Medicaid Managed Care Policies & Procedures Archive (2023) - Continued page 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:

Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2023-UHC-211	Fecal Calprotectin Testing	6/15/23	7/30/23	Approved	Fecal Calprotectin Testing
2023-LHCC-423	EPSDT	6/15/23	7/30/23	Approved	EPSDT
2023-UHC-523	Intrauterine Fetal Surgery	6/15/23	7/30/23	Approved	Intrauterine Fetal Surgery
2023-LHCC-1284	Preventive Health and Clinical Practice	6/15/23	7/30/23	Approved	Preventive Health and Clinical Practice
2023-UHC-1399	Glaucoma Surgical Treatment	6/15/23	7/30/23	Approved	Glaucoma Surgical Treatment
2023-UHC-1400	Occipital Nerve Injections and Ablations	6/15/23	7/30/23	Approved	Occipital Nerve Injections and Ablations
2023-UHC-1852	Macular Degeneration Treatment Procedures	6/15/23	7/30/23	Approved	Macular Degeneration Treatment Procedures
2023-UHC-1719	Louisiana BH Supplemental Clinical Care	6/7/23	7/22/23	Approved	Louisiana BH Supplemental Clinical Care
2023-LHCC-635	Coordination of Benefits (COB)/Third Part Liability/Subrogation (TPL)	6/7/23	7/22/23	Approved	Coordination of Benefits (COB)/Third Party Liability/Subrogation (TPL)
2023-LHCC-982	Outpatient Applied Behavior Analysis Medical Necessity	6/7/23	7/22/23	Approved	Outpatient Applied Behavior Analysis Medical Necessity
2023-ACLA-1183	Personal Care Services	6/7/23	7/22/23	Approved	Personal Care Services
2023-UHC-1391	Intraocular Pressure Measurement	6/7/23	7/22/23	Approved	Intraocular Pressure Measurement
2023-UHC-1401	Manipulative Therapy	6/7/23	7/22/23	Approved	Manipulative Therapy
2023-Humana-1428	Preauthorization and Notification List	6/7/23	7/22/23	Approved	Preauthorization and Notification List
2023-UHC-1847	Spinal Fusion and Decompression	6/7/23	7/22/23	Approved	Spinal Fusion and Decompression
2023-Humana-1929	HCPCS-Drugs & Biologicals	6/7/23	7/22/23	Approved	HCPCS-Drugs & Biologicals
2023-ACLA-1955	Blood Pressure Devices	6/7/23	7/22/23	Approved	Blood Pressure Devices
2023-ACLA-1956	Enteral Nutrition	6/7/23	7/22/23	Approved	Enteral Nutrition
2023-ACLA-1957	Genetic Testing Breast/Ovarian Cancer	6/7/23	7/22/23	Approved	Genetic Testing Breast/Ovarian Cancer
2023-ACLA-1958	Wound Care Supplies	6/7/23	7/22/23	Approved	Wound Care Supplies
2023-LHCC-315	Testing Select GU Conditions	6/5/23	7/20/23	Approved	Testing Select GU Conditions
2023-ACLA-815	Vitamin D Policy	6/5/23	7/20/23	Approved	Vitamin D Policy
2023-LHCC-1108	Pediatric Liver Transplant	6/5/23	7/20/23	Approved	Pediatric Liver Transplant
2023-LHCC-1114	Urodynamic Testing	6/5/23	7/20/23	Approved	Urodynamic Testing
2023-LHCC-1212	Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation	6/5/23	7/20/23	Approved	Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation
2023-LHCC-1214	Total Parenteral Nutrition and Intradialytic Parental Nutrition	6/5/23	7/20/23	Approved	Total Parenteral Nutrition and Intradialytic Parental Nutrition
2023-LHCC-1216	Bariatric Surgery	6/5/23	7/20/23	Approved	Bariatric Surgery
2023-LHCC-1217	Ultrasound in Pregnancy	6/5/23	7/20/23	Approved	Ultrasound in Pregnancy
2023-LHCC-1227	Skin and Soft Tissue Substitutes for Chronic Wounds	6/5/23	7/20/23	Approved	Skin and Soft Tissue Substitutes for Chronic Wounds
2023-LHCC-1278	Evoked Potential Testing	6/5/23	7/20/23	Approved	Evoked Potential Testing
2023-LHCC-1353	Articular Cartilage Defect Repairs	6/5/23	7/20/23	Approved	Articular Cartilage Defect Repairs
2023-LHCC-1355	Functional MRI	6/5/23	7/20/23	Approved	Functional MRI
2023-LHCC-1356	Lung Transplantation	6/5/23	7/20/23	Approved	Lung Transplantation
2023-LHCC-1358	Pancreas Transplantation	6/5/23	7/20/23	Approved	Pancreas Transplantation
2023-LHCC-1360	Heart-Lung Transplant	6/5/23	7/20/23	Approved	Heart-Lung Transplant
2023-LHCC-1362	Nonmyeloablative allogeneric SCT	6/5/23	7/20/23	Approved	Nonmyeloablative allogeneric SCT
2023-LHCC-1363	Tandem Transplant	6/5/23	7/20/23	Approved	Tandem Transplant
2023-LHCC-1365	GI Pathogen Nucleic Acid and Detection Panel Testing	6/5/23	7/20/23	Approved	GI Pathogen Nucleic Acid and Detection Panel Testing
2023-LHCC-1378	Wheelchair Seating	6/5/23	7/20/23	Approved	Wheelchair Seating
2023-LHCC-1379	Inhaled Nitric Oxide	6/5/23	7/20/23	Approved	Inhaled Nitric Oxide
2023-LHCC-1380	Multiple Sleep Latency Testing	6/5/23	7/20/23	Approved	Multiple Sleep Latency Testing
2023-LHCC-1381	Bronchial Thermoplasty	6/5/23	7/20/23	Approved	Bronchial Thermoplasty
2023-LHCC-1385	Implantable Wireless PAP Monitoring	6/5/23	7/20/23	Approved	Implantable Wireless PAP Monitoring
2023-LHCC-1386	Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins	6/5/23	7/20/23	Approved	Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins
2023-LHCC-1389	Endometrial Ablation	6/5/23	7/20/23	Approved	Endometrial Ablation
2023-LHCC-1415	Pulmonary Function Testing	6/5/23	7/20/23	Approved	Pulmonary Function Testing
2023-UHC-1432	Pediatric Gait Trainers and Standing Systems	6/5/23	7/20/23	Approved	Pediatric Gait Trainers and Standing Systems
2023-LHCC-1702	Holter Monitor	6/5/23	7/20/23	Approved	Holter Monitor
2023-LHCC-1741	AHCT for Sickle Cell Anemia and Thalassemia	6/5/23	7/20/23	Approved	AHCT for Sickle Cell Anemia and Thalassemia
2023-LHCC-1745	Donor Lymphocyte Infusion	6/5/23	7/20/23	Approved	Donor Lymphocyte Infusion
2023-LHCC-1837	Obstetrical Home Care Programs	6/5/23	7/20/23	Approved	Obstetrical Home Care Programs
2023-LHCC-1841	MNC Policy for CPST and PSR	6/5/23	7/20/23	Approved	MNC Policy for CPST and PSR
