | Completed | Pharmacy |
| 2024-LDH-1 | MCO Manual > Part 9: Provider Network > Primary Care >Enrollee Reassignment Policy | 4/11/24 | 5/26/24 | Completed | Enrollee Reassignment Policy |
| 2024-ACLA-2318 | Peer Support Services | 4/2/24 | 5/17/24 | Approved | Peer Support Services |
| 2024-HBL-2344 | Leadless Pacemaker | 4/2/24 | 5/17/24 | Approved | Leadless Pacemaker |
| 2024-ABH-2360 | AMA XXXX Enteral Nutrition and Infusion Pump | 4/2/24 | 5/17/24 | Approved | AMA XXXX Enteral Nutrition and Infusion Pump |
| 2024-ABH-2364 | AMA XXXX Hospital Bed Mattress and Lift | 4/2/24 | 5/17/24 | Approved | AMA XXXX Hospital Bed Mattress and Lift |
| 2024-HBL-811 | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies | 4/2/24 | 5/17/24 | Approved | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies |
| 2024-UHC-949 | Chemotherapy-Observation or Inpatient Hospitalization | 4/2/24 | 5/17/24 | Approved | Chemotherapy-Observation or Inpatient Hospitalization |
| 2024-ABH-953 | Multi-Systemic Therapy (MST) | 4/2/24 | 5/17/24 | Approved | Multi-Systemic Therapy (MST) |
| 2024-ABH-954 | Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) | 4/2/24 | 5/17/24 | Approved | Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) |
| 2024-ABH-955 | Crisis Intervention (CI) Services | 4/2/24 | 5/17/24 | Approved | Crisis Intervention (CI) Services |
| 2024-LHCC-1214 | Total Parenteral Nutrition and Intradialytic Parental Nutrition | 4/2/24 | 5/17/24 | Approved | Total Parenteral Nutrition and Intradialytic Parental Nutrition |
| 2024-LHCC-1218 | Ventricular Assist Devices | 4/2/24 | 5/17/24 | Approved | Ventricular Assist Devices |
| 2024-LHCC-1353 | Articular Cartilage Defect Repairs | 4/2/24 | 5/17/24 | Approved | Articular Cartilage Defect Repairs |
| 2024-LHCC-1355 | Functional MRI | 4/2/24 | 5/17/24 | Approved | Functional MRI |
| 2024-LHCC-1358 | Pancreas Transplantation | 4/2/24 | 5/17/24 | Approved | Pancreas Transplantation |
| 2024-LHCC-1360 | Heart-Lung Transplant | 4/2/24 | 5/17/24 | Approved | Heart-Lung Transplant |
| 2024-LHCC-1362 | Nonmyeloablative allogeneric SCT | 4/2/24 | 5/17/24 | Approved | Nonmyeloablative allogeneric SCT |
| 2024-LHCC-1363 | Tandem Transplant | 4/2/24 | 5/17/24 | Approved | Tandem Transplant |
| 2024-LHCC-1410 | Neurofeedback for Behavioral Health Disorders | 4/2/24 | 5/17/24 | Approved | Neurofeedback for Behavioral Health Disorders |
| 2024-ABH-1528 | Substance Use Disorder Treatment - Intensive Outpatient and Residential LOC | 4/2/24 | 5/17/24 | Approved | Substance Use Disorder Treatment - Intensive Outpatient and Residential LOC |
| 2024-LHCC-1837 | Obstetrical Home Care Programs | 4/2/24 | 5/17/24 | Approved | Obstetrical Home Care Programs |
| 2024-LHCC-1934 | Experimental Technologies | 4/2/24 | 5/17/24 | Approved | Experimental Technologies |
| 2024-LHCC-1935 | Gastric Electrical Stimulation | 4/2/24 | 5/17/24 | Approved | Gastric Electrical Stimulation |
| 2024-LHCC-2225 | Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy | 4/2/24 | 5/17/24 | Approved | Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy |
| 2024-UHC-126 | Supplemental Clinical Criteria | 3/15/24 | 4/29/24 | Approved | Supplemental Clinical Criteria |
