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| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2025-UHC-247 | Negative Pressure Wound Therapy | 4/2/25 | 5/17/25 | Approved | Negative Pressure Wound Therapy |
| 2025-UHC-375 | Pneumatic Compression Devices | 4/2/25 | 5/17/25 | Approved | Pneumatic Compression Devices |
| 2025-UHC-474 | Rhinoplasty and Other Nasal Procedures | 4/2/25 | 5/17/25 | Approved | Rhinoplasty and Other Nasal Procedures |
| 2025-UHC-555 | Orthognathic (Jaw) Surgery | 4/2/25 | 5/17/25 | Approved | Orthognathic (Jaw) Surgery |
| 2025-UHC-580 | Embolization Ovarian Iliac Pelvic Congestion Syndrome | 4/2/25 | 5/17/25 | Approved | Embolization Ovarian Iliac Pelvic Congestion Syndrome |
| 2025-UHC-1170 | Prostate Surgeries and Interventions | 4/2/25 | 5/17/25 | Approved | Prostate Surgeries and Interventions |
| 2025-LHCC-1214 | Total Parenteral Nutrition and Intradialytic Parental Nutrition | 4/2/25 | 5/17/25 | Approved | Total Parenteral Nutrition and Intradialytic Parental Nutrition |
| 2025-LHCC-1216 | Bariatric Surgery | 4/2/25 | 5/17/25 | Approved | Bariatric Surgery |
| 2025-LHCC-1356 | Lung Transplantation | 4/2/25 | 5/17/25 | Approved | Lung Transplantation |
| 2025-LHCC-1358 | Pancreas Transplantation | 4/2/25 | 5/17/25 | Approved | Pancreas Transplantation |
| 2025-LHCC-1360 | Heart-Lung Transplant | 4/2/25 | 5/17/25 | Approved | Heart-Lung Transplant |
| 2025-LHCC-1362 | Nonmyeloablative allogeneric SCT | 4/2/25 | 5/17/25 | Approved | Nonmyeloablative allogeneric SCT |
| 2025-LHCC-1363 | Tandem Transplant | 4/2/25 | 5/17/25 | Approved | Tandem Transplant |
| 2025-LHCC-1385 | Implantable Wireless PAP Monitoring | 4/2/25 | 5/17/25 | Approved | Implantable Wireless PAP Monitoring |
| 2025-UHC-1523 | Facet Joint and Medial Branch Block Injections for Spinal Pain | 4/2/25 | 5/17/25 | Approved | Facet Joint and Medial Branch Block Injections for Spinal Pain |
| 2025-LHCC-1527 | Nerve Blocks and Neurolysis for Pain Management | 4/2/25 | 5/17/25 | Approved | Nerve Blocks and Neurolysis for Pain Management |
| 2025-LHCC-1703 | Pediatric Kidney Transplant | 4/2/25 | 5/17/25 | Approved | Pediatric Kidney Transplant |
| 2025-LHCC-1744 | Phototherapy for Neonatal Hyperbilirubinemia | 4/2/25 | 5/17/25 | Approved | Phototherapy for Neonatal Hyperbilirubinemia |
| 2025-LHCC-1745 | Donor Lymphocyte Infusion | 4/2/25 | 5/17/25 | Approved | Donor Lymphocyte Infusion |
| 2025-LHCC-1838 | Intensity-Modulated Radiotherapy | 4/2/25 | 5/17/25 | Approved | Intensity-Modulated Radiotherapy |
| 2025-LHCC-1934 | Experimental Technologies | 4/2/25 | 5/17/25 | Approved | Experimental Technologies |
| 2025-LHCC-1935 | Gastric Electrical Stimulation | 4/2/25 | 5/17/25 | Approved | Gastric Electrical Stimulation |
| 2025-LHCC-498 | Mental Health Rehab MNC Policy | 3/27/25 | 5/11/25 | Approved | |
| 2025-ACLA-874 | CT (Virtual) Colonoscopy | 3/27/25 | 5/11/25 | Approved | |
| 2025-ACLA-877 | Chest MRA | 3/27/25 | 5/11/25 | Approved | |
| 2025-LHCC-1167 | DME Clinical Policy | 3/27/25 | 5/11/25 | Approved | |
| 2025-LHCC-1417 | Adult Crisis Stabilization | 3/27/25 | 5/11/25 | Approved | |