2023-UHC-1906	Facility-Based Sleep Studies for OSA	6/5/23	7/20/23	Approved	Facility-Based Sleep Studies for OSA
2023-LHCC-1918	Diabetes Self-Management Training	6/5/23	7/20/23	Approved	Diabetes Self-Management Training
2023-LHCC-1934	Experimental Technologies	6/5/23	7/20/23	Approved	Experimental Technologies
2023-LHCC-1935	Gastric Electrical Stimulation	6/5/23	7/20/23	Approved	Gastric Electrical Stimulation
2023-LHCC-1944	Laser Therapy for Skin Conditions	6/5/23	7/20/23	Approved	Laser Therapy for Skin Conditions
2023-LHCC-1945	Homocysteine Testing	6/5/23	7/20/23	Approved	Homocysteine Testing
2023-LHCC-1946	Low-Frequency US and NNWT	6/5/23	7/20/23	Approved	Low-Frequency US and NNWT
2023-LHCC-1948	Implantable Loop recorder	6/5/23	7/20/23	Approved	Implantable Loop recorder
2023-ACLA-1951	Sacral Nerve Modulation Stimulation	6/5/23	7/20/23	Approved	Sacral Nerve Modulation Stimulation
2023-ACLA-1952	Oral Nutritional Supplements	6/5/23	7/20/23	Approved	Oral Nutritional Supplements
2023-ACLA-1953	Virtual Colonoscopy	6/5/23	7/20/23	Approved	Virtual Colonoscopy
2023-LDH-7	MCO Manual > Part 4: Services > In Lieu of Services > Physical Health Services > Outpatient Lactation Support (Proposed effective date = 6/30/2023)	5/23/2023	7/7/2023	Pending	Outpatient Lactation Support
2023-LDH-6	MCO Manual > Part 4: Services > Pharmacy (Proposed effective date = 8/14/2023)	5/23/2023	7/7/2023	Pending	Pharmacy
2023-LDH-5	MCO Manual > Part 4: Services > Hospital Services > Outpatient Hospital Services > Common Observation Policy (Effective date = 8/14/2023)	5/23/2023	7/7/2023	Pending	Common Observation Policy
2023-UHC-247	Negative Pressure Wound Therapy	5/26/23	7/10/23	Approved	Negative Pressure Wound Therapy
2023-LHCC-336	Care Management Program Description	5/26/23	7/10/23	Approved	Care Management Program Description
2023-UHC-474	Rhinoplasty and Other Nasal Procedures	5/26/23	7/10/23	Approved	Rhinoplasty and Other Nasal Procedures
2023-UHC-492	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins	5/26/23	7/10/23	Approved	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins
2023-UHC-520	Panniculectomy Body Contouring Procedures	5/26/23	7/10/23	Approved	Panniculectomy Body Contouring Procedures
2023-UHC-555	Orthognathic (Jaw) Surgery	5/26/23	7/10/23	Approved	Orthognathic (Jaw) Surgery
2023-UHC-586	Chelation Therapy	5/26/23	7/10/23	Approved	Chelation Therapy
2023-UHC-783	Electrical Bioimpedance for Cardiac Output Measurement	5/26/23	7/10/23	Approved	Electrical Bioimpedance for Cardiac Output Measurement
2023-ABH-822	ABH Provider Manual	5/26/23	7/10/23	Approved	ABH Provider Manual
2023-UHC-949	Chemotherapy-Observation or Inpatient Hospitalization	5/26/23	7/10/23	Approved	Chemotherapy-Observation or Inpatient Hospitalization
2023-LHCC-966	Cultural and Linguistic Policy	5/26/23	7/10/23	Approved	Cultural and Linguistic Policy
2023-ABH-1174	Applied Behavior Analysis	5/26/23	7/10/23	Approved	Applied Behavior Analysis
2023-UHC-1340	Gynecomastia Surgery	5/26/23	7/10/23	Approved	Gynecomastia Surgery
2023-UHC-1342	Pectus Deformity Repair	5/26/23	7/10/23	Approved	Pectus Deformity Repair
2023-UHC-1350	Gender Dysphoria Treatment	5/26/23	7/10/23	Approved	Gender Dysphoria Treatment
2023-UHC-1392	Gastrointestinal Motility Disorders	5/26/23	7/10/23	Approved	Gastrointestinal Motility Disorders
2023-UHC-1395	Motorized Spinal Traction	5/26/23	7/10/23	Approved	Motorized Spinal Traction
2023-ABH-1528	Substance Use Disorder Treatment - Intensive Outpatient and Residential LOC	5/26/23	7/10/23	Approved	Substance Use Disorder Treatment - Intensive Outpatient and Residential LOC
2023-ABH-1930	Eye Vendor - Provider Manual	5/26/23	7/10/23	Approved	Eye Vendor - Provider Manual
2023-LHCC-1933	Personal Care Services (PCS)	5/26/23	7/10/23	Approved	Personal Care Services (PCS)
2023-Humana-1936	Humana Code Edit - Outpatient Services while Inpatient	5/26/23	7/10/23	Approved	Humana Code Edit - Outpatient Services while Inpatient
2023-UHC-1941	Louisiana ABA Policy	5/26/23	7/10/23	Approved	Louisiana ABA Policy
2023-UHC-486	Abnormal Uterine Bleeding and Uterine Fibroids	6/7/23	7/5/23	withdrawn	Abnormal Uterine Bleeding and Uterine Fibroids
2023-UHC-1523	Facet Joint and Medial Branch Block Injections for Spinal Pain	5/26/23	7/5/23	Withdrawn	Facet Joint and Medial Branch Block Injections for Spinal Pain
2023-LHCC-1218	Ventricular Assist Devices	6/5/23	7/20/23	Withdrawn	Ventricular Assist Devices
2023-UHC-217	Omnibus Codes	5/5/23	6/19/23	Approved	Omnibus Codes
2023-UHC-490	Cardiovascular Disease Risk Tests	5/5/23	6/19/23	Approved	Cardiovascular Disease Risk Tests
2023-UHC-1170	Prostate Surgeries and Interventions	5/5/23	6/19/23	Approved	Prostate Surgeries and Interventions
2023-UHC-1367	Patient Lifts	5/5/23	6/19/23	Approved	Patient Lifts
2023-Humana-1857	Multiple Initial Hospital Care Services	5/5/23	6/19/23	Approved	Multiple Initial Hospital Care Services
2023-LHCC-1916	Individual Placement and Support	5/5/23	6/19/23	Approved	Individual Placement and Support
2023-Humana-1923	Pregnant SUD ILOS	5/5/23	6/19/23	Approved	Pregnant SUD ILOS
2023-UHC-1931	Fecal Microbiota Transplantation	5/5/23	6/19/23	Approved	Fecal Microbiota Transplantation
2023-UHC-1932	Corneal Collagen Cross-Linking	5/5/23	6/19/23	Approved	Corneal Collagen Cross-Linking
2023-UHC-222	Skin and Soft Tissue Substitutes	5/2/23	6/16/23	Approved	Skin and Soft Tissue Substitutes
2023-UHC-375	Pneumatic Compression Devices	5/2/23	6/16/23	Approved	Pneumatic Compression Devices