| 2024-UHC-247 | Negative Pressure Wound Therapy | 3/15/24 | 4/29/24 | Approved | Negative Pressure Wound Therapy |
| 2024-HBL-366 | Out-of-Area, Out-of-Network Care | 3/15/24 | 4/29/24 | Approved | Out-of-Area, Out-of-Network Care |
| 2024-LHCC-636 | Authorization for Second Clinical Opinions PP | 3/15/24 | 4/29/24 | Approved | Authorization for Second Clinical Opinions PP |
| 2024-UHC-1371 | Athletic Pubalgia Surgery | 3/15/24 | 4/29/24 | Approved | Athletic Pubalgia Surgery |
| 2024-ABH-1891 | Member Appeals | 3/15/24 | 4/29/24 | Approved | Member Appeals |
| 2024-UHC-1931 | Fecal Microbiota Transplantation | 3/15/24 | 4/29/24 | Approved | Fecal Microbiota Transplantation |
| 2024-ABH-2255 | Decision Making Criteris Notification Amendment | 3/15/24 | 4/29/24 | Approved | Decision Making Criteris Notification Amendment |
| 2024-HUM-2267 | HPS Finance OPS Post Adj Procedure | 3/15/24 | 4/29/24 | Approved | HPS Finance OPS Post Adj Procedure |
| 2024-HUM-2273 | Additions and Removals to PAL | 3/15/24 | 4/29/24 | Approved | Additions and Removals to PAL |
| 2024-HBL-2348 | Pharmacogenomic Testing | 3/15/24 | 4/29/24 | Approved | Pharmacogenomic Testing |
| 2024-ABH-2349 | AMA XXXX Bariatric Surgery | 3/15/24 | 4/29/24 | Approved | AMA XXXX Bariatric Surgery |
| 2024-ABH-2350 | AMA XXXX BRCA Genetic Testing and Counseling | 3/15/24 | 4/29/24 | Approved | AMA XXXX BRCA Genetic Testing and Counseling |
| 2024-ABH-2351 | AMA XXXX Continuous Positive Airway Pressure | 3/15/24 | 4/29/24 | Approved | AMA XXXX Continuous Positive Airway Pressure |
| 2024-LHCC-2352 | ID Multisystem Lab Testing | 3/15/24 | 4/29/24 | Approved | ID Multisystem Lab Testing |
| 2024-LHCC-2353 | Dermatologic Lab Testing | 3/15/24 | 4/29/24 | Approved | Dermatologic Lab Testing |
| 2024-LHCC-2354 | ID Respiratory Lab Testing | 3/15/24 | 4/29/24 | Approved | ID Respiratory Lab Testing |
| 2024-LHCC-2355 | ID Vector Borne and Tropical Disease Lab Testing | 3/15/24 | 4/29/24 | Approved | ID Vector Borne and Tropical Disease Lab Testing |
| 2024-LHCC-2356 | Primary Care Preventative Lab Testing | 3/15/24 | 4/29/24 | Approved | Primary Care Preventative Lab Testing |
| 2024-LHCC-2357 | ID Genitourinary Lab Testing | 3/15/24 | 4/29/24 | Approved | ID Genitourinary Lab Testing |
| 2024-ABH-2358 | AMA XXXX CPT Vest-High Frequency Chest Wall Oscillation Device | 3/15/24 | 4/29/24 | Approved | AMA XXXX CPT Vest-High Frequency Chest Wall Oscillation Device |
| 2024-LHCC-2359 | Gastroenterologic Lab Testing | 3/15/24 | 4/29/24 | Approved | Gastroenterologic Lab Testing |
| 2024-HBL-810 | Bone Mineral Density Testing Measurement | 3/7/24 | 4/21/24 | Approved | Bone Mineral Density Testing Measurement |
| 2024-LHCC-1112 | Digital EEG Analysis | 3/7/24 | 4/21/24 | Approved | Digital EEG Analysis |
| 2024-HBL-1198 | Treatment of Keloids and Scar Revision | 3/7/24 | 4/21/24 | Approved | Treatment of Keloids and Scar Revision |
| 2024-LHCC-1212 | Spinal Cord Stimulation | 3/7/24 | 4/21/24 | Approved | Spinal Cord Stimulation |
| 2024-LHCC-1224 | Fetal Surgery in Utero | 3/7/24 | 4/21/24 | Approved | Fetal Surgery in Utero |
| 2024-LHCC-1378 | Wheelchair Seating | 3/7/24 | 4/21/24 | Approved | Wheelchair Seating |