| 2025-LHCC-1507 | Clinical Validation of Modifier 59 | 3/27/25 | 5/11/25 | Pending | |
| 2025-LHCC-1910 | Implantable Intrathecal or Epidural Pain Pump | 3/27/25 | 5/11/25 | Approved | |
| 2025-LHCC-2236 | Concert Genetics Immune Autoimmune and Rheumatoid Disorders | 3/27/25 | 5/11/25 | Approved | |
| 2025-HBL-2573 | Prior Auth Chngs for Gndr Affrmng Care-GAC Ph III-Caid | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2621 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2622 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2623 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2624 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2625 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2626 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2627 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2628 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2629 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2630 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2631 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2632 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2633 | Drugs & Biologicals HCPCS | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2669 | Gender-Specific Services for Transgender or Intersex Members | 3/27/25 | 5/11/25 | Approved |
Gender-Specific Services for Transgender or Intersex Members |
| 2025-HBL-2671 | Genetic Testing | 3/27/25 | 5/11/25 | Approved | |
| 2025-HBL-2672 | PA Req Changes for UM AROW | 3/27/25 | 5/11/25 | Approved | |
| 2025-HUM-2673 | Drugs & Biologicals | 3/27/25 | 5/11/25 | Approved | |
| 2025-LHCC-982 | Outpatient Applied Behavior Analysis Medical Necessity | 3/19/25 | N/A | N/A | |
| 2025-UHC-222 | Skin and Soft Tissue Substitutes | 3/14/25 | 4/28/25 | Approved | Skin and Soft Tissue Substitutes |
| 2025-HBL-362 | Pediatric Day Health Care and Personal Care Services | 3/14/25 | 4/28/25 | Approved | Pediatric Day Health Care and Personal Care Services |
| 2025-UHC-490 | Cardiovascular Disease Risk Tests | 3/14/25 | 4/28/25 | Approved | Cardiovascular Disease Risk Tests |
| 2025-UHC-782 | Discogenic Pain Treatment | 3/14/25 | 4/28/25 | Approved | Discogenic Pain Treatment |
| 2025-UHC-825 | Cardiac Event Monitoring | 3/14/25 | 4/28/25 | Approved | Cardiac Event Monitoring |
| 2025-UHC-949 | Chemotherapy-Observation or Inpatient Hospitalization | 3/14/25 | 4/28/25 | Approved | Chemotherapy-Observation or Inpatient Hospitalization |
| 2025-LHCC-1480 | Pre-operative Visits | 3/14/25 | 4/28/25 | Approved | Pre-operative Visits |
| 2025-LHCC-1507 | Clinical Validation of Modifier 59 | 3/14/25 | 4/28/25 | Withdrawn | Clinical Validation of Modifier 59 |
| 2025-LHCC-1509 | Clinical Validation of Modifier 25 | 3/14/25 | 4/28/25 | Withdrawn | Clinical Validation of Modifier 25 |
| 2025-LHCC-1747 | PCS-EPSDT Policy | 3/14/25 | 4/28/25 | Approved | PCS-EPSDT Policy |
| 2025-HUM-2668 | LA MEDICAID ASC PROCEDURE MAX | 3/14/25 | 4/28/25 | Approved | LA MEDICAID ASC PROCEDURE MAX |
| 2025-LHCC-107 | UM Program Description | 3/10/25 | 4/24/25 | Approved | UM Program Description |