2023-UHC-379	Brow Ptosis and Eyelid Repair	5/2/23	6/16/23	Approved	Brow Ptosis and Eyelid Repair
2023-UHC-482	Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions	5/2/23	6/16/23	Approved	Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions
2023-UHC-578	Thermography	5/2/23	6/16/23	Approved	Thermography
2023-LHCC-682	Active Procedures in Physical Medicine	5/2/23	6/16/23	Approved	Active Procedures in Physical Medicine
2023-LHCC-685	Experimental, Unproven, or Investigational Services	5/2/23	6/16/23	Approved	Experimental, Unproven, or Investigational Services
2023-LHCC-687	Measurable Progressive Improvement	5/2/23	6/16/23	Approved	Measurable Progressive Improvement
2023-LHCC-689	Outpatient Habilitative PT and OT Therapy Final	5/2/23	6/16/23	Approved	Outpatient Habilitative PT and OT Therapy Final
2023-LHCC-690	Outpatient Habilitative Speech Therapy	5/2/23	6/16/23	Approved	Outpatient Habilitative Speech Therapy
2023-LHCC-691	Passive Treatment	5/2/23	6/16/23	Approved	Passive Treatment
2023-UHC-825	Cardiac Event Monitoring	5/2/23	6/16/23	Approved	Cardiac Event Monitoring
2023-HBL-986	Diagnostic Coronary Angiography	5/2/23	6/16/23	Approved	Diagnostic Coronary Angiography
2023-HBL-1009	Advanced Imaging of the Heart	5/2/23	6/16/23	Approved	Advanced Imaging of the Heart
2023-HBL-1058	Whole Genome Sequ. Whole Exome Sequ. Gene Panels and Molecular Prof	5/2/23	6/16/23	Approved	Whole Genome Sequ. Whole Exome Sequ. Gene Panels and Molecular Prof
2023-HBL-1250	Radiation Oncology	5/2/23	6/16/23	Approved	Radiation Oncology
2023-LHCC-1275	Oxygen Use and Concentrators	5/2/23	6/16/23	Approved	Oxygen Use and Concentrators
2023-UHC-1371	Athletic Pubalgia Surgery	5/2/23	6/16/23	Approved	Athletic Pubalgia Surgery
2023-UHC-1394	Transpupillary Thermotherapy	5/2/23	6/16/23	Approved	Transpupillary Thermotherapy
2023-LHCC-1430	Record Keeping and Documentation Standards: Physical Medicine	5/2/23	6/16/23	Approved	Record Keeping and Documentation Standards: Physical Medicine
2023-UHC-1816	Enteral Nutrition (Oral and Tube Feeding)	5/2/23	6/16/23	Approved	Enteral Nutrition (Oral and Tube Feeding)
2023-ABH-1900	Physical Safety for Field Based Colleagues	5/2/23	6/16/23	Complete	Physical Safety for Field Based Colleagues
2023-LHCC-1909	Peer Support Services	5/2/23	6/16/23	Approved	Peer Support Services
2023-LHCC-1910	Implantable Intrathecal or Epidural Pain Pump	5/2/23	6/16/23	Approved	Implantable Intrathecal or Epidural Pain Pump
2023-LHCC-1911	Ambulatory Surgery Center Optimization	5/2/23	6/16/23	Approved	Ambulatory Surgery Center Optimization
2023-LHCC-1912	Multi-Systemic Therapy (MST)	5/2/23	6/16/23	Approved	Multi-Systemic Therapy (MST)
2023-Humana-1914	Louisiana Medicaid Occurrence Date	5/2/23	6/16/23	Approved	Louisiana Medicaid Occurrence Date
2023-LHCC-1915	E&M Services billed with Treatment Room Rev Code	5/2/23	6/16/23	Approved	E&M Services billed with Treatment Room Rev Code
2023-UHC-1928	Transanal Endoscopic Microsurgery	5/2/23	6/16/23	Approved	Transanal Endoscopic Microsurgery
2023-LDH-4	MCO Manual > Part 4: Services > Pharmacy (Proposed effective date = 10/1/2023)	4/26/23	6/10/23	Completed	Pharmacy
2023-LDH-3	MCO Manual > Part 4: Services > Professional Services > Obstetrics (Effective date = 4/6/2023)	4/26/23	NA	Completed	Obstetrics – Alpha Hydroxyprogesterone Caproate Imminent Peril Justification
2023-Humana-1531	ABA Clinical Coverage	4/18/23	6/2/23	Approved	ABA Clinical Coverage
2023-Humana-1739	NEMT Meals and Lodging	4/18/23	6/2/23	Approved	NEMT Meals and Lodging
2023-Humana-1740	NEMT Geo Access Standards	4/18/23	6/2/23	Approved	NEMT Geo Access Standards
2023-ABH-1765	NEMT - Non-emergency Medical Transportation	4/18/23	6/2/23	Approved	NEMT - Non-emergency Medical Transportation
2023-ABH-1899	Prenatal Services	4/18/23	6/2/23	Approved	Prenatal Services
2023-LHCC-1902	Cosmetic Procedures	4/18/23	6/2/23	Approved	Cosmetic Procedures
2023-LHCC-1917	Repair of Nasal Valve Compromise	4/18/23	6/2/23	Approved	Repair of Nasal Valve Compromise
2023-LHCC-24	Advance Directives	4/14/23	5/29/23	Complete	Advance Directives
2023-LHCC-129	Provider Directory and Electronic Files from Portico	4/14/23	5/29/23	Complete	Provider Directory and Electronic Files from Portico
2023-LHCC-419	Provider Termination	4/14/23	5/29/23	Complete	Provider Termination
2023-LHCC-422	Network Development and Management	4/14/23	5/29/23	Complete	Network Development and Management
2023-LHCC-430	Covered Benefits and Services	4/14/23	5/29/23	Complete	Covered Benefits and Services
2023-LHCC-680	Provider Reimbursement	4/14/23	5/29/23	Complete	Provider Reimbursement
2023-LHCC-829	Interrater Reliability - Act 421	4/14/23	5/29/23	Complete	Interrater Reliability - Act 421
2023-LHCC-910	Network Selection and Retention	4/14/23	5/29/23	Complete	Network Selection and Retention
2023-LHCC-916	Case Management Assessment Process	4/14/23	5/29/23	Complete	Case Management Assessment Process
2023-LHCC-925	Provider Complaints	4/14/23	5/29/23	Complete	Provider Complaints
2023-LHCC-963	Claims Management-Payment to Provider	4/14/23	5/29/23	Complete	Claims Management-Payment to Provider
2023-LHCC-982	Outpatient Applied Behavior Analysis Medical Necessity	4/14/23	5/29/23	Approved	Outpatient Applied Behavior Analysis Medical Necessity
2023-LHCC-994	Ambulatory Insulin Pump	4/14/23	5/29/23	Approved	Ambulatory Insulin Pump
2023-LHCC-1769	Abuse and Neglect Reporting	4/14/23	5/29/23	Complete	Abuse and Neglect Reporting