| 2024-UHC-1407 | Utilization Management of Behavioral Health Benefits Addendum | 3/7/24 | 4/21/24 | Approved | Utilization Management of Behavioral Health Benefits Addendum |
| 2024-LHCC-1455 | Optic Nerve Decompression Surgery | 3/7/24 | 4/21/24 | Approved | Optic Nerve Decompression Surgery |
| 2024-UHC-1733 | Coordination, Continuity and Transition of Behavioral Health Care | 3/7/24 | 4/21/24 | Approved | Coordination, Continuity and Transition of Behavioral Health Care |
| 2024-LHCC-1843 | Extended Home Health Services | 3/7/24 | 4/21/24 | Approved | Extended Home Health Services |
| 2024-LHCC-1845 | PDHC Policy | 3/7/24 | 4/21/24 | Approved | PDHC Policy |
| 2024-UHC-1849 | Upper Extremity Myoelectric Prosthetic Devices | 3/7/24 | 4/21/24 | Approved | Upper Extremity Myoelectric Prosthetic Devices |
| 2024-LHCC-1904 | Homebuilder Services | 3/7/24 | 4/21/24 | Approved | Homebuilder Services |
| 2024-LHCC-1905 | Stereotactic Body Radiation Therapy | 3/7/24 | 4/21/24 | Approved | Stereotactic Body Radiation Therapy |
| 2024-LHCC-1906 | Facility-Based Sleep Studies for OSA | 3/7/24 | 4/21/24 | Approved | Facility-Based Sleep Studies for OSA |
| 2024-LHCC-1907 | Hyperhidrousis Treatments | 3/7/24 | 4/21/24 | Approved | Hyperhidrousis Treatments |
| 2024-LHCC-1948 | Implantable Loop recorder | 3/7/24 | 4/21/24 | Approved | Implantable Loop recorder |
| 2024-LHCC-2242 | Concert Genetics Prenatal and Preconception Carrier Screening | 3/7/24 | 4/21/24 | Approved | Concert Genetics Prenatal and Preconception Carrier Screening |
| 2024-LHCC-2246 | Concert Genetics Metabolic Endocrine Mitochondrial Dsrdr | 3/7/24 | 4/21/24 | Approved | Concert Genetics Metabolic Endocrine Mitochondrial Dsrdr |
| 2024-LHCC-2269 | Concert Genetics Hereditary Cancer Susceptibility | 3/7/24 | 4/21/24 | Approved | Concert Genetics Hereditary Cancer Susceptibility |
| 2024-ABH-2336 | Personal Care Services- Behavioral Health | 3/7/24 | 4/21/24 | Approved | Personal Care Services- Behavioral Health |
| 2024-HBL-2348 | Pharmacogenomic Testing | 3/7/24 | 4/21/24 | Approved | Pharmacogenomic Testing |
| 2024-ABH-2335 | Privacy and Confidentiality Amendment | 3/1/24 | 4/15/24 | Approved | Privacy and Confidentiality Amendment |
| 2024-ABH-2338 | Peer to Peer Amendment | 3/1/24 | 4/15/24 | Approved | Peer to Peer Amendment |
| 2024-HBL-2341 | PA CHANGES | 3/1/24 | 4/15/24 | Completed | PA CHANGES |
| 2024-HBL-2342 | Gene Therapy for Duchenne Muscular Dystrophy | 3/1/24 | 4/15/24 | Approved | Gene Therapy for Duchenne Muscular Dystrophy |
| 2024-UHC-2343 | Electrical Stimulation for Wounds | 3/1/24 | 4/15/24 | Approved | Electrical Stimulation for Wounds |
| 2024-HBL-2345 | Parenteral Antibiotics for the Treatment of Lyme Disease | 3/1/24 | 4/15/24 | Approved | Parenteral Antibiotics for the Treatment of Lyme Disease |
| 2024-HBL-2346 | Noninvasive Imaging Technologies for the Evaluation of Skin Lesions | 3/1/24 | 4/15/24 | Approved | Noninvasive Imaging Technologies for the Evaluation of Skin Lesions |
| 2024-HBL-2347 | Cellfree DNA Testing (Liquid Biopsy) for the Management of Cancer | 3/1/24 | 4/15/24 | Approved | Cellfree DNA Testing (Liquid Biopsy) for the Management of Cancer |