| 2025-LHCC-772 | Implantable Cardioverter Defibrillator (ICD) | 3/10/25 | 4/24/25 | Approved | Implantable Cardioverter Defibrillator (ICD) |
| 2025-HBL-951 | Durable Medical Equipment | 3/10/25 | 4/24/25 | Approved | Durable Medical Equipment |
| 2025-ABH-1179 | Prior Authorizations | 3/10/25 | 4/24/25 | Approved | Prior Authorizations |
| 2025-LHCC-1212 | Spinal Cord Stimulation | 3/10/25 | 4/24/25 | Approved | Spinal Cord Stimulation |
| 2025-LHCC-1218 | Ventricular Assist Devices | 3/10/25 | 4/24/25 | Approved | Ventricular Assist Devices |
| 2025-LHCC-1270 | Urinary Incontinence Devices and Treatments | 3/10/25 | 4/24/25 | Approved | Urinary Incontinence Devices and Treatments |
| 2025-LHCC-1271 | Implantable Hypoglossal Nerve Stimulation for OSA | 3/10/25 | 4/24/25 | Approved | Implantable Hypoglossal Nerve Stimulation for OSA |
| 2025-LHCC-1379 | Inhaled Niric Oxide | 3/10/25 | 4/24/25 | Approved | Inhaled Niric Oxide |
| 2025-LHCC-1403 | Continuuity and Coordination of Medical Care | 3/10/25 | 4/24/25 | Approved | Continuuity and Coordination of Medical Care |
| 2025-HUM-1531 | ABA Clinical Coverage | 3/10/25 | 4/24/25 | Approved | ABA Clinical Coverage |
| 2025-HUM-1593 | Provider Manual | 3/10/25 | 4/24/25 | Approved | Provider Manual |
| 2025-HUM-1818 | Functional Family Therapy (FFT) | 3/10/25 | 4/24/25 | Approved | Functional Family Therapy (FFT) |
| 2025-LHCC-1819 | Burn Surgery | 3/10/25 | 4/24/25 | Approved | Burn Surgery |
| 2025-LHCC-1821 | Selective Dorsal Rhizotomy for Spasticity in CP | 3/10/25 | 4/24/25 | Approved | Selective Dorsal Rhizotomy for Spasticity in CP |
| 2025-LHCC-1825 | Proton and Neutron Beam Therapies | 3/10/25 | 4/24/25 | Approved | Proton and Neutron Beam Therapies |
| 2025-LHCC-1837 | Obstetrical Home Care Programs | 3/10/25 | 4/24/25 | Approved | Obstetrical Home Care Programs |
| 2025-LHCC-1907 | Hyperhidrousis Treatments | 3/10/25 | 4/24/25 | Approved | Hyperhidrousis Treatments |
| 2025-UHC-1941 | Louisiana ABA Policy | 3/10/25 | 4/24/25 | Approved | Louisiana ABA Policy |
| 2025-LHCC-1948 | Implantable Loop recorder | 3/10/25 | 4/24/25 | Approved | Implantable Loop recorder |
| 2025-LHCC-2354 | ID Respiratory Lab Testing | 3/10/25 | 4/24/25 | Approved | ID Respiratory Lab Testing |
| 2025-LHCC-2612 | Multiple ER Visits, Same Day | 3/10/25 | 4/24/25 | Pending | Multiple ER Visits, Same Day |
| 2025-LHCC-2613 | 30 Day Readmission | 3/10/25 | 4/24/25 | Pending | 30 Day Readmission |
| 2025-LHCC- 2614 | Leveling of ER Services | 3/10/25 | 4/24/25 | Pending | Leveling of ER Services |
| 2025-ABH-2645 | Treatment at Home In Lieu of Service | 3/10/25 | 4/24/25 | Approved | Treatment at Home In Lieu of Service |
| 2025-LDH-8 | MCO Manual > Part 4: Services > Medical Transportation > Non-Emergency Medical Transportation > Scheduling and Dispatching Effective Date 5/18/2025 | 2/25/25 | 4/11/25 | Pending | NEMT - Confirmation Number |
| 2025-LDH-7 | MCO Manual > Part 4: Services > Hospital Services > Inpatient Hospital Services > Hysterectomies Effective Date 5/18/2025 | 2/25/25 | 4/11/25 | Pending | Hysterectomies - Ancillary Providers |
| 2025-UHC-207 | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation | 2/25/25 | 4/11/25 | Approved | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation |
| 2025-UHC-510 | Collagen Crosslinks and Biochemical Markers of Bone Turnover | 2/25/25 | 4/11/25 | Approved | Collagen Crosslinks and Biochemical Markers of Bone Turnover |
| 2025-UHC-511 | Manipulation Under Anesthesia | 2/25/25 | 4/11/25 | Approved | Manipulation Under Anesthesia |
| 2025-UHC-557 | Transcranial Magnetic Stimulation | 2/25/25 | 4/11/25 | Approved | Transcranial Magnetic Stimulation |
| 2025-UHC-785 | Hearing Aids and Devices including wearable, bone-anchored and semi-implantable | 2/25/25 | 4/11/25 | Approved | Hearing Aids and Devices including wearable, bone-anchored and semi-implantable |
| 2025-UHC-791 | Neurophysiologic Testing | 2/25/25 | 4/11/25 | Approved | Neurophysiologic Testing |
| 2025-UHC-828 | Minimally Invasive Spine Surgery Procedures | 2/25/25 | 4/11/25 | Approved | Minimally Invasive Spine Surgery Procedures |
| 2025-UHC-1120 | Percutaneous Patent Foramen Ovale (PFO) Closure | 2/25/25 | 4/11/25 | Approved | Percutaneous Patent Foramen Ovale (PFO) Closure |
| 2025-LHCC-1190 | PCP Auto-Assignment PP | 2/25/25 | 4/11/25 | Approved | PCP Auto-Assignment PP |
| 2025-HUM-1540 | Crisis Stabilization Services for Adults | 2/25/25 | 4/11/25 | Approved | Crisis Stabilization Services for Adults |
| 2025-HUM-1659 | Inhaled Nitric Oxide Clinical Coverage Policy | 2/25/25 | 4/11/25 | Approved | Inhaled Nitric Oxide Clinical Coverage Policy |
| 2025-HUM-1661 | Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy | 2/25/25 | 4/11/25 | Approved | Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy |
| 2025-HUM-1668 | Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy | 2/25/25 | 4/11/25 | Approved | Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy |
| 2025-UHC-1815 | Sacral Nerve Stimulation for Urinary and Fecal Indications | 2/25/25 | 4/11/25 | Approved | Sacral Nerve Stimulation for Urinary and Fecal Indications |
| 2025-UHC-1849 | Upper Extremity Myoelectric Prosthetic Devices | 2/25/25 | 4/11/25 | Approved | Upper Extremity Myoelectric Prosthetic Devices |
| 2025-UHC-1851 | Whole Exome and Whole Genome Sequencing | 2/25/25 | 4/11/25 | Approved | Whole Exome and Whole Genome Sequencing |
| 2025-LHCC-1909 | Peer Support Services | 2/25/25 | 4/11/25 | Approved | Peer Support Services |
| 2025-HUM-2180 | Homebuilders | 2/25/25 | 4/11/25 | Approved | Homebuilders |
| 2025-ABH-2350 | AMA XXXX BRCA Genetic Testing and Counseling | 2/25/25 | 4/11/25 | Approved | AMA XXXX BRCA Genetic Testing and Counseling |
| 2025-ABH-2497 | Louisiana Substance Use Disorder Treatment-Intensive Outpatient and Residential Levels of Care | 2/25/25 | 4/11/25 | Approved | Louisiana Substance Use Disorder Treatment-Intensive Outpatient and Residential Levels of Care |
| 2025-ACLA-2650 | Hypoglossal-nerve-stimulation | 2/25/25 | 4/11/25 | Approved | Hypoglossal-nerve-stimulation |
| 2025-LDH-6 | MCO Manual > Part 4: Services > Professional Services > Eye Care and Vision Services Effective Date: 4/1/2025 | 2/11/25 | 3/28/25 | Pending | 2025-LDH-6 Eye Care and Vision Services |