2023-UHC-1798	Case Management Process	4/14/23	5/29/23	Complete	Case Management Process
2023-LHCC-1875	Ongoing Monitoring of Sanctions & Complaints	4/14/23	5/29/23	Complete	Ongoing Monitoring of Sanctions & Complaints
2023-LHCC-1876	Practitioner Disciplinary Action and Reporting	4/14/23	5/29/23	Complete	Practitioner Disciplinary Action and Reporting
2023-LHCC-1877	Provider Directory for Members	4/14/23	5/29/23	Complete	Provider Directory for Members
2023-ABH-1893	Provider Disputes	4/14/23	5/29/23	Complete	Provider Disputes
2023-ABH-1894	Provider Complaints	4/14/23	5/29/23	Complete	Provider Complaints
2023-LHCC-111	Functional Family Therapy - Child Welfare	4/10/23	5/25/23	Complete	Functional Family Therapy - Child Welfare
2023-Humana-1532	Assertive Community Treatment (ACT/FACT)	4/10/23	5/25/23	Approved	Assertive Community Treatment (ACT/FACT)
2023-UHC-1719	Louisiana BH Supplemental Clinical Care	4/10/23	5/25/23	Approved	Louisiana BH Supplemental Clinical Care
2023-UHC-1804	Policy Submissions to LDH	4/10/23	5/25/23	Complete	Policy Submissions to LDH
2023-UHC-1805	Transition of Care Coordination	4/10/23	5/25/23	Complete	Transition of Care Coordination
2023-UHC-1811	Integration of Physical Health Through Whole Person Care	4/10/23	5/25/23	Complete	Integration of Physical Health Through Whole Person Care
2023-LHCC-1843	Extended Home Health Services	4/10/23	5/25/23	Approved	Extended Home Health Services
2023-LHCC-1872	Retroactive Reimbursement	4/10/23	5/25/23	Approved	Retroactive Reimbursement
2023-ACLA-1895	Chiropractic ILOS	4/10/23	5/25/23	Approved	Chiropractic ILOS
2023-ACLA-1896	Doula ILOS	4/10/23	5/25/23	Approved	Doula ILOS
2023-ACLA-1897	Remote Patient Monitoring ILOS	4/10/23	5/25/23	Approved	Remote Patient Monitoring ILOS
2023-LHCC-1903	Renal Hemodialysis	4/10/23	5/25/23	Approved	Renal Hemodialysis
2023-LHCC-1904	Homebuilder Services	4/10/23	5/25/23	Approved	Homebuilder Services
2023-LHCC-1905	Stereotactic Body Radiation Therapy	4/10/23	5/25/23	Pending	Stereotactic Body Radiation Therapy
2023-LHCC-1907	Hyperhidrosis Treatments	4/10/23	5/25/23	Approved	Hyperhidrosis Treatments
2023-LHCC-1906	Sleep Center Polysomnography and Split-Night Studies for OSA	4/10/23	5/25/23	Withdrawn	Sleep Center Polysomnography and Split-Night Studies for OSA
2023-UHC-1761	Home Health	3/31/23	5/15/23	Approved	Home Health
2023-Humana-1854	Rebundling	3/31/23	5/15/23	Approved	Rebundling
2023-Humana-1855	External Cause Diagnosis Codes	3/31/23	5/15/23	Complete	External Cause Diagnosis Codes
2023-Humana-1856	Modifier JW – Drug Waste	3/31/23	5/15/23	Complete	Modifier JW – Drug Waste
2023-ACLA-1874	Adverse Incident Reporting	3/31/23	5/15/23	Approved	Adverse Incident Reporting
2023-ABH-1892	Member Grievance	3/31/23	5/15/23	Approved	Member Grievance
2023-ABH-1901	Reporting Abuse, Neglect, and Exploitation	3/31/23	5/15/23	Approved	Reporting Abuse, Neglect, and Exploitation
2023-LDH-2	MCO Manual > Part 4: Services > Hospital Services > Inpatient Hospital Services (Proposed effective date = 1/1/2023)	3/31/23	5/15/23	Approved	Rapid Whole Genome Sequencing of Critically Ill Infants
2023-LHCC-1363	Tandem Transplant	4/10/23	5/12/23	Withdrawn	Tandem Transplant
2023-LDH-1	MCO Manual > Part 4: Services > In Lieu of Services > Physical Health Services (Proposed effective date = 2/9/2023)	3/24/23	5/8/23	Approved	Remote Patient Monitoring
2023-UHC-524	DME, Orthotics, Medical Supplies and Repairs/Replacements	3/24/23	5/8/23	Approved	DME, Orthotics, Medical Supplies and Repairs/Replacements
2023-ACLA-872	CT Coronary Angiography (CCTA)	3/24/23	5/8/23	Approved	CT Coronary Angiography (CCTA)
2023-LHCC-911	Network Adequacy	3/24/23	5/8/23	Approved	Network Adequacy
2023-ABH-1289	Mental Health Intensive Outpatient	3/24/23	5/8/23	Complete	Mental Health Intensive Outpatient
2023-LHCC-1389	Endometrial Ablation	3/24/23	5/8/23	Approved	Endometrial Ablation
2023-UHC-1849	Upper Extremity Myoelectric Prosthetic Devices	3/24/23	5/8/23	Approved	Upper Extremity Myoelectric Prosthetic Devices
2023-UHC-1873	Lower Extremity Prosthetics	3/24/23	5/8/23	Approved	Lower Extremity Prosthetics
2023-ABH-1891	Member Appeals	3/24/23	5/8/23	Approved	Member Appeals
2023-ABH-1898	Case Rounds	3/24/23	5/8/23	Approved	Case Rounds
2023-ACLA-1864	Speech Therapy	3/16/23	4/30/23	Approved	Speech Therapy
2023-ACLA-1865	Pancreas Transplantation	3/16/23	4/30/23	Approved	Pancreas Transplantation
2023-ACLA-1866	Gastroparesis Evaluations	3/16/23	4/30/23	Approved	Gastroparesis Evaluations
2023-ACLA-1868	Electrical Muscle Stimulation	3/16/23	4/30/23	Approved	Electrical Muscle Stimulation
2023-ACLA-1871	Three dimensional imaging interpretation	3/16/23	4/30/23	Approved	Three dimensional imaging interpretation
2023-LHCC-1878	Cervical Spine Surgery	3/16/23	4/30/23	Approved	Cervical Spine Surgery
2023-LHCC-1879	Deformity Surgery	3/16/23	4/30/23	Approved	Deformity Surgery
2023-LHCC-1880	Hip Arthroplasty	3/16/23	4/30/23	Approved	Hip Arthroplasty
2023-LHCC-1881	Hip Arthroscopy	3/16/23	4/30/23	Approved	Hip Arthroscopy
2023-LHCC-1882	Knee Arthroplasty	3/16/23	4/30/23	Approved	Knee Arthroplasty
2023-LHCC-1883	Lumbar Artificial Disc Replacement	3/16/23	4/30/23	Approved	Lumbar Artificial Disc Replacement
2023-LHCC-1884	Lumbar Spine Surgery	3/16/23	4/30/23	Approved	Lumbar Spine Surgery
2023-LHCC-1885	Knee Arthroscopy	3/16/23	4/30/23	Approved	Knee Arthroscopy
2023-LHCC-1886	Sacroiliac Joint Infusion	3/16/23	4/30/23	Approved	Sacroiliac Joint Infusion
2023-LHCC-1887	Shoulder Arthroplasty	3/16/23	4/30/23	Approved	Shoulder Arthroplasty