| 2024-UHC-375 | Pneumatic Compression Devices | 3/1/24 | 4/15/24 | Approved | Pneumatic Compression Devices |
| 2024-UHC-491 | Electrical Stimulation And Electromagnetic Therapy For Wounds | 3/1/24 | 4/15/24 | Approved | Electrical Stimulation And Electromagnetic Therapy For Wounds |
| 2024-LHCC-1167 | DME Clinical Policy | 3/1/24 | 4/15/24 | Approved | DME Clinical Policy |
| 2024-ABH-1173 | Peer Support Services | 3/1/24 | 4/15/24 | Approved | Peer Support Services |
| 2024-HBL-1250 | Radiation Oncology | 3/1/24 | 4/15/24 | Approved | Radiation Oncology |
| 2024-ACLA-1292 | Durable Medical Equipment | 3/1/24 | 4/15/24 | Approved | Durable Medical Equipment |
| 2024-HBL-1343 | Intermittent Abdominal Pressure Ventilation Devices | 3/1/24 | 4/15/24 | Approved | Intermittent Abdominal Pressure Ventilation Devices |
| 2024-UHC-1873 | Lower Extremity Prosthetics | 3/1/24 | 4/15/24 | Approved | Lower Extremity Prosthetics |
| 2024-UHC-1932 | Corneal Collagen Cross-Linking | 3/1/24 | 4/15/24 | Approved | Corneal Collagen Cross-Linking |
| 2024-ACLA-2133 | Prior Authorization Services List | 3/1/24 | 4/15/24 | Approved | Prior Authorization Services List |
| 2024-ABH-2256 | Assertive Community Treatment (ACT) | 3/1/24 | 4/15/24 | Approved | Assertive Community Treatment (ACT) |
| 2024-HUM-2310 | CPT Eval & Mngt Services | 3/1/24 | 4/15/24 | Approved | CPT Eval & Mngt Services |
| 2024-HUM-2316 | Hospital-Based Care Coordination of Pregnant | 3/1/24 | 4/15/24 | Approved | Hospital-Based Care Coordination of Pregnant |
| 2024-ACLA-2317 | Wheelchairs | 3/1/24 | 4/15/24 | Approved | Wheelchairs |
| 2024-UHC-2320 | Member Enrollment & Disenrollment | 3/1/24 | 4/15/24 | Approved | Member Enrollment & Disenrollment |
| 2024-ABH-2330 | Hours of Operation and After Hours Call Amend | 3/1/24 | 4/15/24 | Approved | Hours of Operation and After Hours Call Amend |
| 2024-ABH-2331 | Clinical Personnel License Requirements | 3/1/24 | 4/15/24 | Approved | Clinical Personnel License Requirements |
| 2024-ABH-2332 | Electronic and Remote Access of Medical Records Amend | 3/1/24 | 4/15/24 | Approved | Electronic and Remote Access of Medical Records Amend |
| 2024-ABH-2333 | Potential Quality of Care Amendment | 3/1/24 | 4/15/24 | Approved | Potential Quality of Care Amendment |
| 2024-ABH-2334 | Reviewing-Additional Information Following Initial Denial Amendment | 3/1/24 | 4/15/24 | Approved | Reviewing-Additional Information Following Initial Denial Amendment |
| 2024-HBL-2325 | Chromosomal Microarray Analysis | 2/21/24 | 4/6/24 | Approved | Chromosomal Microarray Analysis |
| 2024-HBL-2326 | Hereditary Cancer Testing | 2/21/24 | 4/6/24 | Approved | Hereditary Cancer Testing |
| 2024-HBL-2327 | Endovas Revascul Mngmnt of Arterial Dis of Low Ext | 2/21/24 | 4/6/24 | Approved | Endovas Revascul Mngmnt of Arterial Dis of Low Ext |
| 2024-HBL-2328 | Carrier Screening Prenatal Set and Preimplant Gen Testing | 2/21/24 | 4/6/24 | Approved | Carrier Screening Prenatal Set and Preimplant Gen Testing |
| 2024-HBL-2329 | Somatic Tumor Testing | 2/21/24 | 4/6/24 | Approved | Somatic Tumor Testing |
| 2024-LHCC-419 | Provider Termination | 2/21/24 | 4/6/24 | Approved | Provider Termination |