| 2025-LDH-5 | MCO Manual > Part 4: Services > Hospital Services > Inpatient Hospital Services > Transplant Services Effective Date: 4/1/2025 | 2/11/25 | 3/28/25 | Pending | 2025-LDH-5 Transplant Services |
| 2025-LHCC-2241 | Concert Genetics Oncology Cancer Screening | 2/11/25 | 3/28/25 | Approved | Concert Genetics Oncology Cancer Screening |
| 2025-LHCC-2242 | Concert Genetics Prenatal and Preconception Carrier Screening | 2/11/25 | 3/28/25 | Approved | Concert Genetics Prenatal and Preconception Carrier Screening |
| 2025-LHCC-2243 | Concert Genetics Non-invasive Prenatal Screening | 2/11/25 | 3/28/25 | Approved | Concert Genetics Non-invasive Prenatal Screening |
| 2025-LHCC-2244 | Concert Genetics Prenatal Diagnosis Pregnancy Loss | 2/11/25 | 3/28/25 | Approved | Concert Genetics Prenatal Diagnosis Pregnancy Loss |
| 2025-LHCC-2245 | Concert Genetics Multi-system Inherited Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Multi-system Inherited Disorders |
| 2025-LHCC-2246 | Concert Genetics Metabolic Endocrine Mitochondrial Dsrd | 2/11/25 | 3/28/25 | Approved | Concert Genetics Metabolic Endocrine Mitochondrial Dsrdr |
| 2025-LHCC-2269 | Concert Genetics Hereditary Cancer Susceptibility | 2/11/25 | 3/28/25 | Approved | Concert Genetics Hereditary Cancer Susceptibility |
| 2025-HUM-2299 | OON OOS Policy | 2/11/25 | 3/28/25 | Approved | OON OOS Policy |
| 2025-LHCC-2302 | Concert Genetics Oncology Algorithmic Testing | 2/11/25 | 3/28/25 | Approved | Concert Genetics Oncology Algorithmic Testing |
| 2025-LHCC-2303 | Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies | 2/11/25 | 3/28/25 | Approved | Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies |
| 2025-LHCC-2304 | Concert Genetic Pharmacogenetics | 2/11/25 | 3/28/25 | Approved | Concert Genetic Pharmacogenetics |
| 2025-LHCC-2305 | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) | 2/11/25 | 3/28/25 | Approved | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) |
| 2025-UHC-2343 | Electrical Stimulation for Wounds | 2/11/25 | 3/28/25 | Approved | Electrical Stimulation for Wounds |
| 2025-LHCC-2464 | Concert Genetics Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders |
| 2025-HUM-2618 | Care at Home | 2/11/25 | 3/28/25 | Approved | Care at Home |
| 2025-HUM-2649 | LA MCD PAL A | 2/11/25 | 3/28/25 | Completed | LA MCD PAL A |
| 2025-UHC-310 | Total Artificial Disc Replacement Spine – Revised | 2/11/25 | 3/28/25 | Approved | Total Artificial Disc Replacement Spine – Revised |
| 2025-UHC-312 | Intensity Modulated Radiation Therapy – Revised | 2/11/25 | 3/28/25 | Approved | Intensity Modulated Radiation Therapy – Revised |
| 2025-UHC-781 | Deep Brain Cortical Stimulation | 2/11/25 | 3/28/25 | Approved | Deep Brain Cortical Stimulation |
| 2025-LHCC-1211 | Reduction Mammoplasty and Gynecomastia Surgery | 2/11/25 | 3/28/25 | Approved | Reduction Mammoplasty and Gynecomastia Surgery |
| 2025-HUM-1541 | Crisis Stabilization for Children and Adolescents | 2/11/25 | 3/28/25 | Approved | Crisis Stabilization for Children and Adolescents |
| 2025-UHC-1817 | Proton Beam Radiation Therapy | 2/11/25 | 3/28/25 | Approved | Proton Beam Radiation Therapy |