2023-LHCC-1888	Spine Surgery Other	3/16/23	4/30/23	Approved	Spine Surgery Other
2023-LHCC-1889	Shoulder Arthroscopy	3/16/23	4/30/23	Approved	Shoulder Arthroscopy
2023-LHCC-1890	Thoracic Spine Surgery	3/16/23	4/30/23	Approved	Thoracic Spine Surgery
2023-LHCC-679	Claims Management /Claims Processing	3/16/23	4/30/23	Approved	Claims Management /Claims Processing
2023-LHCC-692	Claims Management Reporting and Auditing	3/16/23	4/30/23	Approved	Claims Management Reporting and Auditing
2023-LHCC-932	Potential QOC Incidents Policy	3/16/23	4/30/23	Approved	Potential QOC Incidents Policy
2023-LHCC-962	Claims Management Functionality	3/16/23	4/30/23	Approved	Claims Management Functionality
2023-UHC-1178	Liposuction for Lipedema	3/16/23	4/30/23	Approved	Liposuction for Lipedema
2023-Humana-1590	Chiropractic ILOS	3/16/23	4/30/23	Approved	Chiropractic ILOS
2023-Humana-1818	Functional Family Therapy (FFT)	3/16/23	4/30/23	Approved	Functional Family Therapy (FFT)
2023-Humana-1826	Revenue Codes for Outpatient Services	3/16/23	4/30/23	Approved	Revenue Codes for Outpatient Services
2023-LHCC-1833	Assertive Community Treatment (ACT)	3/16/23	4/30/23	Approved	Assertive Community Treatment (ACT)
2023-LHCC-1845	PDHC Policy	3/16/23	4/30/23	Approved	PDHC Policy
2023-UHC-1851	Whole Exome and Whole Genome Sequencing	3/16/23	4/30/23	Approved	Whole Exome and Whole Genome Sequencing
2023-UHC-1852	Macular Degeneration Treatment Procedures	3/16/23	4/30/23	Approved	Macular Degeneration Treatment Procedures
2023-ACLA-1859	Nonpharmacologic treatments for chronic vertigo	3/16/23	4/30/23	Approved	Nonpharmacologic treatments for chronic vertigo
2023-ACLA-1860	Phototherapy & Photochemotherapy for skin conditions	3/16/23	4/30/23	Approved	Phototherapy & Photochemotherapy for skin conditions
2023-ACLA-1861	Lung Transplants	3/16/23	4/30/23	Approved	Lung Transplants
2023-ACLA-1863	Excimer laser for Vitiligo	3/16/23	4/30/23	Approved	Excimer laser for Vitiligo
2023-UHC-311	Transcatheter Heart Valve Procedures	3/7/23	4/21/23	Approved	Transcatheter Heart Valve Procedures
2023-LHCC-432	Psychiatric Treatment Facility	3/7/23	4/21/23	Approved	Psychiatric Treatment Facility
2023-UHC-491	Electrical Stimulation And Electromagnetic Therapy For Wounds	3/7/23	4/21/23	Approved	Electrical Stimulation And Electromagnetic Therapy For Wounds
2023-UHC-511	Manipulation Under Anesthesia	3/7/23	4/21/23	Approved	Manipulation Under Anesthesia
2023-UHC-580	Embolization Ovarian Iliac Pelvic Congestion Syndrome	3/7/23	4/21/23	Approved	Embolization Ovarian Iliac Pelvic Congestion Syndrome
2023-UHC-961	Elective Inpatient Services	3/7/23	4/21/23	Approved	Elective Inpatient Services
2023-UHC-1458	Hepatitis Screening	3/7/23	4/21/23	Approved	Hepatitis Screening
2023-ABH-1529	Abortion Procedures	3/7/23	4/21/23	Approved	Abortion Procedures
2023-UHC-1846	Interspinous Fusion and Decompression Devices	3/7/23	4/21/23	Approved	Interspinous Fusion and Decompression Devices
2023-UHC-1847	Spinal Fusion and Decompression	3/7/23	4/21/23	Approved	Spinal Fusion and Decompression
2023-HBL-586	Global Surgical Package Reimbursement Policy	3/1/23	4/15/23	Approved	Global Surgical Package Reimbursement Policy
2023-LHCC-712	CT Coronary Angiography (CCTA)	3/1/23	4/15/23	Approved	CT Coronary Angiography (CCTA)
2023-Humana-1548	Individual Placement and Support (IPS)	3/1/23	4/15/23	Approved	Individual Placement and Support (IPS)
2023-Humana-1561	Multi-Systemic Therapy (MST)	3/1/23	4/15/23	Approved	Multi-Systemic Therapy (MST)
2023-LHCC-1835	Continuous Glucose Monitors	3/1/23	4/15/23	Approved	Continuous Glucose Monitors
2023-LHCC-1840	Cochlear Implants and Replacements	3/1/23	4/15/23	Approved	Cochlear Implants and Replacements
2023-LHCC-1841	MNC Policy for CPST and PSR	3/1/23	4/15/23	Denied	MNC Policy for CPST and PSR
2023-LHCC-1842	Cosmetic and Reconstructive Procedures	3/1/23	4/15/23	Approved	Cosmetic and Reconstructive Procedures
2023-LHCC-1844	Transplant Service Documentation Requirements	3/1/23	4/15/23	Approved	Transplant Service Documentation Requirements
2023-UHC-312	Intensity Modulated Radiation Therapy	2/23/23	4/9/23	Approved	Intensity Modulated Radiation Therapy
2023-UHC-377	Implanted Electrical Stimulator for Spinal Cord	2/23/23	4/9/23	Approved	Implanted Electrical Stimulator for Spinal Cord
2023-LHCC-426	Adverse Incidents	2/23/23	4/9/23	Approved	Adverse Incidents
2023-UHC-557	Transcranial Magnetic Stimulation	2/23/23	4/9/23	Approved	Transcranial Magnetic Stimulation
2023-UHC-782	Discogenic Pain Treatment	2/23/23	4/9/23	Approved	Discogenic Pain Treatment
2023-UHC-785	Hearing Aids and Devices including wearable, bone-anchored and semi-implantable	2/23/23	4/9/23	Approved	Hearing Aids and Devices including wearable, bone-anchored and semi-implantable
2023-UHC-828	Minimally Invasive Spine Surgery Procedures	2/23/23	4/9/23	Approved	Minimally Invasive Spine Surgery Procedures
2023-LHCC-1109	Diaphragmatic/Phrenic Nerve Stimulation	2/23/23	4/9/23	Approved	Diaphragmatic/Phrenic Nerve Stimulation
2023-LHCC-1211	Reduction Mammoplasty and Gynecomastia Surgery	2/23/23	4/9/23	Approved	Reduction Mammoplasty and Gynecomastia Surgery
2023-LHCC-1361	Pediatric Heart Transplant	2/23/23	4/9/23	Approved	Pediatric Heart Transplant
2023-Humana-1540	Crisis Stabilization Services for Adults	2/23/23	4/9/23	Approved	Crisis Stabilization Services for Adults
2023-UHC-1830	Hysterectomy	2/23/23	4/9/23	Approved	Hysterectomy
2023-LHCC-1831	Bilateral Procedures	2/23/23	4/9/23	Completed	Bilateral Procedures