| 2024-UHC-443 | Ambulance Services | 2/21/24 | 4/6/24 | Approved | Ambulance Services |
| 2024-HBL-1051 | Implantable Cardioverter Defibrillator (ICD) | 2/21/24 | 4/6/24 | Approved | Implantable Cardioverter Defibrillator (ICD) |
| 2024HBL-1014 | Imaging of the Chest AIM Guidelines | 2/21/24 | 4/6/24 | Approved | Imaging of the Chest AIM Guidelines |
| 2024-HBL-1199 | Continuous Glucose Monitoring Devices and External Insulin Infusion Pumps | 2/21/24 | 4/6/24 | Approved | Continuous Glucose Monitoring Devices and External Insulin Infusion Pumps |
| 2024-HBL-1239 | Advanced Imaging of the Brain | 2/21/24 | 4/6/24 | Approved | Advanced Imaging of the Brain |
| 2024-HBL-1241 | Advanced Imaging of the Head and Neck | 2/21/24 | 4/6/24 | Approved | Advanced Imaging of the Head and Neck |
| 2024-HBL-1243 | Musculoskeletal Program- Interventional Pain Management | 2/21/24 | 4/6/24 | Approved | Musculoskeletal Program- Interventional Pain Management |
| 2024-HBL-1310 | HBL-Cell-free Prenatal DNA Testing | 2/21/24 | 4/6/24 | Approved | HBL-Cell-free Prenatal DNA Testing |
| 2024-HBL-1327 | Advanced Imaging-Oncologic Imaging | 2/21/24 | 4/6/24 | Approved | Advanced Imaging-Oncologic Imaging |
| 2024-HBL-1349 | Outpatient Rehabilitative and Habilitative AIM | 2/21/24 | 4/6/24 | Approved | Outpatient Rehabilitative and Habilitative AIM |
| 2024-LHCC-2209 | MTM Provider Manual | 2/21/24 | 4/6/24 | Approved | MTM Provider Manual |
| 2024-ACLA-2313 | Microwave Thermotherapy Lung Kidney Tumors | 2/21/24 | 4/6/24 | Approved | Microwave Thermotherapy Lung Kidney Tumors |
| 2024-ACLA-2314 | Prostatic Urethral Lift UroLift Benign Prostatic Hypertrophy | 2/21/24 | 4/6/24 | Approved | Prostatic Urethral Lift UroLift Benign Prostatic Hypertrophy |
| 2024-ACLA-2315 | Chronic Pain Management | 2/21/24 | 4/6/24 | Approved | Chronic Pain Management |
| 2024-ACLA-2319 | Opioid Treatment | 2/21/24 | 4/6/24 | Approved | Opioid Treatment |
| 2024-LHCC-107 | Utilization Management Program Description | 2/21/24 | 4/6/24 | Completed | Utilization Management Program Description |
| 2024-HBL-2322 | Whole Exome Sequencing and Whole Genome Sequencing | 2/21/24 | 4/6/24 | Approved | Whole Exome Sequencing and Whole Genome Sequencing |
| 2024-HBL-2323 | Polygenic Risk Scores in Genetic Testing | 2/21/24 | 4/6/24 | Approved | Polygenic Risk Scores in Genetic Testing |
| 2024-HBL-2324 | Genetic Testing for Inherited Conditions | 2/21/24 | 4/6/24 | Approved | Genetic Testing for Inherited Conditions |
| 2024-LHCC-814 | Crisis Intervention Policy | 2/7/24 | 3/23/24 | Approved | Crisis Intervention Policy |
| 2024-LHCC-1270 | Urinary Incontinence Devices and Treatments | 2/7/24 | 3/23/24 | Approved | Urinary Incontinence Devices and Treatments |
| 2024-LHCC-1271 | Implantable Hypoglossal Nerve Stimulation for OSA | 2/7/24 | 3/23/24 | Approved | Implantable Hypoglossal Nerve Stimulation for OSA |
| 2024-LHCC-1272 | PCR Respiratory Viral Panel Testing | 2/7/24 | 3/23/24 | Approved | PCR Respiratory Viral Panel Testing |
| 2024-UHC- 1350 | Gender Dysphoria Treatment | 2/7/24 | 3/23/24 | Approved | Gender Dysphoria Treatment |
