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Clinical Policies
- CP.MP.92 Acupuncture (PDF)
- CP.MP.124 ADHD Assessment and Treatment (PDF)
- CP.MP.175 Air Ambulance (PDF)
- CP.MP.100 Allergy Testing and Therapy (PDF)
- CP.MP.108 Allogeneic hematopoietic cell transplants for sickle cell anemia and beta-thalassemia (PDF)
- CP.MP.96 Ambulatory EEG (PDF)
- CP.MP.158 Ambulatory Surgery Center Optimization (PDF)
- CP.MP.26 Articular Cartilage Defect Repairs
- CP.MP.37 Bariatric Surgery (PDF)
- CP.MP.168 Biofeedback (PDF)
- CP.MP.93 Bone-anchored hearing aid (PDF)
- CP.MP.110 Bronchial Thermoplasty (PDF)
- CP.MP.186 Burn Surgery (PDF)
- CP.MP.156 Cardiac Biomarker Testing (PDF)
- CP.MP.164 Caudal or Interlaminar Epidural Steroid Injections (PDF)
- CP.MP.84 Cell-free Fetal DNA Testing (PDF)
- CP.MP.94 Clinical Trials (PDF)
- CP.MP.14 Cochlear Implant Replacements (PDF)
- CP.MP.31 Cosmetic and Reconstructive Surgery (PDF)
- CP.MP.61 Dental Anesthesia (PDF)
- CP.MP.203 Diaphragmatic/Phrenic Nerve Stimulation (PDF)
- CP.MP.105 Digital electroencephalography spike analysis (PDF)
- CP.MP.114 Disc Decompression Procedures (PDF)
- CP.MP.115 Discography (PDF)
- CP.MP.101 Donor Lymphocyte Infusion (PDF)
- CP.MP.50 Drugs of Abuse, Definitive Testing (PDF)
- CP.MP. 107 Durable Medical Equipment (DME) (PDF)
- CP.MP.145 Electric Tumor Treating Fields (PDF)
- CP.MP.155 Electroencephalography in the evaluation of headache (PDF)
- CP.MP.211 Electromyography and Nerve Conduction Studies (PDF)
- CP.MP.106 Endometrial ablation (PDF)
- CP.MP.131 Essure Removal (PDF)
- CP.MP.134 Evoked Potential Testing (PDF)
- CP.MP.36 Experimental Technologies (PDF)
- CP.MP.171 Facet Joint Interventions (PDF)
- CP.MP.137 Fecal incontinence treatments (PDF)
- CP.MP.53 Ferriscan R2-MRI
- CP.MP.130 Fertility preservation (PDF)
- CP.MP.129 Fetal surgery in utero for prenatally diagnosed malformations (PDF)
- CP.MP.43 Functional MRI (PDF)
- CP.MP.40 Gastric Electrical Stimulation (PDF)
- CP.MP.89 Genetic and Pharmacogenetic Testing (PDF)
- CP.MP.215 Genetic Testing Aortopathies and Connective Tissue Disorders (PDF)
- CP.MP.216 Genetic Testing Cardiac Disorders (PDF)
- CP.MP.217 Genetic Testing Dermatologic Conditions (PDF)
- CP.MP.218 Genetic Testing Epilepsy Neurodegenerative and Neuromuscular Disorders (PDF)
- CP.MP.219 Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF)
- CP.MP.220 Genetic Testing Eye Disorders (PDF)
- CP.MP.231 Genetic Testing for Non-Invasive Prenatal Screening (NIPS) (PDF)
- CP.MP.221 Genetic Testing Gastroenterologic Disorders (non-cancerous) (PDF)
- CP.MP.222 Genetic Testing General Approach to Genetic Testing (PDF)
- CP.MP.223 Genetic Testing Hearing Loss (PDF)
- CP.MP.224 Genetic Testing Hematologic Condition (non-cancerous) (PDF)
- CP.MP.225 Genetic Testing Hereditary Cancer Susceptibility (PDF)
- CP.MP.226 Genetic Testing Immune, Autoimmune, and Rheumatoid Disorders (PDF)
- CP.MP.227 Genetic Testing Kidney Disorders (PDF)
- CP.MP.228 Genetic Testing Lung Disorders (PDF)
- CP.MP.229 Genetic Testing Metabolic Endocrine and Mitochondrial Disorders (PDF)
- CP.MP.230 Genetic Testing Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (PDF)
- CP.MP.237 Genetic Testing Oncology Algorithmic Testing (PDF)
- CP.MP.238 Genetic Testing Oncology Cancer Screening (PDF)
- CP.MP.240 Genetic Testing Oncology Cytogenetic Testing (PDF)
- CP.MP.241 Genetic Testing Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF)
- CP.MP.232 Genetic Testing Pharmacogenetics (PDF)
- CP.MP.233 Genetic Testing Preimplantation Genetic Testing (PDF)
- CP.MP.234 Genetic Testing Prenatal and Preconception Carrier Screening (PDF)
- CP.MP.235 Genetic Testing Prenatal Diagnosis (PDF)
- CP.MP.236 Genetic Testing Skeletal Dysplasia and Rare Bone Disorders (PDF)
