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Medicaid Managed Care Policies & Procedures Archive (2024)
"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 |
|---|---|---|---|---|---|
| 2024-LHCC-1906 | Facility-Based Sleep Studies for OSA | 12/10/24 | 1/24/25 | Approved | Facility-Based Sleep Studies for OSA |
| 2024-LHCC-1912 | Multi-Systemic Therapy (MST) | 12/10/24 | 1/24/25 | Approved | Multi-Systemic Therapy (MST) |
| 2024-HBL-2463 | PM COVER TO COVER 2024 | 12/10/24 | 1/24/25 | Approved | PM COVER TO COVER 2024 |
| 2024-HUM-2575 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2576 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2578 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2579 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2580 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2582 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2583 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2584 | Drugs & Biologicals HCPCS | 12/10/24 | 1/24/25 | Approved | Drugs & Biologicals HCPCS |
| 2024-HUM-2608 | Outpatient Lactation Support ILOS | 12/10/24 | 1/24/25 | Approved | Outpatient Lactation Support ILOS |
| 2024-LHCC-2611 | Respiratory Viral Panels | 12/10/24 | 1/24/25 | Approved | Respiratory Viral Panels |
| 2024-UHC-787 | Lithotripsy Salivary Stones | 12/10/24 | 1/24/25 | Approved | Lithotripsy Salivary Stones |
| 2024-UHC-789 | Minimally Invasive Procedures GERD | 12/10/24 | 1/24/25 | Approved | Minimally Invasive Procedures GERD |
| 2024-UHC-823 | UHC Provider Manual | 12/10/24 | 1/24/25 | Approved | UHC Provider Manual |
| 2024-UHC-827 | Prolotherapy and Platelet Rich Plasma Therapies | 12/10/24 | 1/24/25 | Approved | Prolotherapy and Platelet Rich Plasma Therapies |
| 2024-LHCC-1111 | Thyroid Insulin Test in Ped | 12/10/24 | 1/24/25 | Approved | Thyroid Insulin Test in Ped |
| 2024-LHCC-1113 | Cardiac Biomarker Testing | 12/10/24 | 1/24/25 | Approved | Cardiac Biomarker Testing |
| 2024-LHCC-1115 | Vitamin D Testing in Peds | 12/10/24 | 1/24/25 | Approved | Vitamin D Testing in Peds |
| 2024-LHCC-1168 | Allergy Testing & Therapy | 12/10/24 | 1/24/25 | Approved | Allergy Testing & Therapy |
| 2024-LHCC-1217 | Ultrasound in Pregnancy | 12/10/24 | 1/24/25 | Approved | Ultrasound in Pregnancy |
| 2024-LHCC-1278 | Evoked Potential Testing | 12/10/24 | 1/24/25 | Approved | Evoked Potential Testing |
| 2024-LHCC-1279 | Measure Serum 1.25 Vit D | 12/10/24 | 1/24/25 | Approved | Measure Serum 1.25 Vit D |
| 2024-LHCC-1280 | EEG headache | 12/10/24 | 1/24/25 | Approved | EEG headache |
| 2024-LHCC-1702 | Holter Monitor | 12/10/24 | 1/24/25 | Approved | Holter Monitor |
| 2024-LHCC-1706 | Wireless Motility Capsule | 12/10/24 | 1/24/25 | Approved | Wireless Motility Capsule |
| 2024-UHC-1785 | Plagiocephaly and Craniosynostosis Treatment | 12/10/24 | 1/24/25 | Approved | Plagiocephaly and Craniosynostosis Treatment |
| 2024-LHCC-1823 | Mechanical Stretch devices | 12/10/24 | 1/24/25 | Approved | Mechanical Stretch devices |
| 2024-LHCC-1824 | Electric Tumor Treatment Fields | 12/10/24 | 1/24/25 | Approved | Electric Tumor Treatment Fields |
| 2024-UHC-1829 | Pharmacognetic Panel Testing | 12/10/24 | 1/24/25 | Approved | Pharmacognetic Panel Testing |
| 2024-LHCC-1844 | Transplant Service Documentation Requirements | 12/10/24 | 1/24/25 | Approved | Transplant Service Documentation Requirements |
| 2024-LHCC-1905 | Stereotactic Body Radiation Therapy | 12/10/24 | 1/24/25 | Approved | Stereotactic Body Radiation Therapy |
| 2024-ABH-2535 | AMA XXXX.XX Louisiana Transcranial Magnetic Stimulation (TMS) Policy | 12/6/24 | 1/20/25 | Approved | AMA XXXX.XX Louisiana Transcranial Magnetic Stimulation (TMS) Policy |
| 2024-HUM-2577 | Correct Coding | 12/6/24 | 1/20/25 | Approved | Correct Coding |
| 2024-HUM-2581 | Modifiers HCPCS | 12/6/24 | 1/20/25 | Approved | Modifiers HCPCS |
| 2024-HUM-2603 | Observation policy | 12/6/24 | 1/20/25 | Approved | Observation policy |
| 2024-UHC-201 | Apheresis | 12/6/24 | 1/20/25 | Approved | Apheresis |
| 2024-LHCC-338 | Perinatal Substance Use Disorder Care Management Program | 12/6/24 | 1/20/25 | Approved | Perinatal Substance Use Disorder Care Management Program |
| 2024-UHC-374 | Electrical and Ultrasound Bone Growth Stimulators | 12/6/24 | 1/20/25 | Approved | Electrical and Ultrasound Bone Growth Stimulators |
| 2024-UHC-486 | Abnormal Uterine Bleeding and Uterine Fibroids | 12/6/24 | 1/20/25 | Approved | Abnormal Uterine Bleeding and Uterine Fibroids |
| 2024-UHC-780 | Core Decompression AvascularNecrosis | 12/6/24 | 1/20/25 | Approved | Core Decompression AvascularNecrosis |
| 2024-LHCC-1167 | DME Clinical Policy | 12/6/24 | 1/20/25 | Approved | DME Clinical Policy |
| 2024-UHC-1461 | Unicondylar Spacer Devices for Treatment of Pain or Disability | 12/6/24 | 1/20/25 | Approved | Unicondylar Spacer Devices for Treatment of Pain or Disability |
| 2024-LHCC-1513 | Continuity and Coordination of Services | 12/6/24 | 1/20/25 | Approved | Continuity and Coordination of Services |
| 2024-HUM-1543 | EPSDT Personal Care Services (PCS) | 12/6/24 | 1/20/25 | Approved | EPSDT Personal Care Services (PCS) |
| 2024-HUM-1557 | Chisholm Policy | 12/6/24 | 1/20/25 | Approved | Chisholm Policy |
| 2024-HUM-1622 | Continuity of Care and Care Transitions | 12/6/24 | 1/20/25 | Approved | Continuity of Care and Care Transitions |
| 2024-HUM-1643 | Bariatric Surgery Clinical Coverage Policy | 12/6/24 | 1/20/25 | Approved | Bariatric Surgery Clinical Coverage Policy |
| 2024-HUM-1651 | Gender Affirmation Surgery Clinical Coverage Policy | 12/6/24 | 1/20/25 | Approved | Gender Affirmation Surgery Clinical Coverage Policy |
| 2024-HUM-1652 | Genetic Testing for Breast and Ovarian Cancer, FAP, and Lynch Syndrome Clinical Coverage Policy | 12/6/24 | 1/20/25 | Approved | Genetic Testing for Breast and Ovarian Cancer, FAP, and Lynch Syndrome Clinical Coverage Policy |