| 2024-LHCC-1819 | Burn Surgery | 2/7/24 | 3/23/24 | Approved | Burn Surgery |
| 2024-LHCC-1820 | Transcatheter Closure of Patent Foramen Ovale | 2/7/24 | 3/23/24 | Approved | Transcatheter Closure of Patent Foramen Ovale |
| 2024-LHCC-1821 | Selective Dorsal Rhizotomy for Spasticity in CP | 2/7/24 | 3/23/24 | Approved | Selective Dorsal Rhizotomy for Spasticity in CP |
| 2024-LHCC-1822 | Opioid Use Disorder (OUD) treatment in Opiod Treatment Programs | 2/7/24 | 3/23/24 | Approved | Opioid Use Disorder (OUD) treatment in Opiod Treatment Programs |
| 2024-LHCC-1823 | Mechanical Stretch devices | 2/7/24 | 3/23/24 | Approved | Mechanical Stretch devices |
| 2024-LHCC-1824 | Electric Tumor Treatment Fields | 2/7/24 | 3/23/24 | Approved | Electric Tumor Treatment Fields |
| 2024-LHCC-1825 | Proton and Neutron Beam Therapies | 2/7/24 | 3/23/24 | Approved | Proton and Neutron Beam Therapies |
| 2024-LHCC-1837 | Obstetrical Home Care Programs | 2/7/24 | 3/23/24 | Approved | Obstetrical Home Care Programs |
| 2024-LHCC-1844 | Transplant Service Documentation Requirements | 2/7/24 | 3/23/24 | Approved | Transplant Service Documentation Requirements |
| 2024-ACLA-1954 | Cochlear Implants | 2/7/24 | 3/23/24 | Approved | Cochlear Implants |
| 2024-ACLA-2201 | Therapeutic Group Homes | 2/7/24 | 3/23/24 | Approved | Therapeutic Group Homes |
| 2024-UHC-2251 | Private Duty Nursing (PDN) and Extended Home Health (EhH) | 2/7/24 | 3/23/24 | Approved | Private Duty Nursing (PDN) and Extended Home Health (EhH) |
| 2024-HUM-2289 | VAB Policy | 2/7/24 | 3/23/24 | Approved | VAB Policy |
| 2024-UHC-2311 | Injectables for Reconstructive Procedures | 2/7/24 | 3/23/24 | Approved | Injectables for Reconstructive Procedures |
| 2024-ACLA-2312 | Plastic Reconstructive Surgery | 2/7/24 | 3/23/24 | Approved | Plastic Reconstructive Surgery |
| 2024-UHC-311 | Transcatheter Heart Valve Procedures | 1/29/24 | 3/14/24 | Approved | Transcatheter Heart Valve Procedures |
| 2024-HBL-819 | HBL Provider Manual | 1/29/24 | 3/14/24 | Approved | HBL Provider Manual |
| 2024-UHC-828 | Minimally Invasive Spine Surgery Procedures | 1/29/24 | 3/14/24 | Approved | Minimally Invasive Spine Surgery Procedures |
| 2024-LHCC-966 | Cultural and Linguistic Policy | 1/29/24 | 3/14/24 | Approved | Cultural and Linguistic Policy |
| 2024-UHC-1847 | Spinal Fusion and Decompression | 1/29/24 | 3/14/24 | Approved | Spinal Fusion and Decompression |
| 2024-UHC-1851 | Whole Exome and Whole Genome Sequencing | 1/29/24 | 3/14/24 | Approved | Whole Exome and Whole Genome Sequencing |
| 2024-HUM-2272 | Negative PAL Change Notification | 1/29/24 | 3/14/24 | Approved | Negative PAL Change Notification |
| 2024-HBL-2274 | Unspcfd Diag Code Site and Lat Art | 1/29/24 | 3/14/24 | Approved | Unspcfd Diag Code Site and Lat Art |
| 2024-UHC-2279 | Special Health Care Needs Membership | 1/29/24 | 3/14/24 | Approved | Special Health Care Needs Membership |
| 2024-UHC-2280 | Management of Care Transition NCM | 1/29/24 | 3/14/24 | Approved | Management of Care Transition NCM |
| 2024-HUM-2307 | Non MCO Covered Codes | 1/29/24 | 3/14/24 | Approved | Non MCO Covered Codes |
| 2024-HBL-2308 | Transanal Irrigation | 1/29/24 | 3/14/24 | Approved | Transanal Irrigation |