2023-LHCC-1832	Vitmin D Testing Policy	2/23/23	4/9/23	Approved	Vitmin D Testing Policy
2023-LHCC-1834	Enteral Nutrition	2/23/23	4/9/23	Approved	Enteral Nutrition
2023-LHCC-1836	CLIA Editing	2/23/23	4/9/23	Completed	CLIA Editing
2023-LHCC-1837	Obstetrical Home Care Programs	2/23/23	4/9/23	Approved	Obstetrical Home Care Programs
2023-LHCC-1838	Intensity-Modulated Radiotherapy	2/23/23	4/9/23	Approved	Intensity-Modulated Radiotherapy
2023-LHCC-1839	Genetic Testing Hereditary Cancer Susceptibility	2/23/23	4/9/23	Approved	Genetic Testing Hereditary Cancer Susceptibility
2023-LHCC-920	Member ID Cards	2/20/23	4/6/23	Approved	Member ID Cards
2023-LHCC-1449	Practitioner Credentialing and Recredentialing	2/20/23	4/6/23	Approved	Practitioner Credentialing and Recredentialing
2023-LHCC-1516	Oversight of Delegated Credentialing	2/20/23	4/6/23	Approved	Oversight of Delegated Credentialing
2023-LHCC-1588	Member Advisory of Provider Contract Termination or Limitation Policy	2/20/23	4/6/23	Completed	Member Advisory of Provider Contract Termination or Limitation Policy
2023-LHCC-1770	Provider Marketing Guidelines	2/20/23	4/6/23	Approved	Provider Marketing Guidelines
2023-LHCC-1771	Allowable Marketing Activities	2/20/23	4/6/23	Approved	Allowable Marketing Activities
2023-LHCC-1772	Notice to Members of Provider Terminations	2/20/23	4/6/23	Approved	Notice to Members of Provider Terminations
2023-LHCC-1773	Written Material Guidelines	2/20/23	4/6/23	Approved	Written Material Guidelines
2023-LHCC-1774	Pharmacy-Related Marketing and Enrollee Education	2/20/23	4/6/23	Approved	Pharmacy-Related Marketing and Enrollee Education
2023-LHCC-1775	Interpretation and Written Translation Services	2/20/23	4/6/23	Approved	Interpretation and Written Translation Services
2023-LHCC-1776	Web and Mobile Based Enrollee Applications	2/20/23	4/6/23	Approved	Web and Mobile Based Enrollee Applications
2023-UHC-207	Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation	2/15/23	4/1/23	Approved	Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
2023-UHC-219	Articular Defect Repairs	2/15/23	4/1/23	Approved	Articular Defect Repairs
2023-UHC-510	Collagen Crosslinks and Biochemical Markers of Bone Turnover	2/15/23	4/1/23	Approved	Collagen Crosslinks and Biochemical Markers of Bone Turnover
2023-LHCC-814	Crisis Intervention Policy	2/15/23	4/1/23	Approved	Crisis Intervention Policy
2023-LHCC-1217	Ultrasound in Pregnancy	2/15/23	4/1/23	Approved	Ultrasound in Pregnancy
2023-LHCC-1227	Skin Substitutes for Chronic Wounds	2/15/23	4/1/23	Approved	Skin Substitutes for Chronic Wounds
2023-LHCC-1270	Urinary Incontinence Devices and Treatments	2/15/23	4/1/23	Approved	Urinary Incontinence Devices and Treatments
2023-LHCC-1271	Implantable Hypoglossal Nerve Stimulation for OSA	2/15/23	4/1/23	Approved	Implantable Hypoglossal Nerve Stimulation for OSA
2023-HBL-1338	Duplicate or Subsequent Services on the Same Day of Service RP	2/15/23	4/1/23	Approved	Duplicate or Subsequent Services on the Same Day of Service RP
2023-LHCC-1365	GI Pathogen Nucleic Acid and Detection Panel Testing	2/15/23	4/1/23	Approved	GI Pathogen Nucleic Acid and Detection Panel Testing
2023-Humana-1531	ABA Clinical Coverage	2/15/23	4/1/23	Approved	ABA Clinical Coverage
2023-Humana-1537	Mental Health Rehabilitation Services - Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR)	2/15/23	4/1/23	Approved	Mental Health Rehabilitation Services - Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR)
2023-Humana-1814	Code Edit – ASC	2/15/23	4/1/23	Approved	Code Edit – ASC
2023-LHCC-1819	Burn Surgery	2/15/23	4/1/23	Approved	Burn Surgery
2023-LHCC-1820	Transcatheter Closure of Patent Foramen Ovale	2/15/23	4/1/23	Approved	Transcatheter Closure of Patent Foramen Ovale
2023-LHCC-1821	Selective Dorsal Rhizotomy for Spasticity in CP	2/15/23	4/1/23	Approved	Selective Dorsal Rhizotomy for Spasticity in CP
2023-LHCC-1822	Opioid Use Disorder (OUD) treatment in Opioid Treatment Programs	2/15/23	4/1/23	Approved	Opioid Use Disorder (OUD) treatment in Opioid Treatment Programs
2023-LHCC-1823	Mechanical Stretch devices	2/15/23	4/1/23	Approved	Mechanical Stretch devices
2023-LHCC-1824	Electric Tumor Treatment Fields	2/15/23	4/1/23	Approved	Electric Tumor Treatment Fields
2023-LHCC-1825	Proton and Neutron Beam Therapies	2/15/23	4/1/23	Approved	Proton and Neutron Beam Therapies
2023-UHC-1829	Pharmacognetic Panel Testing	2/15/23	4/1/23	Approved	Pharmacognetic Panel Testing
2023-LHCC-776	Transesophageal (TEE) Echo	2/14/23	3/31/23	Approved	Transesophageal (TEE) Echo
2023-HBL-1435	Opthalmic use of Nd:YAG Laser for Posterior Capsulotomy	2/14/23	3/31/23	Approved	Opthalmic use of Nd:YAG Laser for Posterior Capsulotomy
2023-LHCC-1487	Sleep Studies Place of Service	2/14/23	3/31/23	Approved	Sleep Studies Place of Service
2023-HBL-1715	Permanent Support Housing	2/14/23	3/31/23	Approved	Permanent Support Housing
2023-LHCC-1741	AHCT for Sickle Cell Anemia and Thalassemia	2/14/23	3/31/23	Approved	AHCT for Sickle Cell Anemia and Thalassemia
2023-LHCC-1742	Ferriscan R2 MRI	2/14/23	3/31/23	Approved	Ferriscan R2 MRI
2023-LHCC-1743	Hospice Services	2/14/23	3/31/23	Approved	Hospice Services
2023-LHCC-1744	Phototherapy for Neonatal Hyperbilirubinemia	2/14/23	3/31/23	Approved	Phototherapy for Neonatal Hyperbilirubinemia
2023-LHCC-1745	Donor Lymphocyte Infusion	2/14/23	3/31/23	Approved	Donor Lymphocyte Infusion
2023-LHCC-1746	Total Artificial Heart	2/14/23	3/31/23	Approved	Total Artificial Heart