| 2024-HUM-1657 | Hospital Bed Clinical Coverage Policy | 12/6/24 | 1/20/25 | Approved | Hospital Bed Clinical Coverage Policy |
| 2024-HUM-1662 | Osteogenic Bone Growth Stimulators | 12/6/24 | 1/20/25 | Approved | Osteogenic Bone Growth Stimulators |
| 2024-HUM-1664 | Pediatric Day Health Care Clinical Coverage Policy | 12/6/24 | 1/20/25 | Approved | Pediatric Day Health Care Clinical Coverage Policy |
| 2024-HUM-1669 | Wound Care Clinical Coverage policy | 12/6/24 | 1/20/25 | Approved | Wound Care Clinical Coverage policy |
| 2024-ACLA-2438 | Diagnosis Procedure Code Gender Guidelines | 12/6/24 | 1/20/25 | Approved | Diagnosis Procedure Code Gender Guidelines |
| 2024-HUM-2442 | Preauthorization and Notification List (PAL) OON OOS addition | 12/6/24 | 1/20/25 | Completed | Preauthorization and Notification List (PAL) OON OOS addition |
| 2024-HBL-1757 | Imaging of the Abdomen and Pelvis | 11/21/24 | 1/5/25 | Approved | Imaging of the Abdomen and Pelvis |
| 2024-ACLA-1859 | Nonpharmacologic treatments for chronic vertigo | 11/21/24 | 1/5/25 | Approved | Nonpharmacologic treatments for chronic vertigo |
| 2024-ACLA-2249 | Tumor Imaging PET-Any Site (Unlisted PET) | 11/21/24 | 1/5/25 | Approved | Tumor Imaging PET-Any Site (Unlisted PET) |
| 2024-ABH-2281 | Aetna Clinical Policy Bulletins (CPBs) | 11/21/24 | 1/5/25 | Completed | Aetna Clinical Policy Bulletins (CPBs) |
| 2024-UHC-2431 | Cultural Proficiency Policy | 11/21/24 | 1/5/25 | Approved | Cultural Proficiency Policy |
| 2024-ABH-2459 | Louisiana Personal Care Services (PCS) AMA | 11/21/24 | 1/5/25 | Approved | Louisiana Personal Care Services (PCS) AMA |
| 2024-ABH-2537 | AMA XXXX.XX Wheelchair Policy | 11/21/24 | 1/5/25 | Approved | AMA XXXX.XX Wheelchair Policy |
| 2024-HUM-2594 | Correct Coding | 11/21/24 | 1/5/25 | Approved | Correct Coding |
| 2024-HUM-2596 | Correct Coding | 11/21/24 | 1/5/25 | Approved | Correct Coding |
| 2024-HUM-2598 | CPT- Evaluation and Management Services | 11/21/24 | 1/5/25 | Approved | CPT- Evaluation and Management Services |
| 2024-HBL-2600 | Gene Therapy for Metachromatic Leukodystrophy | 11/21/24 | 1/5/25 | Approved | Gene Therapy for Metachromatic Leukodystrophy |
| 2024-HUM-2601 | Transcranial Magnetic Stimulation (TMS) | 11/21/24 | 1/5/25 | Approved | Transcranial Magnetic Stimulation (TMS) |
| 2024-HBL-2602 | Therapeutic Radiopharmaceuticals | 11/21/24 | 1/5/25 | Approved | Therapeutic Radiopharmaceuticals |
| 2024-ACLA-878 | Chest (Thorax) MRI | 11/21/24 | 1/5/25 | Approved | Chest (Thorax) MRI |
| 2024-ACLA-879 | Brain (Head) MRS | 11/21/24 | 1/5/25 | Approved | Brain (Head) MRS |
| 2024-ACLA-880 | Cervical Spine MRI | 11/21/24 | 1/5/25 | Approved | Cervical Spine MRI |
| 2024-ACLA-881 | Cervical Spine CT | 11/21/24 | 1/5/25 | Approved | Cervical Spine CT |
| 2024-ACLA-882 | Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) | 11/21/24 | 1/5/25 | Approved | Brain (Head) MRI, Brain (Head) MRI with IAC (Internal Auditory Canal) |
| 2024-ACLA-883 | Brain (Head) CT | 11/21/24 | 1/5/25 | Approved | Brain (Head) CT |
| 2024-ACLA-884 | Brain (Head) MRA/MRV | 11/21/24 | 1/5/25 | Approved | Brain (Head) MRA/MRV |
| 2024-ACLA-885 | Brain (Head) CTA | 11/21/24 | 1/5/25 | Approved | Brain (Head) CTA |
| 2024-ACLA-886 | Bone Marrow MRI | 11/21/24 | 1/5/25 | Approved | Bone Marrow MRI |
| 2024-ACLA-887 | Abdominal Arteries CTAngiography | 11/21/24 | 1/5/25 | Approved | Abdominal Arteries CTAngiography |
| 2024-ACLA-888 | Abdomen/Pelvis CTA Combo | 11/21/24 | 1/5/25 | Approved | Abdomen/Pelvis CTA Combo |
| 2024-ACLA-889 | Abdomen MRA (Angiography) | 11/21/24 | 1/5/25 | Approved | Abdomen MRA (Angiography) |
| 2024-ACLA-890 | Abdomen/Pelvis CT Combo | 11/21/24 | 1/5/25 | Approved | Abdomen/Pelvis CT Combo |
| 2024-ACLA-891 | Abdomen MRI, MRCP | 11/21/24 | 1/5/25 | Approved | Abdomen MRI, MRCP |
| 2024-ACLA-892 | Abdomen CT | 11/21/24 | 1/5/25 | Approved | Abdomen CT |
| 2024-ACLA-893 | Abdomen CTAngiography | 11/21/24 | 1/5/25 | Approved | Abdomen CTAngiography |
| 2024-ACLA-1147 | Brain PET Scan | 11/21/24 | 1/5/25 | Approved | Brain PET Scan |
| 2024-ACLA-1148 | Unlisted Studies | 11/21/24 | 1/5/25 | Approved | Unlisted Studies |
| 2024-ACLA-1370 | EPSDT PCS 1511-04 | 11/21/24 | 1/5/25 | Approved | EPSDT PCS 1511-04 |
| 2024-ACLA-1448 | PET Scans | 11/21/24 | 1/5/25 | Approved | PET Scans |
| 2024-ACLA-856 | Functional Brain MRI | 11/21/24 | 1/5/25 | Approved | Functional Brain MRI |
| 2024-ACLA-857 | CT Heart, CT Heart Congenital (Not including coronary arteries) | 11/21/24 | 1/5/25 | Approved | CT Heart, CT Heart Congenital (Not including coronary arteries) |
| 2024-ACLA-858 | Upper Extremity MRA/MRV | 11/21/24 | 1/5/25 | Approved | Upper Extremity MRA/MRV |
| 2024-ACLA-859 | Upper Extremity MRI | 11/21/24 | 1/5/25 | Approved | Upper Extremity MRI |
| 2024-ACLA-861 | Breast MRI | 11/21/24 | 1/5/25 | Approved | Breast MRI |
| 2024-ACLA-862 | Upper Extremity CT | 11/21/24 | 1/5/25 | Approved | Upper Extremity CT |
| 2024-ACLA-863 | Thoracic Spine MRI | 11/21/24 | 1/5/25 | Approved | Thoracic Spine MRI |
| 2024-ACLA-864 | Lower Extremity CTA/CTV | 11/21/24 | 1/5/25 | Approved | Lower Extremity CTA/CTV |
| 2024-ACLA-865 | Upper Extremity CTA/CTV | 11/21/24 | 1/5/25 | Approved | Upper Extremity CTA/CTV |
| 2024-ACLA-866 | Thoracic Spine CT | 11/21/24 | 1/5/25 | Approved | Thoracic Spine CT |
| 2024-ACLA-867 | Temporomandibular Joint (TMJ) MRI | 11/21/24 | 1/5/25 | Approved | Temporomandibular Joint (TMJ) MRI |
| 2024-ACLA-868 | Spinal Canal MRA | 11/21/24 | 1/5/25 | Approved | Spinal Canal MRA |
| 2024-ACLA-869 | Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT | 11/21/24 | 1/5/25 | Approved | Sinus & Maxillofacial CT Limited or Localized Follow Up Sinus CT |
| 2024-ACLA-870 | Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT | 11/21/24 | 1/5/25 | Approved | Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT |
| 2024-ACLA-871 | Sinus Face Orbit MRI | 11/21/24 | 1/5/25 | Approved | Sinus Face Orbit MRI |
| 2024-ACLA-872 | CT Coronary Angiography (CCTA) | 11/21/24 | 1/5/25 | Approved | CT Coronary Angiography (CCTA) |
| 2024-ACLA-873 | CT Bone Density Study | 11/21/24 | 1/5/25 | Approved | CT Bone Density Study |
| 2024-ACLA-874 | CT (Virtual) Colonoscopy | 11/21/24 | 1/5/25 | Approved | CT (Virtual) Colonoscopy |
| 2024-ACLA-875 | Chest (Thorax) CT | 11/21/24 | 1/5/25 | Approved | Chest (Thorax) CT |
| 2024-ACLA-876 | Chest CTA | 11/21/24 | 1/5/25 | Approved | Chest CTA |
| 2024-ACLA-836 | Pelvis MRI | 11/21/24 | 1/5/25 | Approved | Pelvis MRI |
| 2024-ACLA-837 | Pelvis MRA | 11/21/24 | 1/5/25 | Approved | Pelvis MRA |
| 2024-ACLA-838 | Pelvis CTAngiography | 11/21/24 | 1/5/25 | Approved | Pelvis CTAngiography |
| 2024-ACLA-839 | Pelvis CT | 11/21/24 | 1/5/25 | Approved | Pelvis CT |
| 2024-ACLA-840 | Neck MRA/MRV | 11/21/24 | 1/5/25 | Approved | Neck MRA/MRV |
| 2024-ACLA-841 | Neck CTA | 11/21/24 | 1/5/25 | Approved | Neck CTA |
| 2024-ACLA-842 | MUGA (Multiple Gated Acquisition) Scan | 11/21/24 | 1/5/25 | Approved | MUGA (Multiple Gated Acquisition) Scan |
| 2024-ACLA-843 | Neck CT | 11/21/24 | 1/5/25 | Approved | Neck CT |
| 2024-ACLA-844 | Low Field MRI | 11/21/24 | 1/5/25 | Approved | Low Field MRI |
| 2024-ACLA-845 | MPI - Myocardial Perfusion Imaging | 11/21/24 | 1/5/25 | Approved | MPI - Myocardial Perfusion Imaging |
| 2024-ACLA-846 | Lumbar Spine CT | 11/21/24 | 1/5/25 | Approved | Lumbar Spine CT |
| 2024-ACLA-847 | Lumbar Spine MRI | 11/21/24 | 1/5/25 | Approved | Lumbar Spine MRI |
| 2024-ACLA-848 | Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) | 11/21/24 | 1/5/25 | Approved | Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) |
| 2024-ACLA-849 | Lower Extremity MRA/MRV | 11/21/24 | 1/5/25 | Approved | Lower Extremity MRA/MRV |
| 2024-ACLA-850 | Lower Extremity CT | 11/21/24 | 1/5/25 | Approved | Lower Extremity CT |
| 2024-ACLA-851 | Low Dose CT for Lung Cancer Screening | 11/21/24 | 1/5/25 | Approved | Low Dose CT for Lung Cancer Screening |
| 2024-ACLA-852 | Heart (Cardiac) PET with CT for Attenuation | 11/21/24 | 1/5/25 | Approved | Heart (Cardiac) PET with CT for Attenuation |
| 2024-ACLA-853 | Heart MRI | 11/21/24 | 1/5/25 | Approved | Heart MRI |
| 2024-ACLA-854 | Electron-Beam Tomography (EBCT) or Non-Contrast Coronary Computed Tomography (Non-contrast CCT) | 11/21/24 | 1/5/25 | Approved | Electron-Beam Tomography (EBCT) or Non-Contrast Coronary Computed Tomography (Non-contrast CCT) |
| 2024-ACLA-855 | Heart (cardiac) PET | 11/21/24 | 1/5/25 | Approved | Heart (cardiac) PET |
| 2024-HUM-2557 | Drugs and Biologicals HCPCS | 11/8/24 | 12/23/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HBL-2574 | Carcinoembryonic Antigen Testing | 11/8/24 | 12/23/24 | Approved | Carcinoembryonic Antigen Testing |
| 2024-HBL-2586 | Cancer Antigen | 11/8/24 | 12/23/24 | Approved | Cancer Antigen |
| 2024-HBL-2587 | Hemato Stem Cell Transp Multi Myel Other Plasma Cell Dyscrasias | 11/8/24 | 12/23/24 | Approved | Hemato Stem Cell Transp Multi Myel Other Plasma Cell Dyscrasias |
| 2024-HBL-2588 | Lingual Frenotomy or for Ankyloglossia-Related Feeding Difficulties | 11/8/24 | 12/23/24 | Approved | Lingual Frenotomy or for Ankyloglossia-Related Feeding Difficulties |
| 2024-HBL-2589 | Diagnostic Nasal Endoscopy | 11/8/24 | 12/23/24 | Approved | Diagnostic Nasal Endoscopy |
| 2024-HBL-2590 | Per- and Polyfluoroalkyl Substances PFAS Testing | 11/8/24 | 12/23/24 | Approved | Per- and Polyfluoroalkyl Substances PFAS Testing |
| 2024-HBL-2591 | Brain Computer Interface Rehabilitation Devices | 11/8/24 | 12/23/24 | Approved | Brain Computer Interface Rehabilitation Devices |
| 2024-HBL-2592 | Electric Stim as a Tx for Pain and Other Cond: Surface and Percut Devices | 11/8/24 | 12/23/24 | Approved | Electric Stim as a Tx for Pain and Other Cond: Surface and Percut Devices |
| 2024-HBL-2593 | Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems | 11/8/24 | 12/23/24 | Approved | Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems |
| 2024-UHC-378 | Surgery of the Shoulder | 11/7/24 | 12/22/24 | Approved | Surgery of the Shoulder |
| 2024-UHC-579 | Surgery of the Hip | 11/7/24 | 12/22/24 | Approved | Surgery of the Hip |
| 2024-LHCC-606 | Grievance Process | 11/7/24 | 12/22/24 | Approved | Grievance Process |
| 2024-UHC-790 | Nerve Graft to restore Erectile Function during Radical Prostatectomy | 11/7/24 | 12/22/24 | Approved | Nerve Graft to restore Erectile Function during Radical Prostatectomy |
| 2024-UHC-793 | Virtual Upper Gastrointestinal Endoscopy | 11/7/24 | 12/22/24 | Approved | Virtual Upper Gastrointestinal Endoscopy |
| 2024-HBL-810 | Bone Mineral Density Testing Measurement | 11/7/24 | 12/22/24 | Approved | Bone Mineral Density Testing Measurement |
| 2024-HBL-1149 | Colonoscopy | 11/7/24 | 12/22/24 | Approved | Colonoscopy |
| 2024-HBL-1261 | Systems Pathology Testing for Prostate Cancer | 11/7/24 | 12/22/24 | Approved | Systems Pathology Testing for Prostate Cancer |
| 2024-HBL-1465 | Gene Therapy for Cerebral Adrenoleukodystrophy | 11/7/24 | 12/22/24 | Approved | Gene Therapy for Cerebral Adrenoleukodystrophy |
| 2024-LHCC-1481 | Outpatient Consultation | 11/7/24 | 12/22/24 | Approved | Outpatient Consultation |
| 2024-LHCC-1488 | Unbundled Professional Services | 11/7/24 | 12/22/24 | Approved | Unbundled Professional Services |
| 2024-LHCC-1497 | Modifier to Procedure Code Validation | 11/7/24 | 12/22/24 | Approved | Modifier to Procedure Code Validation |
| 2024-LHCC-1710 | Maternal Child Health Program Description | 11/7/24 | 12/22/24 | Approved | Maternal Child Health Program Description |
| 2024-UHC-1737 | Computer-Assisted Surgical Navigation for Musculoskeletal Procedures | 11/7/24 | 12/22/24 | Approved | Computer-Assisted Surgical Navigation for Musculoskeletal Procedures |