| 2024-LHCC-2236 | Concert Genetics Immune Autoimmune and Rheumatoid Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Immune Autoimmune and Rheumatoid Disorders |
| 2024-LHCC-2237 | Concert Genetics Hematologic Conditions non-cancerous | 1/11/24 | 2/25/24 | Approved | Concert Genetics Hematologic Conditions non-cancerous |
| 2024-LHCC-2238 | Concert Genetics Skeletal Dysplasia Rare Bone Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Skeletal Dysplasia Rare Bone Disorders |
| 2024-LHCC-2239 | Concert Genetics Oncology Cytogenetic Testing | 1/11/24 | 2/25/24 | Approved | Concert Genetics Oncology Cytogenetic Testing |
| 2024-LHCC-2240 | Concert Genetics Preimplantation Genetic Testing | 1/11/24 | 2/25/24 | Approved | Concert Genetics Preimplantation Genetic Testing |
| 2024-LHCC-2241 | Concert Genetics Oncology Cancer Screening | 1/11/24 | 2/25/24 | Approved | Concert Genetics Oncology Cancer Screening |
| 2024-LHCC-2243 | Concert Genetics Non-invasive Prenatal Screening | 1/11/24 | 2/25/24 | Approved | Concert Genetics Non-invasive Prenatal Screening |
| 2024-LHCC-2244 | Concert Genetics Prenatal Diagnosis Pregnancy Loss | 1/11/24 | 2/25/24 | Approved | Concert Genetics Prenatal Diagnosis Pregnancy Loss |
| 2024-LHCC-2245 | Concert Genetics Multi-system Inherited Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Multi-system Inherited Disorders |
| 2024-HBL-2274 | Unspcfd Diag Code Site and Lat Art | 1/11/24 | 2/25/24 | Approved | Unspcfd Diag Code Site and Lat Art |
| 2024-UHC-2301 | Molecular Oncology Companion Diagnostic Testing | 1/11/24 | 2/25/24 | Approved | Molecular Oncology Companion Diagnostic Testing |
| 2024-LHCC-2302 | Concert Genetics Oncology Algorithmic Testing | 1/11/24 | 2/25/24 | Approved | Concert Genetics Oncology Algorithmic Testing |
| 2024-LHCC-2303 | Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies | 1/11/24 | 2/25/24 | Approved | Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies |
| 2024-LHCC-2304 | Concert Genetic Pharmacogenetics | 1/11/24 | 2/25/24 | Approved | Concert Genetic Pharmacogenetics |
| 2024-LHCC-2305 | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) | 1/11/24 | 2/25/24 | Approved | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) |
| 2024-UHC-2306 | Airway Clearance Devices | 1/11/24 | 2/25/24 | Completed | Airway Clearance Devices |
| 2024-UHC-312 | Intensity Modulated Radiation Therapy – Revised | 1/11/24 | 2/25/24 | Approved | Intensity Modulated Radiation Therapy – Revised |
| 2024-UHC-377 | Implanted Electrical Stimulator for Spinal Cord | 1/11/24 | 2/25/24 | Approved | Implanted Electrical Stimulator for Spinal Cord |
| 2024-UHC-511 | Manipulation Under Anesthesia | 1/11/24 | 2/25/24 | Approved | Manipulation Under Anesthesia |
| 2024-UHC-524 | Durable Medical Equipment, Orthotics, Medical Supplies and Repairs/Replacements | 1/11/24 | 2/25/24 | Approved | Durable Medical Equipment, Orthotics, Medical Supplies and Repairs/Replacements |
| 2024-UHC-580 | Embolization Ovarian Iliac Pelvic Congestion Syndrome | 1/11/24 | 2/25/24 | Approved | Embolization Ovarian Iliac Pelvic Congestion Syndrome |
| 2024-UHC-786 | Light and Laser Therapy | 1/11/24 | 2/25/24 | Approved | Light and Laser Therapy |