| 2025-UHC-1873 | Lower Extremity Prosthetics | 2/11/25 | 3/28/25 | Approved | Lower Extremity Prosthetics |
| 2025-LHCC-2226 | Concert Genetics Aortopathies and Connective Tissue Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Aortopathies and Connective Tissue Disorders |
| 2025-LHCC-2227 | Concert Genetics Cardiac Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Cardiac Disorders |
| 2025-LHCC-2228 | Concert Genetics Eye Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Eye Disorders |
| 2025-LHCC-2229 | Concert Genetics Dermatologic Conditions | 2/11/25 | 3/28/25 | Approved | Concert Genetics Dermatologic Conditions |
| 2025-LHCC-2230 | Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions | 2/11/25 | 3/28/25 | Approved | Concert Genetics Epilepsy Neurodegenerative and Neuromuscular Conditions |
| 2025-LHCC-2231 | Concert Genetics Gastroenterologic Disorders non-cancerous | 2/11/25 | 3/28/25 | Approved | Concert Genetics Gastroenterologic Disorders non-cancerous |
| 2025-LHCC-2232 | Concert Genetics General Approach to Genetic Testing | 2/11/25 | 3/28/25 | Approved | Concert Genetics General Approach to Genetic Testing |
| 2025-LHCC-2233 | Concert Genetics Hearing Loss | 2/11/25 | 3/28/25 | Approved | Concert Genetics Hearing Loss |
| 2025-LHCC-2234 | Concert Genetics Lung Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Lung Disorders |
| 2025-LHCC-2235 | Concert Genetics Kidney Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Kidney Disorders |
| 2025-LHCC-2237 | Concert Genetics Hematologic Conditions non-cancerous | 2/11/25 | 3/28/25 | Approved | Concert Genetics Hematologic Conditions non-cancerous |
| 2025-LHCC-2238 | Concert Genetics Skeletal Dysplasia Rare Bone Disorders | 2/11/25 | 3/28/25 | Approved | Concert Genetics Skeletal Dysplasia Rare Bone Disorders |
| 2025-LHCC-2239 | Concert Genetics Oncology Cytogenetic Testing | 2/11/25 | 3/28/25 | Approved | Concert Genetics Oncology Cytogenetic Testing |
| 2025-LHCC-2240 | Concert Genetics Preimplantation Genetic Testing | 2/11/25 | 3/28/25 | Approved | Concert Genetics Preimplantation Genetic Testing |
| 2025-LDH-1 | MCO Manual > Part 2: Administration > Reporting > Financial Reporting Effective Date: 4/1/2025 | 2/3/2025 | 3/20/2025 | Pending | MCO Manual 3.0 Financial Reporting |
| 2025-LDH-2 | MCO Manual > Part 4: Services > MCO Covered Services > Professional Services > Physician Administered Medication Effective Date: 2/1/2025 | 2/3/2025 | 3/20/2025 | Pending | MCO Manual 3.0 Physician Administered Medication |
| 2025-LDH-3 | MCO Manual > Part 4: Services: In Lieu of Services | 2/3/2025 | 3/20/2025 | Pending | MCO Manual 3.0 In Lieu of Services |
| 2025-LDH-4 | MCO Manual > Part 9: Provider Network > Primary Care > Enrollment Reassignment Policy > LDH Notification | 2/3/2025 | 3/20/2025 | Pending | MCO Manual 3.0 PCP LDH Notification |
| 2025-UHC-377 | Implanted Electrical Stimulator for Spinal Cord | 2/3/25 | 3/20/25 | Approved | Implanted Electrical Stimulator for Spinal Cord |
| 2025-LHCC-423 | EPSDT | 2/3/25 | 3/20/25 | Approved | EPSDT |
| 2025-UHC-491 | Electrical Stimulation And Electromagnetic Therapy For Wounds | 2/3/25 | 3/20/25 | Approved | Electrical Stimulation And Electromagnetic Therapy For Wounds |