| 2024-ACLA-2133 | Prior Authorization Services List | 11/7/24 | 12/22/24 | Approved | Prior Authorization Services List |
| 2024-UHC-2293 | Electroretinography | 11/7/24 | 12/22/24 | Approved | Electroretinography |
| 2024-UHC-2294 | Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions | 11/7/24 | 12/22/24 | Approved | Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions |
| 2024-LHCC-2354 | ID Respiratory Lab Testing | 11/7/24 | 12/22/24 | Approved | ID Respiratory Lab Testing |
| 2024-HBL-2457 | Cancer Antigen 125 Testing | 11/7/24 | 12/22/24 | Approved | Cancer Antigen 125 Testing |
| 2024-ABH-2538 | Payment Modifiers Procedure Code Validation Reimbursement Policy | 11/7/24 | 12/22/24 | Approved | Payment Modifiers Procedure Code Validation Reimbursement Policy |
| 2024-HBL-2457 | Cancer Antigen 125 Testing | 11/7/24 | 12/22/24 | Approved | Cancer Antigen 125 Testing |
| 2024-LHCC-2354 | ID Respiratory Lab Testing | 11/7/24 | 12/22/24 | Approved | ID Respiratory Lab Testing |
| 2024-UHC-2294 | Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions | 11/7/24 | 12/22/24 | Approved | Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions |
| 2024-UHC-2293 | Electroretinography | 11/7/24 | 12/22/24 | Approved | Electroretinography |
| 2024-ACLA-2133 | Prior Authorization Services List | 11/7/24 | 12/22/24 | Approved | Prior Authorization Services List |
| 2024-UHC-1737 | Computer-Assisted Surgical Navigation for Musculoskeletal Procedures | 11/7/24 | 12/22/24 | Approved | Computer-Assisted Surgical Navigation for Musculoskeletal Procedures |
| 2024-LHCC-1710 | Maternal Child Health Program Description | 11/7/24 | 12/22/24 | Approved | Maternal Child Health Program Description |
| 2024-LHCC-1497 | Modifier to Procedure Code Validation | 11/7/24 | 12/22/24 | Approved | Modifier to Procedure Code Validation |
| 2024-LHCC-1488 | Unbundled Professional Services | 11/7/24 | 12/22/24 | Approved | Unbundled Professional Services |
| 2024-LHCC-1481 | Outpatient Consultation | 11/7/24 | 12/22/24 | Approved | Outpatient Consultation |
| 2024-HBL-1465 | Gene Therapy for Cerebral Adrenoleukodystrophy | 11/7/24 | 12/22/24 | Approved | Gene Therapy for Cerebral Adrenoleukodystrophy |
| 2024-HBL-1261 | Systems Pathology Testing for Prostate Cancer | 11/7/24 | 12/22/24 | Approved | Systems Pathology Testing for Prostate Cancer |
| 2024-HBL-1149 | Colonoscopy | 11/7/24 | 12/22/24 | Approved | Colonoscopy |
| 2024-HBL-810 | Bone Mineral Density Testing Measurement | 11/7/24 | 12/22/24 | Approved | Bone Mineral Density Testing Measurement |
| 2024-UHC-793 | Virtual Upper Gastrointestinal Endoscopy | 11/7/24 | 12/22/24 | Approved | Virtual Upper Gastrointestinal Endoscopy |
| 2024-UHC-790 | Nerve Graft to restore Erectile Function during Radical Prostatectomy | 11/7/24 | 12/22/24 | Approved | Nerve Graft to restore Erectile Function during Radical Prostatectomy |
| 2024-LHCC-606 | Grievance Process | 11/7/24 | 12/22/24 | Approved | Grievance Process |
| 2024-UHC-579 | Surgery of the Hip | 11/7/24 | 12/22/24 | Approved | Surgery of the Hip |
| 2024-UHC-378 | Surgery of the Shoulder | 11/7/24 | 12/22/24 | Approved | Surgery of the Shoulder |
| 2024-UHC-217 | Omnibus Codes | 10/28/24 | 12/12/24 | Approved | Omnibus Codes |
| 2024-LHCC-608 | Appeal of UM Decision | 10/28/24 | 12/12/24 | Approved | Appeal of UM Decision |
| 2024-LHCC-931 | Appeals Process | 10/28/24 | 12/12/24 | Approved | Appeals Process |
| 2024-HBL-985 | Small Joint Surgery Criteria | 10/28/24 | 12/12/24 | Approved | Small Joint Surgery Criteria |
| 2024-HBL-1051 | Cardioverter Defibrillators | 10/28/24 | 12/12/24 | Approved | Cardioverter Defibrillators |
| 2024-ABH-1169 | Provider Appeals Policy | 10/28/24 | 12/12/24 | Approved | Provider Appeals Policy |
| 2024-HBL-1239 | Advanced Imaging of the Brain | 10/28/24 | 12/12/24 | Approved | Advanced Imaging of the Brain |
| 2024-HBL-1320 | Joint Surgery | 10/28/24 | 12/12/24 | Approved | Joint Surgery |
| 2024-HBL-1321 | Vascular Imaging | 10/28/24 | 12/12/24 | Approved | Vascular Imaging |
| 2024-HBL-1325 | Sleep Disorder Management | 10/28/24 | 12/12/24 | Approved | Sleep Disorder Management |
| 2024-ABH-1891 | Member Appeals | 10/28/24 | 12/12/24 | Approved | Member Appeals |
| 2024-ABH-1892 | Member Grievance | 10/28/24 | 12/12/24 | Approved | Member Grievance |
| 2024-ACLA-2202 | Crisis Stabilization – Adults | 10/28/24 | 12/12/24 | Approved | Crisis Stabilization – Adults |
| 2024-UHC-2427 | Translation Services Policy | 10/28/24 | 12/12/24 | Approved | Translation Services Policy |
| 2024-UHC-2428 | Interdisciplinary Case Conference Policy | 10/28/24 | 12/12/24 | Approved | Interdisciplinary Case Conference Policy |
| 2024-UHC-2430 | Informing and Educating Providers Policy | 10/28/24 | 12/12/24 | Approved | Informing and Educating Providers Policy |
| 2024-HBL-2462 | Permanent Implantable Pacemakers | 10/28/24 | 12/12/24 | Approved | Permanent Implantable Pacemakers |
| 2024-LHCC-2530 | Transportation Policy | 10/28/24 | 12/12/24 | Approved | Transportation Policy |
| 2024-HBL-2585 | SPECT Imaging | 10/28/24 | 12/12/24 | Approved | SPECT Imaging |
| 2024-LHCC-829 | Interrater Reliability - Act 421 | 10/11/24 | 11/25/24 | Completed | Interrater Reliability - Act 421 |
| 2024-LHCC-991 | Concurrent Review | 10/11/24 | 11/25/24 | Approved | Concurrent Review |
| 2024-LHCC-1117 | Contract Effective Date | 10/11/24 | 11/25/24 | Approved | Contract Effective Date |
| 2024-HBL-1250 | Radiation Oncology | 10/11/24 | 11/25/24 | Approved | Radiation Oncology |
| 2024-HBL-1301 | Sacroilac Joint Fusion | 10/11/24 | 11/25/24 | Approved | Sacroilac Joint Fusion |
| 2024-HBL-1319 | Imaging of the Extremities | 10/11/24 | 11/25/24 | Approved | Imaging of the Extremities |
| 2024-HBL-1324 | Spine Surgery | 10/11/24 | 11/25/24 | Approved | Spine Surgery |