- CP.MP.209 GI Pathogen Nucleic Acid Detection Panel Testing (PDF)
- CP.MP.132 Heart-Lung Transplant (PDF)
- CP.MP.113 Holter Monitors (PDF)
- CP.MP.136 Home Birth (PDF)
- CP.MP.121 Homocysteine testing (PDF)
- CP.MP.54 Hospice Services (PDF)
- CP.MP.34 Hyperemesis gravidarum treatment (PDF)
- CP.MP.62 Hyperhidrosis treatments (PDF)
- CP.MP.180 Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (PDF)
- CP.MP.173 Implantable Intrathecal Pain Pump (PDF)
- CP.MP.160 Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF)
- CP.MP.87 Inhaled nitric oxide (PDF)
- CP.MP.69 Intensity-Modulated Radiotherapy (PDF)
- CP.MP.58 Intestinal and multivisceral transplant (PDF)
- CP.MP.167 Intradiscal Steroid Injections for Pain Management (PDF)
- CP.MP.123 Laser therapy for skin conditions (PDF)
- CP.MP.71 Long Term Care Placement Criteria (PDF)
- CP.MP.139 Low-frequency ultrasound and noncontact normothermic wound therapy (PDF)
- CP.MP.57 Lung Transplantation (PDF)
- CP.MP.116 Lysis of Epidural Lesions (PDF)
- CP.MP.152 Measurement of serum 1,25-dihydroxyvitamin D (PDF)
- CP.MP.144 Mechanical Stretching Devices for Joint Stiffness and Contracture (PDF)
- CP.MP.24 Multiple Sleep Latency Testing (PDF)
- CP.MP.170 Nerve Blocks for Pain Management (PDF)
- CP.MP.48 Neuromuscular Electrical Stimulation (NMES) (PDF)
- CP.MP.184 Non-Invasive Home Ventilators (PDF)
- CP.MP.141 Non-myeloablative allogeneic stem cell transplants (PDF)
- CP.MP.91 Obstetrical Home Health Care Programs (PDF)
- CP.MP.239 Oncology Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) (PDF)
- CP.MP.128 Optic nerve decompression surgery (PDF)
- CP.MP.202 Orthognathic Surgery (PDF)
- CP.MP.194 Osteogenic Stimulation (PDF)
- CP.MP.176 Outpatient Cardiac Rehabilitation (PDF)
- CP.MP.190 Oxygen Use and Concentrators (PDF)
- CP.MP.102 Pancreas transplant (PDF)
- CP.MP.109 Panniculectomy (PDF)
- CP.MP.147 Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF)
- CP.MP.49 Physical, Occupational, and Speech Therapy Services (PDF)
- CP.MP.181 Polymerase Chain Reaction Respiratory Viral Panel Testing (PDF)
- CP.MP.213 Post-Acute Care (PDF)
- CP.MP.133 Posterior tibial nerve stimulation for voiding dysfunction (PDF)
- CP.MP.70 Proton and neutron beam therapies (PDF)
- CP.MP.148 Radial Head Implant (PDF)
- CP.MP.187 Radiofrequency Ablation of Uterine Fibroids (PDF)
- CP.MP.51 Reduction mammoplasty and gynecomastia surgery (PDF)
- CP.MP.210 Repair of Nasal Valve Compromise (PDF)
- CP.MP.126 Sacroiliac joint fusion (PDF)
- CP.MP.166 Sacroiliac Joint Interventions for Pain Management (PDF)
- CP.MP.146 Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins (PDF)
- CP.MP.174 Selective Dorsal Rhizotomy (PDF)
- CP.MP.165 Selective Nerve Root Blocks and Transforaminal Epidural Injections (PDF)
- CP.MP.182 Short Inpatient Hospital Stay (PDF)
- CP.MP.206 Skilled Nursing Facility Leveling (PDF)
- CP.MP.185 Skin Substitutes for Chronic Wounds (PDF)
- CP.MP.117 Spinal Cord Stimulation (PDF)
- CP.MP.22 Stereotactic Body Radiation Therapy (PDF)
- CP.MP.162 Tandem Transplant (PDF)
- CP.MP.97 Testing for select genitourinary conditions (PDF)
- CP.MP.189 Thymus Transplantation (PDF)
- CP.MP.154 Thyroid hormones and insulin testing in pediatrics (PDF)
- CP.MP.127 Total artificial heart (PDF)
- CP.MP.163 Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (PDF)
- CP.MP.151 Transcatheter closure of patent foramen ovale (PDF)
- CP.MP.169 Trigger Point Injections for Pain Management (PDF)
- CP.MP.38 Ultrasound in Pregnancy (PDF)
- CP.MP.142 Urinary Incontinence Devices and Treatments (PDF)
- CP.MP.98 Urodynamic testing (PDF)
- CP.MP.12 Vagus Nerve Stimulation (PDF)
- CP.MP.46 Ventricular Assist Devices (PDF)
- CP.MP.177 Video Electroencephalographic Monitoring (PDF)
- CP.MP.99 Wheelchair seating (PDF)
- CP.MP.143 Wireless Motility Capsule (PDF)