| 2024-LHCC-829 | Interrater Reliability - Act 421 | 1/11/24 | 2/25/24 | Completed | Interrater Reliability - Act 421 |
| 2024-LHCC-982 | Outpatient Applied Behavior Analysis Medical Necessity | 1/11/24 | 2/25/24 | Approved | Outpatient Applied Behavior Analysis Medical Necessity |
| 2024-LHCC-1747 | PCS-EPSDT Policy | 1/11/24 | 2/25/24 | Approved | PCS-EPSDT Policy |
| 2024-UHC-1839 | Genetic Testing Hereditary Cancer Susceptibility | 1/11/24 | 2/25/24 | Approved | Genetic Testing Hereditary Cancer Susceptibility |
| 2024-LHCC-2226 | Concert Genetics Aortopathies and Connective Tissue Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Aortopathies and Connective Tissue Disorders |
| 2024-LHCC-2227 | Concert Genetics Cardiac Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Cardiac Disorders |
| 2024-LHCC-2228 | Concert Genetics Eye Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Eye Disorders |
| 2024-LHCC-2229 | Concert Genetics Dermatologic Conditions | 1/11/24 | 2/25/24 | Approved | Concert Genetics Dermatologic Conditions |
| 2024-LHCC-2230 | Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions | 1/11/24 | 2/25/24 | Approved | Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions |
| 2024-LHCC-2231 | Concert Genetics Gastroenterologic Disorders non-cancerous | 1/11/24 | 2/25/24 | Approved | Concert Genetics Gastroenterologic Disorders non-cancerous |
| 2024-LHCC-2232 | Concert Genetics General Approach to Genetic Testing | 1/11/24 | 2/25/24 | Approved | Concert Genetics General Approach to Genetic Testing |
| 2024-LHCC-2233 | Concert Genetics Hearing Loss | 1/11/24 | 2/25/24 | Approved | Concert Genetics Hearing Loss |
| 2024-LHCC-2234 | Concert Genetics Lung Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Lung Disorders |
| 2024-LHCC-2235 | Concert Genetics Kidney Disorders | 1/11/24 | 2/25/24 | Approved | Concert Genetics Kidney Disorders |
| 2023-UHC-2278 | Early Periodic Screening Diagnostic and Treatment EPSDT | 1/5/24 | 2/19/24 | Approved | Early Periodic Screening Diagnostic and Treatment EPSDT |
| 2023-HBL-2288 | Prior Auth Requirement Changes | 1/5/24 | 2/19/24 | Completed | Prior Auth Requirement Changes |
| 2024-UHC-2293 | Electroretinography | 1/5/24 | 2/19/24 | Approved | Electroretinography |
| 2024-UHC-2294 | Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions | 1/5/24 | 2/19/24 | Approved | Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions |
| 2024-HUM-2299 | OON OOS Policy | 1/5/24 | 2/19/24 | Approved | OON OOS Policy |
| 2024-HUM-2300 | Rapid Whole Genome Sequencing | 1/5/24 | 2/19/24 | Approved | Rapid Whole Genome Sequencing |
| 2024-UHC-482 | Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment Decisions | 1/5/24 | 2/19/24 | Approved | Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment Decisions |
| 2024-UHC-207 | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation | 1/5/24 | 2/19/24 | Approved | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation |
Medicaid Managed Care Policies & Procedures Archive (2024) Continued 3
"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.
Below are items previously posted for public comment: