Medicaid Managed Care Policies & Procedures

In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, 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.

The following table contains the LDH and managed care organization policies and procedures that are open for public comment.

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Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2026-LHCC-2854	Percutaneous Coronary Interventions	4/28/26	6/12/26	Pending	Percutaneous Coronary Interventions
2026-LHCC-2855	Interventions for Adults with Congenital Heart Defect	4/28/26	6/12/26	Pending	Interventions for Adults with Congenital Heart Defect
2026-LHCC-2856	Intra Cardiac Echocardiography (ICE)	4/28/26	6/12/26	Pending	Intra Cardiac Echocardiography (ICE)
2026-LHCC-2857	Introduction of Inferior Vena Cava Filter Device	4/28/26	6/12/26	Pending	Introduction of Inferior Vena Cava Filter Device
2026-LHCC-2858	Microvolt T-Wave Alternans	4/28/26	6/12/26	Pending	Microvolt T-Wave Alternans
2026-LHCC-2859	Mitral Valve Surgery	4/28/26	6/12/26	Pending	Mitral Valve Surgery
2026-LHCC-2860	Multiple Gated Acquisition Scan (MUGA)	4/28/26	6/12/26	Pending	Multiple Gated Acquisition Scan (MUGA)
2026-LHCC-2861	Percutaneous Closure of Patent Foramen Ovale (PFO)	4/28/26	6/12/26	Pending	Percutaneous Closure of Patent Foramen Ovale (PFO)
2026-LLHC-2862	Percutaneous Iliocaval Interventions	4/28/26	6/12/26	Pending	Percutaneous Iliocaval Interventions
2026-LHCC-2863	Percutaneous Left Atrial Appendage Closure	4/28/26	6/12/26	Pending	Percutaneous Left Atrial Appendage Closure
2026-LHCC-2864	Pericardial Disease Interventions	4/28/26	6/12/26	Pending	Pericardial Disease Interventions
2026-LHCC-2865	Peripheral Intravascular Arterial and Venous Ultrasound	4/28/26	6/12/26	Pending	Peripheral Intravascular Arterial and Venous Ultrasound
2026-LHCC-2866	Renal/Retroperitoneal Vascular Duplex Ultrasound	4/28/26	6/12/26	Pending	Renal/Retroperitoneal Vascular Duplex Ultrasound
2026-LHCC-2867	Standalone Right Heart Catheterization	4/28/26	6/12/26	Pending	Standalone Right Heart Catheterization
2026-LHCC-2868	Cardioversion of Atrial Fibrillation, Atrial Flutter and Atrial Tachycardia	4/28/26	6/12/26	Pending	Cardioversion of Atrial Fibrillation, Atrial Flutter and Atrial Tachycardia
2026-LHCC-2869	Temporal Artery Biopsy Evolent	4/28/26	6/12/26	Pending	Temporal Artery Biopsy Evolent
2026-LHCC-2870	Thoracentesis and Pleurodesis	4/28/26	6/12/26	Pending	Thoracentesis and Pleurodesis
2026-LHCC-2871	Tilt Table Testing	4/28/26	6/12/26	Pending	Tilt Table Testing
2026-LHCC-2872	Transcatheter Aortic Valve Replacement (TAVR)	4/28/26	6/12/26	Pending	Transcatheter Aortic Valve Replacement (TAVR)
2026-LHCC-2873	Transcatheter Edge to Edge Repair (TEER) of Mitral Valve	4/28/26	6/12/26	Pending	Transcatheter Edge to Edge Repair (TEER) of Mitral Valve
2026-LHCC-2874	Transthoracic Echocardiogram (TTE)	4/28/26	6/12/26	Pending	Transthoracic Echocardiogram (TTE)
2026-LHCC-2875	Tricuspid Valve Surgery	4/28/26	6/12/26	Pending	Tricuspid Valve Surgery
2026-LHCC-2831	Carotid Duplex	4/27/26	6/11/26	Pending	Carotid Duplex
2026-LHCC-2832	Carotid Endarterectomy	4/27/26	6/11/26	Pending	Carotid Endarterectomy
2026-LHCC-2833	Central  Venous Access Procedure	4/27/26	6/11/26	Pending	Central  Venous Access Procedure
2026-LHCC-2834	Coronary Fractional Flow Reserve	4/27/26	6/11/26	Pending	Coronary Fractional Flow Reserve
2026-LHCC-2835	Coronary Intra Vascular Arterial Ultrasound	4/27/26	6/11/26	Pending	Coronary Intra Vascular Arterial Ultrasound
2026-LHCC-2836	Descending Thoracic Aortic Open or Endovascular Surgery	4/27/26	6/11/26	Pending	Descending Thoracic Aortic Open or Endovascular Surgery
2026-LHCC-2837	Duplex Scan of Hemodialysis Access	4/27/26	6/11/26	Pending	Duplex Scan of Hemodialysis Access
2026-LHCC-2838	Guideline Directed Medical Therapy-Heart Failure and Coronary Artery Disease	4/27/26	6/11/26	Pending	Guideline Directed Medical Therapy-Heart Failure and Coronary Artery Disease
2026-LHCC-2839	Atrial Fibrillation Ablation Evolent	4/27/26	6/11/26	Pending	Atrial Fibrillation Ablation Evolent
2026-LHCC-2840	Abdominal Aortography with Bilateral iliofemoral Lower Extremity Runoff	4/27/26	6/11/26	Pending	Abdominal Aortography with Bilateral iliofemoral Lower Extremity Runoff
2026-LHCC-2841	Catheter Ablation of Reentrant or Focal Tachydysrhythmias	4/27/26	6/11/26	Pending	Catheter Ablation of Reentrant or Focal Tachydysrhythmias
2026-LHCC-2842	Abdominal Aortic Aneurysm Repair	4/27/26	6/11/26	Pending	Abdominal Aortic Aneurysm Repair
2026-LHCC-2843	Endomyocardial Biopsy Evolent	4/27/26	6/11/26	Pending	Endomyocardial Biopsy Evolent
2026-LHCC-2844	Endovascular Femoropopliteal Interventions	4/27/26	6/11/26	Pending	Endovascular Femoropopliteal Interventions
2026-LHCC-2845	Endovascular Aortoiliac Interventions	4/27/26	6/11/26	Pending	Endovascular Aortoiliac Interventions
2026-LHCC-2846	Endovascular Infrapopliteal (Tibioperoneal) Interventions	4/27/26	6/11/26	Pending	Endovascular Infrapopliteal (Tibioperoneal) Interventions
2026-LHCC-2847	Catheter Based Carotid and Brachiocephalic Arteriography, Venography, and Intervention	4/27/26	6/11/26	Pending	Catheter Based Carotid and Brachiocephalic Arteriography, Venography, and Intervention
2026-LHCC-2848	Treatment of Varicose Veins	4/27/26	6/11/26	Pending	Treatment of Varicose Veins
2026-LHCC-2849	Enhanced External Counter Pulsation	4/27/26	6/11/26	Pending	Enhanced External Counter Pulsation
2026-LHCC-2850	Infrainguinal Open Arterial Vascular Surgery	4/27/26	6/11/26	Pending	Infrainguinal Open Arterial Vascular Surgery
2026-LHCC-2851	Fractional Flow Reserve Computed Tomography (CT)	4/27/26	6/11/26	Pending	Fractional Flow Reserve Computed Tomography (CT)
2026-LHCC-2852	Hemodialysis Access Creation	4/27/26	6/11/26	Pending	Hemodialysis Access Creation
2026-LHCC-2853	Hemodialysis Access Maintenance	4/27/26	6/11/26	Pending	Hemodialysis Access Maintenance
2026-HUM-1661	Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy	4/24/26	6/8/26	Pending	Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy
2026-HUM-1668	Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy	4/24/26	6/8/26	Pending	Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy
2026-HUM-2300	Rapid Whole Genome Sequencing	4/24/26	6/8/26	Pending	Rapid Whole Genome Sequencing
2026-LHCC-2646	Concert Laboratory Payment Policy	4/24/26	6/8/26	Pending	Concert Laboratory Payment Policy
2026-HUM-2722	Skin and Tissue Substitutes	4/24/26	6/8/26	Pending	Skin and Tissue Substitutes
2026-HUM-2723	23 Hour BH Observation	4/24/26	6/8/26	Pending	23 Hour BH Observation
2026-HUM-2803	Visions of Hope Community	4/24/26	6/8/26	Pending	Visions of Hope Community
2026-HBL-2804	Policy and Procedure Visions of Hope Community Services	4/24/26	6/8/26	Pending	Policy and Procedure Visions of Hope Community Services
2026-LHCC-2814	Abdominal Aortic Ultrasound	4/24/26	6/8/26	Pending	Abdominal Aortic Ultrasound
2026-HBL-2816	UM AROW CMBM A2026M5406	4/24/26	6/8/26	Pending	UM AROW CMBM A2026M5406
2026-LHCC-2817	Ambulatory Rhythm Monitoring	4/24/26	6/8/26	Pending	Ambulatory Rhythm Monitoring
2026-LHCC-2818	Brachial Index in Peripheral Artery Disease	4/24/26	6/8/26	Pending	Brachial Index in Peripheral Artery Disease
2026-LHCC-2819	Coronary Artery Bypass Graft	4/24/26	6/8/26	Pending	Coronary Artery Bypass Graft
2026-LHCC-2820	Renal Endarterectomy or Bypass Surgery	4/24/26	6/8/26	Pending	Renal Endarterectomy or Bypass Surgery
2026-LHCC-2821	Arterial Duplex in Peripheral Artery Disease	4/24/26	6/8/26	Pending	Arterial Duplex in Peripheral Artery Disease
2026-LHCC-2822	Device Interrogation and Programming	4/24/26	6/8/26	Pending	Device Interrogation and Programming
2026-LHCC-2823	Aortic Root, Ascending Aorta and Aortic Arch Surgery	4/24/26	6/8/26	Pending	Aortic Root, Ascending Aorta and Aortic Arch Surgery
2026-LHCC-2824	Automated Ambulatory Blood Pressure Monitoring	4/24/26	6/8/26	Pending	Automated Ambulatory Blood Pressure Monitoring
2026-LHCC-2825	Device (AICD, CRT and/or Pacemaker) Battery Replacement	4/24/26	6/8/26	Pending	Device (AICD, CRT and/or Pacemaker) Battery Replacement
2026-LHCC-2826	Diagnostic Electrophysiologic Testing	4/24/26	6/8/26	Pending	Diagnostic Electrophysiologic Testing
2026-LHCC-2827	Renal and Mesenteric Angiography and Intervention	4/24/26	6/8/26	Pending	Renal and Mesenteric Angiography and Intervention
2026-LHCC-2828	Carotid Artery Stenting	4/24/26	6/8/26	Pending	Carotid Artery Stenting
2026-LHCC-532	Appropriate UM Professionals	4/20/26	6/4/26	Pending	Appropriate UM Professionals
2026-LHCC-1224	Fetal Surgery in Utero	4/20/26	6/4/26	Pending	Fetal Surgery in Utero
2026-LHCC-1483	Inpatient Consultation	4/20/26	6/4/26	Pending	Inpatient Consultation
2026-LHCC-1515	Temporary Limited Authorization Reviews	4/20/26	6/4/26	Pending	Temporary Limited Authorization Reviews
2026-HUM-1646	Cochlear Implant Clinical Coverage Policy	4/20/26	6/4/26	Pending	Cochlear Implant Clinical Coverage Policy
2026-HBL-2805	Care at Home, Clinic at Home	4/20/26	6/4/26	Pending	Care at Home, Clinic at Home
2026-LHCC-2808	Brain and Neck Computed Tomography Angiography (CTA)	4/20/26	6/4/26	Pending	Brain and Neck Computed Tomography Angiography (CTA)
2026-HBL-2809	Additional State Specific Regulatory or Contractual Requirements	4/20/26	6/4/26	Pending	Additional State Specific Regulatory or Contractual Requirements
2026-LHCC-2241	Concert Genetics Oncology Cancer Screening	4/9/26	5/24/26	Pending	Concert Genetics Oncology Cancer Screening
2026-LHCC-2242	Concert Genetics Prenatal and Preconception Carrier Screening	4/9/26	5/24/26	Pending	Concert Genetics Prenatal and Preconception Carrier Screening
2026-LHCC-2243	Concert Genetics Non-invasive Prenatal Screening	4/9/26	5/24/26	Pending	Concert Genetics Non-invasive Prenatal Screening
2026-LHCC-2244	Concert Genetics Prenatal Diagnosis Pregnancy Loss	4/9/26	5/24/26	Pending	Concert Genetics Prenatal Diagnosis Pregnancy Loss
2026-LHCC-2245	Concert Genetics Multi-system Inherited Disorders	4/9/26	5/24/26	Pending	Concert Genetics Multi-system Inherited Disorders
2026-LHCC-2268	Genetic and Molecular Testing	4/9/26	5/24/26	Pending	Genetic and Molecular Testing
2026-LHCC-2269	Concert Genetics Hereditary Cancer Susceptibility	4/9/26	5/24/26	Pending	Concert Genetics Hereditary Cancer Susceptibility
2026-LHCC-2302	Concert Genetics Oncology Algorithmic Testing	4/9/26	5/24/26	Pending	Concert Genetics Oncology Algorithmic Testing
2026-LHCC-2303	Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies	4/9/26	5/24/26	Pending	Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies
2026-LHCC-2304	Concert Genetic Pharmacogenetics	4/9/26	5/24/26	Pending	Concert Genetic Pharmacogenetics
2026-ABH-2800	Therapy Authorization Guidelines	4/9/26	5/24/26	Pending	Therapy Authorization Guidelines
2026-LHCC-2801	Follow-Up, Limited or Localized Computed Tomography (CT)	4/9/26	5/24/26	Pending	Follow-Up, Limited or Localized Computed Tomography (CT)
2026-ACLA-874	CT (Virtual) Colonoscopy	4/9/26	5/24/26	Pending	CT (Virtual) Colonoscopy
2026-ACLA-879	Brain (Head) MRS	4/9/26	5/24/26	Pending	Brain (Head) MRS
2026-LHCC-1214	Total Parenteral Nutrition and Intradialytic Parental Nutrition	4/9/26	5/24/26	Pending	Total Parenteral Nutrition and Intradialytic Parental Nutrition
2026-LHCC-1358	Pancreas Transplantation	4/9/26	5/24/26	Pending	Pancreas Transplantation
2026-LHCC-1362	Nonmyeloablative allogeneric SCT	4/9/26	5/24/26	Pending	Nonmyeloablative allogeneric SCT
2026-LHCC-1363	Tandem Transplant	4/9/26	5/24/26	Pending	Tandem Transplant
2026-LHCC-1934	Experimental Technologies	4/9/26	5/24/26	Pending	Experimental Technologies
2026-LHCC-1935	Gastric Electrical Stimulation	4/9/26	5/24/26	Pending	Gastric Electrical Stimulation
2026-LHCC-2178	Allogeneic Hematopoietic Progenitor Cell Therapy	4/9/26	5/24/26	Pending	Allogeneic Hematopoietic Progenitor Cell Therapy
2026-LHCC-2227	Concert Genetics Cardiac Disorders	4/9/26	5/24/26	Pending	Concert Genetics Cardiac Disorders
2026-LHCC-2228	Concert Genetics Eye Disorders	4/9/26	5/24/26	Pending	Concert Genetics Eye Disorders
2026-LHCC-2229	Concert Genetics Dermatologic Conditions	4/9/26	5/24/26	Pending	Concert Genetics Dermatologic Conditions
2026-LHCC-2230	Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions	4/9/26	5/24/26	Pending	Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions
2026-LHCC-2231	Concert Genetics Gastroenterologic Disorders non-cancerous	4/9/26	5/24/26	Pending	Concert Genetics Gastroenterologic Disorders non-cancerous
2026-LHCC-2233	Concert Genetics Hearing Loss	4/9/26	5/24/26	Pending	Concert Genetics Hearing Loss
2026-LHCC-2234	Concert Genetics Lung Disorders	4/9/26	5/24/26	Pending	Concert Genetics Lung Disorders
2026-LHCC-2235	Concert Genetics Kidney Disorders	4/9/26	5/24/26	Pending	Concert Genetics Kidney Disorders
2026-LHCC-2236	Concert Genetics Immune Autoimmune and Rheumatoid Disorders	4/9/26	5/24/26	Pending	Concert Genetics Immune Autoimmune and Rheumatoid Disorders
2026-LHCC-2237	Concert Genetics Hematologic Conditions non-cancerous	4/9/26	5/24/26	Pending	Concert Genetics Hematologic Conditions non-cancerous
2026-LHCC-2238	Concert Genetics Skeletal Dysplasia Rare Bone Disorders	4/9/26	5/24/26	Pending	Concert Genetics Skeletal Dysplasia Rare Bone Disorders