2023-LHCC-1747	PCS-EPSDT Policy	2/14/23	3/31/23	Approved	PCS-EPSDT Policy
2023-ABH-1748	Interdisciplinary Care Team	2/14/23	3/31/23	Complete	Interdisciplinary Care Team
2023-HBL-1749	Gene Therapy for Hemophilia	2/14/23	3/31/23	Approved	Gene Therapy for Hemophilia
2023-LHCC-1750	Sacroiliac Joint Injections – NIA	2/14/23	3/31/23	Approved	Sacroiliac Joint Injections – NIA
2023-LHCC-1751	Spinal Cord Stimulation – NIA	2/14/23	3/31/23	Approved	Spinal Cord Stimulation – NIA
2023-LHCC-1752	Epidural Spine Injections – NIA	2/14/23	3/31/23	Approved	Epidural Spine Injections – NIA
2023-LHCC-1753	Implantable Infusion Pump Insertion – NIA	2/14/23	3/31/23	Approved	Implantable Infusion Pump Insertion – NIA
2023-LHCC-1754	Epidural Spine Injection Trial Intrathecal Hybrid – NIA	2/14/23	3/31/23	Approved	Epidural Spine Injection Trial Intrathecal Hybrid – NIA
2023-LHCC-1755	Facet Injection or Blocks - NIA	2/14/23	3/31/23	Approved	Facet Injection or Blocks - NIA
2023-UHC-222	Skin and Soft Tissue Substitutes	2/7/23	3/24/23	Approved	Skin and Soft Tissue Substitutes
2023-UHC-223	Vagus and External Trigeminal Nerve Stimulation	2/7/23	3/24/23	Approved	Vagus and External Trigeminal Nerve Stimulation
2023-UHC-310	Total Artificial Disc Replacement Spine	2/7/23	3/24/23	Approved	Total Artificial Disc Replacement Spine
2023-UHC-781	Deep Brain Cortical Stimulation	2/7/23	3/24/23	Approved	Deep Brain Cortical Stimulation
2023-UHC-788	Mechanical Stretching Devices	2/7/23	3/24/23	Approved	Mechanical Stretching Devices
2023-UHC-791	Neurophysiologic Testing	2/7/23	3/24/23	Approved	Neurophysiologic Testing
2023-UHC-948	Catheter Ablation for Atrial Fibrillation	2/7/23	3/24/23	Approved	Catheter Ablation for Atrial Fibrillation
2023-UHC-1120	Percutaneous Patent Foramen Ovale (PFO) Closure	2/7/23	3/24/23	Approved	Percutaneous Patent Foramen Ovale (PFO) Closure
2023-UHC-1792	Public Communication and Marketing	2/7/23	3/24/23	Approved	Public Communication and Marketing
2023-UHC-1794	Document Oversight and Adherence	2/7/23	3/24/23	Approved	Document Oversight and Adherence
2023-UHC-1808	Peer Clinical Review	2/7/23	3/24/23	Denied	Peer Clinical Review
2023-UHC-1809	Performance Assessment and Incentives	2/7/23	3/24/23	Approved	Performance Assessment and Incentives
2023-UHC-1815	Sacral Nerve Stimulation for Urinary and Fecal Indications	2/7/23	3/24/23	Approved	Sacral Nerve Stimulation for Urinary and Fecal Indications
2023-UHC-1816	Oral and Enteral Nutrition	2/7/23	3/24/23	Approved	Oral and Enteral Nutrition
2023-UHC-1817	Proton Beam Radiation Therapy	2/7/23	3/24/23	Approved	Proton Beam Radiation Therapy
2023-LHCC-608	Appeal of UM Decision	1/27/23	3/13/23	Complete	Appeal of UM Decision
2023-LHCC-931	Appeals Process	1/27/23	3/13/23	Approved	Appeals Process
2023-UHC-1063	Temporomandibular Joint Disorder	1/27/23	3/13/23	Approved	Temporomandibular Joint Disorder
2022-LHCC-1710	Maternal Child Health Program Description	1/27/23	3/13/23	Approved	Maternal Child Health Program Description
2023-HBL-359	Justice Involved Case Management	1/25/23	3/11/23	Approved	Justice Involved Case Management
2023-HBL-1241	Advanced Imaging of the Head and Neck	1/25/23	3/11/23	Approved	Advanced Imaging of the Head and Neck
2023-HBL-1288	Advanced Imaging of the Abdomen and Pelvis	1/25/23	3/11/23	Approved	Advanced Imaging of the Abdomen and Pelvis
2023-HBL-1718	Coordinated Systems of Care (CSoC)	1/25/23	3/11/23	Approved	Coordinated Systems of Care (CSoC)
2022-ACLA-1734	PCP Auto Assignment	1/25/23	3/11/23	Approved	PCP Auto Assignment
2022-HBL-1738	LA UM Arow notification 20 visit	1/25/23	3/11/23	Approved	LA UM Arow notification 20 visit
2023-UHC-1799	Case Manager Orientation and Performance Management	1/25/23	3/11/23	Complete	Case Manager Orientation and Performance Management
2023-UHC-1802	Long Term Emergency Room Stay	1/25/23	3/11/23	Complete	Long Term Emergency Room Stay
2023-HBL-1812	Screening for Vitamin D Deficiency in Average Risk Individuals	1/25/23	3/11/23	Approved	Screening for Vitamin D Deficiency in Average Risk Individuals
2023-HBL-1813	Claim Processing Error Resolution	1/25/23	3/11/23	Complete	Claim Processing Error Resolution
2023-HBL-796	Surface Electromyography Devices for Seizure Monitoring	1/18/23	3/4/23	Approved	Surface Electromyography Devices for Seizure Monitoring
2023-HBL-1012	Oncologic Imaging AIM Guidelines	1/18/23	3/4/23	Approved	Oncologic Imaging AIM Guidelines
2023-HBL-1088	Scoliosis Surgery	1/18/23	3/4/23	Approved	Scoliosis Surgery
2023-HBL-1220	Gender Affirming Surgery	1/18/23	3/4/23	Approved	Gender Affirming Surgery
2023-HBL-1235	Treatments for Urinary Incontinence	1/18/23	3/4/23	Approved	Treatments for Urinary Incontinence
2023-HBL-1254	Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome	1/18/23	3/4/23	Approved	Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome
2023-HBL-1263	Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures	1/18/23	3/4/23	Approved	Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures
2023-LHCC-1410	Neurofeedback for Behavioral Health Disorders	1/18/23	3/4/23	Approved	Neurofeedback for Behavioral Health Disorders
2023-HBL-1444	Gene Therapy for Beta Thalassemia	1/18/23	3/4/23	Approved	Gene Therapy for Beta Thalassemia
2023-HBL-1465	Gene Therapy for Cerebral Adrenoleukodystrophy	1/18/23	3/4/23	Approved	Gene Therapy for Cerebral Adrenoleukodystrophy
2023-UHC-1466	Provider Administered Drugs Site of Care	1/18/23	3/4/23	Approved	Provider Administered Drugs Site of Care
2023-LHCC-1521	Permanent Supportive Housing	1/18/23	3/4/23	Approved	Permanent Supportive Housing
2023-UHC-1759	Permanent Support Housing	1/18/23	3/4/23	Approved	Permanent Support Housing
2023-HBL-1781	MRI of the Breast	1/18/23	3/4/23	Approved	MRI of the Breast
2023-HBL-1782	Small Bowel, Small Bowel/Liver and Multivisceral Transplantation	1/18/23	3/4/23	Approved	Small Bowel, Small Bowel/Liver and Multivisceral Transplantation
2023-HBL-1783	Mechanical Embolectomy for Treatment of Stroke	1/18/23	3/4/23	Approved	Mechanical Embolectomy for Treatment of Stroke
2023-HBL-1784	Navigational Bronchoscopy	1/18/23	3/4/23	Approved	Navigational Bronchoscopy
2023-UHC-1785	Plagiocephaly and Craniosynostosis Treatment	1/18/23	3/4/23	Approved	Plagiocephaly and Craniosynostosis Treatment
2023-HBL-1786	Ingestible Devices for the Treatment of Constipation	1/18/23	3/4/23	Approved	Ingestible Devices for the Treatment of Constipation
2023-HBL-1787	Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias	1/18/23	3/4/23	Approved	Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias
2023-HBL-1788	Power Wheeled Mobility Devices	1/18/23	3/4/23	Approved	Power Wheeled Mobility Devices
2023-UHC-205	Computed Tomographic Colonography	1/18/23	3/4/23	Approved	Computed Tomographic Colonography
2023-UHC-248	Vertebral Tethering for Scoliosis	1/18/23	3/4/23	Approved	Vertebral Tethering for Scoliosis
2023-LHCC-730	Heart MRI	1/18/23	3/4/23	Approved	Heart MRI
2023-LHCC-735	Low Dose CT for Lung Cancer Screening	1/18/23	3/4/23	Approved	Low Dose CT for Lung Cancer Screening
2023-LHCC-739	Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI)	1/18/23	3/4/23	Approved	Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI)
2023-LHCC-1429	Heart PET with CT Attenuation	1/13/23	2/27/23	Approved	Heart PET with CT Attenuation
2023-LHCC-1756	Facet Joint Denervation	1/13/23	2/27/23	Approved	Facet Joint Denervation
2023-HBL-1758	Surgical Treatment of Hyperhidrosis	1/13/23	2/27/23	Approved	Surgical Treatment of Hyperhidrosis
2023-UHC-1760	Radiation Therapy	1/13/23	2/27/23	Approved	Radiation Therapy
2023-UHC-1762	Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery	1/13/23	2/27/23	Approved	Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery
2023-HBL-1763	Medical Policy Formation	1/13/23	2/27/23	Approved	Medical Policy Formation
2023-LHCC-1764	Single Photon Emission Computed Tomography SPECT	1/13/23	2/27/23	Approved	Single Photon Emission Computed Tomography SPECT
2023-HBL-1766	Inpatient Interfaclity Transfers	1/13/23	2/27/23	Approved	Inpatient Interfaclity Transfers
2023-HBL-1767	Skin Nerve Fiber Density Testing	1/13/23	2/27/23	Approved	Skin Nerve Fiber Density Testing
2023-HBL-1768	Outpatient Urine Culture	1/13/23	2/27/23	Approved	Outpatient Urine Culture
2023-LHCC-1777	Disclosure of Medical Necessity Criteria	1/13/23	2/27/23	Approved	Disclosure of Medical Necessity Criteria
2023-HBL-1778	Outpatient Glycated Hemoglobin and Protein Testing	1/13/23	2/27/23	Approved	Outpatient Glycated Hemoglobin and Protein Testing
2023-HBL-1779	Blepharoplasty, Blepharoptosis Repair and Brow Lift	1/13/23	2/27/23	Approved	Blepharoplasty, Blepharoptosis Repair and Brow Lift
2023-HBL-1780	Foot Care Services	1/13/23	2/27/23	Approved	Foot Care Services
2022-LDH-17	MCO Manual > Part 4: Services > In Lieu of Services > Behavioral Health Services (Proposed effective date = 1/1/2023)	1/13/23	2/27/23	Completed	Integrated Behavioral Health Homes
2023-LHCC-766	Upper Extremity MRA/MRV	1/13/23	2/27/23	Approved	Upper Extremity MRA/MRV
2023-LHCC-767	Upper Extremity MRI (Hand, Wrist, Elbow, Long bone, or Shoulder MRI)	1/13/23	2/27/23	Approved	Upper Extremity MRI (Hand, Wrist, Elbow, Long bone, or Shoulder MRI)
2023-LHCC-769	Cardiac Resynchronization Therapy (CRT)	1/13/23	2/27/23	Approved	Cardiac Resynchronization Therapy (CRT)
2023-LHCC-770	Fractional Flow Reserve CT	1/13/23	2/27/23	Approved	Fractional Flow Reserve CT
2023-LHCC-771	Heart Catheterization	1/13/23	2/27/23	Approved	Heart Catheterization
2023-LHCC-775	Stress Echocardiography	1/13/23	2/27/23	Approved	Stress Echocardiography
2023-LHCC-778	Transthoracic (TTE) Echo	1/13/23	2/27/23	Approved	Transthoracic (TTE) Echo
2023-HBL-819	HBL Provider Manual	1/13/23	2/27/23	Complete	HBL Provider Manual
2023-LHCC-994	Ambulatory Insulin Pump	1/13/23	2/27/23	Approved	Ambulatory Insulin Pump
2023-HBL-1010	Imaging of the Brain AIM Guidelines	1/13/23	2/27/23	Approved	Imaging of the Brain AIM Guidelines
2023-HBL-1014	Imaging of the Chest AIM Guidelines	1/13/23	2/27/23	Approved	Imaging of the Chest AIM Guidelines
2023-HBL-1023	Genetic Testing for Inherited Diseases	1/13/23	2/27/23	Approved	Genetic Testing for Inherited Diseases
2023-HBL-1038	Enhanced External Counter pulsation in the Outpatient Setting	1/13/23	2/27/23	Approved	Enhanced External Counter pulsation in the Outpatient Setting
2023-LHCC-1168	Allergy Testing & Therapy	1/13/23	2/27/23	Approved	Allergy Testing & Therapy
2023-HBL-1243	Musculoskeletal Program- Interventional Pain Management	1/13/23	2/27/23	Approved	Musculoskeletal Program- Interventional Pain Management
2023-HBL-1258	Iontophoresis	1/13/23	2/27/23	Approved	Iontophoresis
2023-LHCC-1267	Cosmetic and Reconstructive Procedures	1/13/23	2/27/23	Approved	Cosmetic and Reconstructive Procedures
2023-LHCC-1273	Orthognathic Surgery	1/13/23	2/27/23	Approved	Orthognathic Surgery
2023-LHCC-1277	Panniculectomy	1/13/23	2/27/23	Approved	Panniculectomy

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