| 2024-LHCC-1478 | Visits on Same Day as Surgery | 10/11/24 | 11/25/24 | Approved | Visits on Same Day as Surgery |
| 2024-LHCC-1588 | Member Advisory of Provider Contract Termination or Limitation Policy | 10/11/24 | 11/25/24 | Completed | Member Advisory of Provider Contract Termination or Limitation Policy |
| 2024-LHCC-2242 | Concert Genetics Prenatal and Preconception Carrier Screening | 10/11/24 | 11/25/24 | Approved | Concert Genetics Prenatal and Preconception Carrier Screening |
| 2024-LHCC-2372 | Member Reassignment | 10/11/24 | 11/25/24 | Approved | Member Reassignment |
| 2024-ABH-2571 | Disposable Incontinent Supplies Policy | 10/11/24 | 11/25/24 | Approved | Disposable Incontinent Supplies Policy |
| 2024-ACLA-2544 | Apnea Monitoring | 10/4/24 | 11/18/24 | Approved | Apnea Monitoring |
| 2024-HUM-2546 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2547 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2548 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2549 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2550 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2551 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2552 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2553 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2554 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2555 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2558 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2559 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2560 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2561 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2562 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2563 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2564 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2565 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2566 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2567 | Drugs and Biologicals HCPCS | 10/4/24 | 11/18/24 | Approved | Drugs and Biologicals HCPCS |
| 2024-HUM-2568 | Modifiers 7535 | 10/4/24 | 11/18/24 | Approved | Modifiers 7535 |
| 2024-HUM-2569 | Modifiers 7560 | 10/4/24 | 11/18/24 | Approved | Modifiers 7560 |
| 2024-HBL-2570 | Advanced Imaging: Site of Care | 10/4/24 | 11/18/24 | Pending | Advanced Imaging: Site of Care |
| 2024-UHC-2572 | Ocular Photo Screening | 10/4/24 | 11/18/24 | Approved | Ocular Photo Screening |
| 2024-LHCC-1833 | Assertive Community Treatment (ACT) | 10/4/24 | 11/18/24 | Approved | Assertive Community Treatment (ACT) |
| 2024-LHCC-1842 | Cosmetic and Reconstructive Procedures | 10/4/24 | 11/18/24 | Approved | Cosmetic and Reconstructive Procedures |
| 2024-LHCC- 1959 | BH Treatment Documentation Requirements | 10/4/24 | 11/18/24 | Approved | BH Treatment Documentation Requirements |
| 2024-UHC-2252 | Hospital Services: Observation and Inpatient | 10/4/24 | 11/18/24 | Approved | Hospital Services: Observation and Inpatient |
| 2024-UHC-2311 | Injectable Dermal Fillers and Bulking Agents | 10/4/24 | 11/18/24 | Approved | Injectable Dermal Fillers and Bulking Agents |
| 2024-HBL-2323 | Predictive and Prognostic Polygenic Testing | 10/4/24 | 11/18/24 | Approved | Predictive and Prognostic Polygenic Testing |
| 2024-HBL-2325 | Chromosomal Microarray Analysis | 10/4/24 | 11/18/24 | Approved | Chromosomal Microarray Analysis |
| 2024-HBL-2329 | Somatic Tumor Testing | 10/4/24 | 11/18/24 | Approved | Somatic Tumor Testing |
| 2024-HBL-2348 | Pharmacogenomic Testing | 10/4/24 | 11/18/24 | Approved | Pharmacogenomic Testing |
| 2024-HBL-2500 | Selected Protein Biomarker Algorithmic Assays | 10/4/24 | 11/18/24 | Approved | Selected Protein Biomarker Algorithmic Assays |
| 2024-HBL-2508 | Combined Pathogen Identification and Drug Resistance Testing | 10/4/24 | 11/18/24 | Approved | Combined Pathogen Identification and Drug Resistance Testing |
| 2024-HBL-2511 | Absolute Quantitation of Myocardial Blood Flow Measurement | 10/4/24 | 11/18/24 | Approved | Absolute Quantitation of Myocardial Blood Flow Measurement |
| 2024-HBL-2512 | Fecal Analysis Panels in the Diagnosis of Intestinal Disorders | 10/4/24 | 11/18/24 | Approved | Fecal Analysis Panels in the Diagnosis of Intestinal Disorders |
| 2024-HUM-2521 | Code Edit LabPathology CPTs | 10/4/24 | 11/18/24 | Approved | Code Edit LabPathology CPTs |
| 2024-HUM-2522 | Code Edit_Modifier 23 | 10/4/24 | 11/18/24 | Approved | Code Edit_Modifier 23 |
| 2024-HBL-2529 | Preadmin Srvs Inpatient Stays STATE | 10/4/24 | 11/18/24 | Approved | Preadmin Srvs Inpatient Stays STATE |
| 2024-LHCC-2531 | Eligibility Guide | 10/4/24 | 11/18/24 | Approved | Eligibility Guide |
| 2024-ABH-2533 | Vaginitis Lab Testing | 10/4/24 | 11/18/24 | Approved | Vaginitis Lab Testing |
| 2024-ABH-2536 | Community Brief Crisis Support (CBCS) and Behavioral Health Crisis Care (BHCC) Policy | 10/4/24 | 11/18/24 | Approved | Community Brief Crisis Support (CBCS) and Behavioral Health Crisis Care (BHCC) Policy |
| 2024-ABH-2539 | Laboratory & Radiology (Non-Hospital) Prior Authorization Requirements | 10/4/24 | 11/18/24 | Approved | Laboratory & Radiology (Non-Hospital) Prior Authorization Requirements |
| 2024-UHC-1404 | Breast Imaging for Screening and Diagnosing Cancer | 10/3/24 | 11/17/24 | Approved | Breast Imaging for Screening and Diagnosing Cancer |
| 2024-UHC-206 | Electric Tumor Treatment Field Therapy | 10/3/24 | 11/17/24 | Approved | Electric Tumor Treatment Field Therapy |
| 2024-LHCC-704 | Brain (Head) CT | 10/3/24 | 11/17/24 | Approved | Brain (Head) CT |
| 2024-UHC-788 | Mechanical Stretching Devices | 10/3/24 | 11/17/24 | Approved | Mechanical Stretching Devices |
| 2024-HBL-1051 | Cardioverter Defibrillators | 10/3/24 | 11/17/24 | Approved | Cardioverter Defibrillators |
| 2024-ACLA-1185 | Individual Placement and Support | 10/3/24 | 11/17/24 | Approved | Individual Placement and Support |
| 2024-LHCC-1271 | Implantable Hypoglossal Nerve Stimulation for OSA | 10/3/24 | 11/17/24 | Approved | Implantable Hypoglossal Nerve Stimulation for OSA |
| 2024-LHCC-1273 | Orthognathic Surgery | 10/3/24 | 11/17/24 | Approved | Orthognathic Surgery |
| 2024-LHCC-1277 | Panniculectomy | 10/3/24 | 11/17/24 | Approved | Panniculectomy |
| 2024-ABH-1330 | Community Brief Crisis Support and Behaviral Health Crisis Care | 10/3/24 | 11/17/24 | Approved | Community Brief Crisis Support and Behaviral Health Crisis Care |
| 2024-LHCC-1361 | Pediatric Heart Transplant | 10/3/24 | 11/17/24 | Approved | Pediatric Heart Transplant |
| 2024-LHCC-1411 | Medical Necessity Criteria | 10/3/24 | 11/17/24 | Approved | Medical Necessity Criteria |
| 2024-LHCC-1482 | Modifier Date of Service Validation | 10/3/24 | 11/17/24 | Approved | Modifier Date of Service Validation |
| 2024-LHCC-1491 | NCCI Unbunding | 10/3/24 | 11/17/24 | Approved | NCCI Unbunding |
| 2024-LHCC-1494 | Assistant Surgeon | 10/3/24 | 11/17/24 | Approved | Assistant Surgeon |
| 2024-LHCC-1502 | Professional Services Billed with Labs | 10/3/24 | 11/17/24 | Approved | Professional Services Billed with Labs |
| 2024-HUM-1535 | Community Brief Crisis Support (CBCS) | 10/3/24 | 11/17/24 | Approved | Community Brief Crisis Support (CBCS) |
| 2024-HUM-1540 | Crisis Stabilization Services for Adults | 10/3/24 | 11/17/24 | Approved | Crisis Stabilization Services for Adults |
| 2024-LHCC-1701 | Outpatient Testing for DOA (Drugs of Use) | 10/3/24 | 11/17/24 | Approved | Outpatient Testing for DOA (Drugs of Use) |
| 2024-LHCC-1741 | AHCT for Sickle Cell Anemia and Thalassemia | 10/3/24 | 11/17/24 | Approved | AHCT for Sickle Cell Anemia and Thalassemia |
| 2024-LHCC-1744 | Phototherapy for Neonatal Hyperbilirubinemia | 10/3/24 | 11/17/24 | Approved | Phototherapy for Neonatal Hyperbilirubinemia |
| 2024-LHCC-758 | Thoracic Spine CT | 9/18/24 | 11/2/24 | Approved | Thoracic Spine CT |
| 2024-LHCC-759 | Thoracic Spine MRI | 9/18/24 | 11/2/24 | Approved | Thoracic Spine MRI |
| 2024-LHCC-760 | Tumor Imaging PET -Breast Cancer - Initial DX | 9/18/24 | 11/2/24 | Approved | Tumor Imaging PET -Breast Cancer - Initial DX |
| 2024-LHCC-761 | Tumor Imaging PET Melanoma - Noncovered Indications | 9/18/24 | 11/2/24 | Approved | Tumor Imaging PET Melanoma - Noncovered Indications |
| 2024-LHCC-762 | Tumor Imaging PET - ANY SITE (Unlisted PET) | 9/18/24 | 11/2/24 | Approved | Tumor Imaging PET - ANY SITE (Unlisted PET) |
| 2024-HBL-2324 | Genetic Testing for Inherited Conditions | 9/18/24 | 11/2/24 | Approved | Genetic Testing for Inherited Conditions |
| 2024-LHCC-499 | Retrospective Review For Services Requiring Authorizations | 9/18/24 | 11/2/24 | Completed | Retrospective Review For Services Requiring Authorizations |
| 2024-LHCC-699 | Abdomen/Pelvis CT Combo | 9/18/24 | 11/2/24 | Approved | Abdomen/Pelvis CT Combo |
| 2024-LHCC-700 | Abdomen/Pelvis CTA | 9/18/24 | 11/2/24 | Approved | Abdomen/Pelvis CTA |
| 2024-LHCC-701 | CTA Aortogram with Runoff | 9/18/24 | 11/2/24 | Approved | CTA Aortogram with Runoff |
| 2024-LHCC-703 | Bone Marrow MRI | 9/18/24 | 11/2/24 | Approved | Bone Marrow MRI |
| 2024-LHCC-709 | Brain PET Scan | 9/18/24 | 11/2/24 | Approved | Brain PET Scan |
| 2024-LHCC-712 | CT Coronary Angiography (CCTA) | 9/18/24 | 11/2/24 | Approved | CT Coronary Angiography (CCTA) |
| 2024-LHCC-715 | Cervical Spine CT | 9/18/24 | 11/2/24 | Approved | Cervical Spine CT |
| 2024-LHCC-716 | Cervical Spine MRI | 9/18/24 | 11/2/24 | Approved | Cervical Spine MRI |
| 2024-LHCC-723 | CT Bone Density Study | 9/18/24 | 11/2/24 | Approved | CT Bone Density Study |
| 2024-LHCC-727 | Fetal MRI | 9/18/24 | 11/2/24 | Approved | Fetal MRI |
| 2024-LHCC-732 | Heart (cardiac) PET | 9/18/24 | 11/2/24 | Approved | Heart (cardiac) PET |
| 2024-LHCC-738 | Lower Extremity MRA/MRV | 9/18/24 | 11/2/24 | Approved | Lower Extremity MRA/MRV |
| 2024-LHCC-740 | Lumbar Spine CT | 9/18/24 | 11/2/24 | Approved | Lumbar Spine CT |
| 2024-LHCC-741 | Lumbar Spine MRI | 9/18/24 | 11/2/24 | Approved | Lumbar Spine MRI |
| 2024-LHCC-749 | Pelvis CT | 9/18/24 | 11/2/24 | Approved | Pelvis CT |
| 2024-LHCC-748 | Oncology PET Scans | 9/18/24 | 11/2/24 | Approved | Oncology PET Scans |
| 2024-LHCC-750 | Pelvis CT Angiography | 9/18/24 | 11/2/24 | Approved | Pelvis CT Angiography |
| 2024-LHCC-751 | Pelvis MRA | 9/18/24 | 11/2/24 | Approved | Pelvis MRA |
| 2024-LHCC-752 | Pelvis MRI | 9/18/24 | 11/2/24 | Approved | Pelvis MRI |
| 2024-LHCC-745 | Neck CT (soft tissue) | 9/16/24 | 10/31/24 | Approved | Neck CT (soft tissue) |
| 2024-LHCC-746 | Neck CTA | 9/16/24 | 10/31/24 | Approved | Neck CTA |
| 2024-LHCC-747 | Neck MRA/MRV | 9/16/24 | 10/31/24 | Approved | Neck MRA/MRV |
| 2024-LHCC-753 | Orbit, Face, Neck, Sinus MRI | 9/16/24 | 10/31/24 | Approved | Orbit, Face, Neck, Sinus MRI |
| 2024-LHCC-754 | Sinus & Maxillofacial CT limited or localized f/u Sinus CT | 9/16/24 | 10/31/24 | Approved | Sinus & Maxillofacial CT limited or localized f/u Sinus CT |
| 2024-LHCC-755 | Spinal Canal MRA | 9/16/24 | 10/31/24 | Approved | Spinal Canal MRA |
| 2024-LHCC-757 | Temporomandibular Joint (TMJ) MRI | 9/16/24 | 10/31/24 | Approved | Temporomandibular Joint (TMJ) MRI |
| 2024-LHCC-764 | Upper Extremity CT (Hand, Wrist, Long bone, or Shoulder CT) | 9/16/24 | 10/31/24 | Approved | Upper Extremity CT (Hand, Wrist, Long bone, or Shoulder CT) |
| 2024-LHCC-767 | Upper Extremity MRI (Hand, Wrist, Elbow, Long bone, or Shoulder MRI) | 9/16/24 | 10/31/24 | Approved | Upper Extremity MRI (Hand, Wrist, Elbow, Long bone, or Shoulder MRI) |
| 2024-UHC-786 | Light and Laser Therapy | 9/16/24 | 10/31/24 | Approved | Light and Laser Therapy |
| 2024-LHCC-934 | Behavioral Health Provider Quality Program | 9/16/24 | 10/31/24 | Approved | Behavioral Health Provider Quality Program |
| 2024-LHCC-1510 | EM Bundling with Labs and Radiology | 9/16/24 | 10/31/24 | Approved | EM Bundling with Labs and Radiology |
| 2024-LHCC-1513 | Continuity and Coordination of Services | 9/16/24 | 10/31/24 | Approved | Continuity and Coordination of Services |
| 2024-ACLA-2248 | Team Surgery | 9/16/24 | 10/31/24 | Approved | Team Surgery |
| 2024-UHC-2436 | Anatomical Modifier Requirement Policy, Professional | 9/16/24 | 10/31/24 | Approved | Anatomical Modifier Requirement Policy, Professional |
| 2024-HBL-2545 | Fetal Surgery for Prenatally Diagnosed Malformations | 9/16/24 | 10/31/24 | Approved | Fetal Surgery for Prenatally Diagnosed Malformations |
| 2024-LHCC-695 | Abdomen CT | 9/16/24 | 10/31/24 | Approved | Abdomen CT |
| 2024-LHCC-696 | Abdomen CT Angiography | 9/16/24 | 10/31/24 | Approved | Abdomen CT Angiography |
| 2024-LHCC-697 | Abdomen MRA (Angiography) | 9/16/24 | 10/31/24 | Approved | Abdomen MRA (Angiography) |
| 2024-LHCC-698 | Abdomen MRI | 9/16/24 | 10/31/24 | Approved | Abdomen MRI |
| 2024-LHCC-711 | Breast MRI | 9/16/24 | 10/31/24 | Approved | Breast MRI |
| 2024-LHCC-713 | Cerebral Perfusion CT | 9/16/24 | 10/31/24 | Approved | Cerebral Perfusion CT |
| 2024-LHCC-717 | Chest (Thorax) CT | 9/16/24 | 10/31/24 | Approved | Chest (Thorax) CT |
| 2024-LHCC-718 | Chest (Thorax) MRI | 9/16/24 | 10/31/24 | Approved | Chest (Thorax) MRI |
| 2024-LHCC-719 | Chest CTA | 9/16/24 | 10/31/24 | Approved | Chest CTA |
| 2024-LHCC-721 | CT (Virtual) Colonoscopy | 9/16/24 | 10/31/24 | Approved | CT (Virtual) Colonoscopy |
| 2024-LHCC-722 | CT (Virtual) Colonoscopy | 9/16/24 | 10/31/24 | Approved | CT (Virtual) Colonoscopy |
| 2024-LHCC-726 | Coronary Artery Calcium Scoring by: EBCT or Non-Contrast CCT | 9/16/24 | 10/31/24 | Approved | Coronary Artery Calcium Scoring by: EBCT or Non-Contrast CCT |
| 2024-LHCC-728 | Functional Brain MRI | 9/16/24 | 10/31/24 | Approved | Functional Brain MRI |
| 2024-LHCC-729 | CT Heart CT heart Congenital | 9/16/24 | 10/31/24 | Approved | CT Heart CT heart Congenital |
| 2024-LHCC-730 | Heart MRI | 9/16/24 | 10/31/24 | Approved | Heart MRI |
| 2024-LHCC-735 | Low Dose CT for Lung Cancer Screening | 9/16/24 | 10/31/24 | Approved | Low Dose CT for Lung Cancer Screening |
| 2024-LHCC-736 | Lower Extremity CT (foot, ankle, leg or hip CT) | 9/16/24 | 10/31/24 | Approved | Lower Extremity CT (foot, ankle, leg or hip CT) |
| 2024-LHCC-739 | Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) | 9/16/24 | 10/31/24 | Approved | Lower Extremity MRI (foot, ankle, knee, leg, or hip MRI) |
| 2024-LHCC-742 | Myocardial Perfusion Imaging (Nuclear Cardiac Imaging Study) | 9/16/24 | 10/31/24 | Approved | Myocardial Perfusion Imaging (Nuclear Cardiac Imaging Study) |
| 2024-LHCC-744 | MUGA (Multiple Gated Acquisition) Scan | 9/16/24 | 10/31/24 | Approved | MUGA (Multiple Gated Acquisition) Scan |
| 2024-HBL-1431 | Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver | 9/10/24 | 10/24/24 | Approved | Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver |
| 2024-LHCC-1479 | High Complexity Medical Decision-Making | 9/10/24 | 10/24/24 | Approved | High Complexity Medical Decision-Making |
| 2024-LHCC-1705 | Invasive and Non-Invasive Home Ventilator | 9/10/24 | 10/24/24 | Approved | Invasive and Non-Invasive Home Ventilator |
| 2024-LHCC-1837 | Obstetrical Home Care Programs | 9/10/24 | 10/24/24 | Approved | Obstetrical Home Care Programs |
| 2024-LHCC-1945 | Homocysteine Testing | 9/10/24 | 10/24/24 | Approved | Homocysteine Testing |
| 2024-HBL-2388 | Sacral Nerve Stim and Percut or Implant Tib Nerve Stim Urin and Fecal Incont Urin Ret | 9/10/24 | 10/24/24 | Approved | Sacral Nerve Stim and Percut or Implant Tib Nerve Stim Urin and Fecal Incont Urin Ret |
| 2024-HBL-2396 | Vestibular Function Testing | 9/10/24 | 10/24/24 | Approved | Vestibular Function Testing |
| 2024-HBL-2515 | Implant Ambul Event Monitors and Mobile Cardiac Telemetry | 9/10/24 | 10/24/24 | Approved | Implant Ambul Event Monitors and Mobile Cardiac Telemetry |
| 2024-LHCC-2523 | Sinus Surgery | 9/10/24 | 10/24/24 | Approved | Sinus Surgery |
| 2024-ABH-2535 | AMA XXXX.XX Louisiana Transcranial Magnetic Stimulation (TMS) Policy | 9/10/24 | 10/24/24 | Approved | AMA XXXX.XX Louisiana Transcranial Magnetic Stimulation (TMS) Policy |
| 2024-UHC-215 | Spinal Fusion and Bone Healing Enhancement Products | 9/10/24 | 10/24/24 | Approved | Spinal Fusion and Bone Healing Enhancement Products |
| 2024-HBL-597 | Electric Tumor Treatment Field | 9/10/24 | 10/24/24 | Approved | Electric Tumor Treatment Field |
| 2024-LHCC-705 | Brain (Head) CTA | 9/10/24 | 10/24/24 | Approved | Brain (Head) CTA |
| 2024-LHCC-706 | Brain (Head) MRA/MRV | 9/10/24 | 10/24/24 | Approved | Brain (Head) MRA/MRV |
| 2024-LHCC-707 | Brain (Head) MRI/Brain (Head) MRI w Internal Auditory Canal | 9/10/24 | 10/24/24 | Approved | Brain (Head) MRI/Brain (Head) MRI w Internal Auditory Canal |
| 2024-LHCC-708 | Brain (Head) MRS | 9/10/24 | 10/24/24 | Approved | Brain (Head) MRS |
| 2024-LHCC-737 | Lower Extremity CT Angiography | 9/10/24 | 10/24/24 | Approved | Lower Extremity CT Angiography |
| 2024-LHCC-756 | Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Cancal CT | 9/10/24 | 10/24/24 | Approved | Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Cancal CT |
| 2024-LHCC-769 | Cardiac Resynchonization Terapy (CRT) | 9/10/24 | 10/24/24 | Approved | Cardiac Resynchonization Terapy (CRT) |
| 2024-LHCC-770 | Fractional Flow Reserve CT | 9/10/24 | 10/24/24 | Approved | Fractional Flow Reserve CT |
| 2024-LHCC-771 | Heart Catheterization | 9/10/24 | 10/24/24 | Approved | Heart Catheterization |
| 2024-HBL-811 | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies | 9/10/24 | 10/24/24 | Approved | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies |
| 2024-HBL-1033 | Therapeutic Apheresis | 9/10/24 | 10/24/24 | Approved | Therapeutic Apheresis |