2026-LHCC-2240	Concert Genetics Preimplantation Genetic Testing	4/9/26	5/24/26	Pending	Concert Genetics Preimplantation Genetic Testing
2026-ACLA-836	Pelvis MRI	4/1/26	5/16/26	Pending	Pelvis MRI
2026-ACLA-837	Pelvis MRA	4/1/26	5/16/26	Pending	Pelvis MRA
2026-ACLA-838	Pelvis CTAngiography	4/1/26	5/16/26	Pending	Pelvis CTAngiography
2026-ACLA-839	Pelvis CT	4/1/26	5/16/26	Pending	Pelvis CT
2026-ACLA-840	Neck MRA/MRV	4/1/26	5/16/26	Pending	Neck MRA/MRV
2026-ACLA-841	Neck CTA	4/1/26	5/16/26	Pending	Neck CTA
2026-ACLA-842	MUGA (Multiple Gated Acquisition) Scan	4/1/26	5/16/26	Pending	MUGA (Multiple Gated Acquisition) Scan
2026-ACLA-843	Neck CT	4/1/26	5/16/26	Pending	Neck CT
2026-ACLA-846	Lumbar Spine CT	4/1/26	5/16/26	Pending	Lumbar Spine CT
2026-ACLA-847	Lumbar Spine MRI	4/1/26	5/16/26	Pending	Lumbar Spine MRI
2026-ACLA-848	Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI)	4/1/26	5/16/26	Pending	Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI)
2026-ACLA-849	Lower Extremity MRA/MRV	4/1/26	5/16/26	Pending	Lower Extremity MRA/MRV
2026-ACLA-853	Heart MRI	4/1/26	5/16/26	Pending	Heart MRI
2026-ACLA-857	CT Heart, CT Heart Congenital (Not including coronary arteries)	4/1/26	5/16/26	Pending	CT Heart, CT Heart Congenital (Not including coronary arteries)
2026-ACLA-858	Upper Extremity MRA/MRV	4/1/26	5/16/26	Pending	Upper Extremity MRA/MRV
2026-ACLA-859	Upper Extremity MRI	4/1/26	5/16/26	Pending	Upper Extremity MRI
2026-ACLA-862	Upper Extremity CT	4/1/26	5/16/26	Pending	Upper Extremity CT
2026-ACLA-863	Thoracic Spine MRI	4/1/26	5/16/26	Pending	Thoracic Spine MRI
2026-ACLA-864	Lower Extremity CTA/CTV	4/1/26	5/16/26	Pending	Lower Extremity CTA/CTV
2026-ACLA-865	Upper Extremity CTA/CTV	4/1/26	5/16/26	Pending	Upper Extremity CTA/CTV
2026-ACLA-866	Thoracic Spine CT	4/1/26	5/16/26	Pending	Thoracic Spine CT
2026-ACLA-867	Temporomandibular Joint (TMJ) MRI	4/1/26	5/16/26	Pending	Temporomandibular Joint (TMJ) MRI
2026-ACLA-868	Spinal Canal MRA	4/1/26	5/16/26	Pending	Spinal Canal MRA
2026-ACLA-869	Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT	4/1/26	5/16/26	Pending	Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT
2026-ACLA-870	Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT	4/1/26	5/16/26	Pending	Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT
2026-ACLA-871	Sinus Face Orbit MRI	4/1/26	5/16/26	Pending	Sinus Face Orbit MRI
2026-ACLA-1448	PET Scans	4/1/26	5/16/26	Pending	PET Scans
2026-ACLA-2249	Tumor Imaging PET-Any Site (Unlisted PET)	4/1/26	5/16/26	Pending	Tumor Imaging PET-Any Site (Unlisted PET)
2026-LDH-9	MCO Manual > Louisiana Department of Children and Family Services (DCFS)	3/25/26	5/9/26	Pending	MCO Manual – DCFS
2026-LHCC-1213	Sacroiliac Joint Fusion Evolent	3/20/26	5/4/26	Pending	Sacroiliac Joint Fusion Evolent
2026-HUM-1584	Therapeutic Group Home	3/20/26	5/4/26	Pending	Therapeutic Group Home
2026-LHCC-423	EPSDT	3/20/26	5/4/26	Pending	EPSDT
2026-ABH-1331	Supporting Members in Crisis	3/20/26	5/4/26	Pending	Supporting Members in Crisis
2026-HUM-1540	Crisis Stabilization for Adults	3/20/26	5/4/26	Pending	Crisis Stabilization for Adults
2026-ACLA-2769	Call Center Manual	3/20/26	5/4/26	Pending	Call Center Manual
2026-HBL-2799	LA Provider Training	3/20/26	5/4/26	Pending	LA Provider Training