| 2024-HBL-1102 | Allogen, Xeno, Synthc and Composite Products for Wound Healing and Soft Tissue Grafting | 9/10/24 | 10/24/24 | Approved | Allogen, Xeno, Synthc and Composite Products for Wound Healing and Soft Tissue Grafting |
| 2024-ABH-1174 | Applied Behavior Analysis | 9/10/24 | 10/24/24 | Approved | Applied Behavior Analysis |
| 2024-LHCC-1212 | Spinal Cord Stimulation | 9/10/24 | 10/24/24 | Approved | Spinal Cord Stimulation |
| 2024-LHCC-1365 | GI Pathogen Nucleic Acid and Detection Panel Testing | 9/10/24 | 10/24/24 | Approved | GI Pathogen Nucleic Acid and Detection Panel Testing |
| 2024-LHCC-1410 | Neurofeedback for Behavioral Health Disorders | 9/10/24 | 10/24/24 | Approved | Neurofeedback for Behavioral Health Disorders |
| 2024-LHCC-1415 | Pulmonary Function Testing | 9/10/24 | 10/24/24 | Approved | Pulmonary Function Testing |
| 2024-LHCC-1416 | Transportation Policy | 9/10/24 | 10/24/24 | Approved | Transportation Policy |
| 2024-LHCC-1526 | Trigger Point Injections | 9/6/24 | 10/21/24 | Approved | Trigger Point Injections |
| 2024-HUM-1580 | Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI) | 9/6/24 | 10/21/24 | Approved | Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI) |
| 2024-LHCC-1743 | Hospice Services | 9/6/24 | 10/21/24 | Approved | Hospice Services |
| 2024-LHCC-1841 | MNC Policy for CPST and PSR | 9/6/24 | 10/21/24 | Approved | MNC Policy for CPST and PSR |
| 2024-LHCC-1919 | Cardiovascular Services | 9/6/24 | 10/21/24 | Approved | Cardiovascular Services |
| 2024-LHCC-2225 | Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy | 9/6/24 | 10/21/24 | Approved | Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy |
| 2024-LHCC-2228 | Concert Genetics Eye Disorders | 9/6/24 | 10/21/24 | Approved | Concert Genetics Eye Disorders |
| 2024-ABH-2497 | Louisiana Substance Use Disorder Treatment-Intensive Outpatient and Residential Levels of Care | 9/6/24 | 10/21/24 | Approved | Louisiana Substance Use Disorder Treatment-Intensive Outpatient and Residential Levels of Care |
| 2024-HUM-2525 | Claims Payment Policy | 9/6/24 | 10/21/24 | Approved | Claims Payment Policy |
| 2024-ACLA-2541 | Outpatient Lactation Services In Lieu Of | 9/6/24 | 10/21/24 | Pending | Outpatient Lactation Services In Lieu Of |
| 2024-LHCC-2542 | Transcranial Magnetic Stimulation (TMS) | 9/6/24 | 10/21/24 | Approved | Transcranial Magnetic Stimulation (TMS) |
| 2024-LHCC-140 | Timeliness of UM Decisions | 9/5/24 | 10/20/24 | Approved | Timeliness of UM Decisions |
| 2024-ACLA-506 | Applied Behavior Analysis | 9/5/24 | 10/20/24 | Approved | Applied Behavior Analysis |
| 2024-LHCC-1109 | Diaphragmatic/Phrenic Nerve Stimulation | 9/5/24 | 10/20/24 | Approved | Diaphragmatic/Phrenic Nerve Stimulation |
| 2024-LHCC-1228 | Sacroiliac Joint Interventions for Pain Management | 9/5/24 | 10/20/24 | Approved | Sacroiliac Joint Interventions for Pain Management |
| 2024-LHCC-1265 | Vagus Nerve Stimulation | 9/5/24 | 10/20/24 | Approved | Vagus Nerve Stimulation |
| 2024-LHCC-1274 | Osteogenic Stimulation | 9/5/24 | 10/20/24 | Approved | Osteogenic Stimulation |
| 2024-ABH-1335 | In lieu of Service Doula Care | 9/5/24 | 10/20/24 | Approved | In lieu of Service Doula Care |
| 2024-UHC-1418 | Autologous Cellular Therapy | 9/5/24 | 10/20/24 | Approved | Autologous Cellular Therapy |
| 2024-UHC-1422 | Left artrial appendage closure | 9/5/24 | 10/20/24 | Approved | Left artrial appendage closure |
| 2024-UHC-1426 | Genetic Testing for Cardiac Disease | 9/5/24 | 10/20/24 | Approved | Genetic Testing for Cardiac Disease |
| 2024-ABH-1451 | Crisis Stabilization Services for Adults | 9/5/24 | 10/20/24 | Approved | Crisis Stabilization Services for Adults |
| 2024-LHCC-1472 | Transparency Policy: Place of Service Mismatch | 9/5/24 | 10/20/24 | Approved | Transparency Policy: Place of Service Mismatch |
| 2024-LHCC-1480 | Pre-operative Visits | 9/5/24 | 10/20/24 | Completed | Pre-operative Visits |
| 2024-LHCC-1485 | Unbundled Surgical Procedures | 9/5/24 | 10/20/24 | Approved | Unbundled Surgical Procedures |
| 2024-LHCC-1486 | Post-operative Visits | 9/5/24 | 10/20/24 | Completed | Post-operative Visits |
| 2024-LHCC-1496 | Hospital Visit Codes Billed with Labs | 9/5/24 | 10/20/24 | Approved | Hospital Visit Codes Billed with Labs |
| 2024-LHCC-1501 | Distinct Procedural Modifiers | 9/5/24 | 10/20/24 | Approved | Distinct Procedural Modifiers |
| 2024-LHCC-1506 | Never Paid Events | 9/5/24 | 10/20/24 | Approved | Never Paid Events |
| 2024-LHCC-1524 | Posterior Tibial Nerve Stimulation for Voiding Dysfunction | 9/5/24 | 10/20/24 | Approved | Posterior Tibial Nerve Stimulation for Voiding Dysfunction |
| 2024-LHCC-1525 | Intradiscal Steroid Injections for Pain Management | 9/5/24 | 10/20/24 | Approved | Intradiscal Steroid Injections for Pain Management |
| 2024-UHC-379 | Brow Ptosis and Eyelid Repair | 8/20/24 | 10/4/24 | Approved | Brow Ptosis and Eyelid Repair |
| 2024-UHC-561 | Cognitive Rehabilitation | 8/20/24 | 10/4/24 | Approved | Cognitive Rehabilitation |
| 2024-UHC-1123 | Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds | 8/20/24 | 10/4/24 | Approved | Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds |
| 2024-LHCC-1268 | Bone-Anchored Hearing Aid | 8/20/24 | 10/4/24 | Approved | Bone-Anchored Hearing Aid |
| 2024-UHC-1425 | Neuropsychological Testing under the Medical Benefit | 8/20/24 | 10/4/24 | Approved | Neuropsychological Testing under the Medical Benefit |
| 2024-HUM-2224 | Provider Quality Monitoring Strategy | 8/20/24 | 10/4/24 | Approved | Provider Quality Monitoring Strategy |
| 2024-UHC-2443 | EMS Policy | 8/20/24 | 10/4/24 | Approved | EMS Policy |
| 2024-ACLA-2520 | Care at Home In Lieu Of | 8/20/24 | 10/4/24 | Approved | Care at Home In Lieu Of |
| 2024-UHC-2524 | In Lieu of Services: Doula Policy | 8/20/24 | 10/4/24 | Approved | In Lieu of Services: Doula Policy |
| 2024-HUM-2528 | Applied Behavioral Analysis DRAFT | 8/20/24 | 10/4/24 | Approved | Applied Behavioral Analysis DRAFT |