| 2025-LHCC-773 | Pacemaker | 2/3/25 | 3/20/25 | Approved | Pacemaker |
| 2025-HBL-1014 | Imaging of the Chest AIM Guidelines | 2/3/25 | 3/20/25 | Approved | Imaging of the Chest AIM Guidelines |
| 2025-UHC-1178 | Liposuction for Lipodema | 2/3/25 | 3/20/25 | Approved | Liposuction for Lipodema |
| 2025-HBL-1467 | AIM Perirectal Hydrogel Spacer for Prostate Radiotherapy | 2/3/25 | 3/20/25 | Approved | AIM Perirectal Hydrogel Spacer for Prostate Radiotherapy |
| 2025-LHCC-1504 | Reporting the Global Maternity Package | 2/3/25 | 3/20/25 | Approved | Reporting the Global Maternity Package |
| 2025-HUM-1584 | Therapeutic Group Therapy | 2/3/25 | 3/20/25 | Approved | Therapeutic Group Therapy |
| 2025-HUM-1616 | Covered Benefits and Services UM8 | 2/3/25 | 3/20/25 | Approved | Covered Benefits and Services UM8 |
| 2025-HUM-1644 | Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage | 2/3/25 | 3/20/25 | Approved | Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage |
| 2025-HUM-1674 | Inter Rater Reliability Assessment - Clinical Staff | 2/3/25 | 3/20/25 | Approved | Inter Rater Reliability Assessment - Clinical Staff |
| 2025-UHC-1846 | Interspinous Fusion and Decompression Devices | 2/3/25 | 3/20/25 | Approved | Interspinous Fusion and Decompression Devices |
| 2025-UHC-1847 | Spinal Fusion and Decompression | 2/3/25 | 3/20/25 | Approved | Spinal Fusion and Decompression |
| 2025-ABH-1893 | Provider Disputes | 2/3/25 | 3/20/25 | Approved | Provider Disputes |
| 2025-ACLA-2133 | Prior Authorization Services List | 2/3/25 | 3/20/25 | Approved | Prior Authorization Services List |
| 2025-LHCC-2295 | Bilateral Services | 2/3/25 | 3/20/25 | Approved | Bilateral Services |
| 2025-ABH-2361 | AMA XXXX EPSDT Personal Care Services | 2/3/25 | 3/20/25 | Approved | AMA XXXX EPSDT Personal Care Services |
| 2025-ABH-2604 | Unattended Sleep Studies | 2/3/25 | 3/20/25 | Approved | Unattended Sleep Studies |
| 2025-ABH-2605 | Vitamin D Testing | 2/3/25 | 3/20/25 | Approved | Vitamin D Testing |
| 2025ABH-2606 | Gastrointestinal Panel Testing | 2/3/25 | 3/20/25 | Approved | Gastrointestinal Panel Testing |
| 2025-ABH-2607 | Diagnostic Mammograms | 2/3/25 | 3/20/25 | Approved | Diagnostic Mammograms |
| 2025-LHCC-2609 | Outpatient Therapy by Licensed Practitioners | 2/3/25 | 3/20/25 | Approved | Outpatient Therapy by Licensed Practitioners |
| 2025-UHC-2617 | ED Reduction Policy/Care at Home | 2/3/25 | 3/20/25 | Approved | ED Reduction Policy/Care at Home |
| 2025-ACLA-2648 | Respiratory Viral Panel Testing | 2/3/25 | 3/20/25 | Approved | Respiratory Viral Panel Testing |
| 2025-UHC-223 | Vagus and External Trigeminal Nerve Stimulation | 1/24/25 | 3/10/25 | Approved | Vagus and External Trigeminal Nerve Stimulation |
| 2025-UHC-224 | Visual Information Processing Evaluation and Orthoptic and Vision Therapy | 1/24/25 | 3/10/25 | Approved | Visual Information Processing Evaluation and Orthoptic and Vision Therapy |
| 2025-UHC-248 | Vertebral Tethering for Scoliosis | 1/24/25 | 3/10/25 | Approved | Vertebral Tethering for Scoliosis |
| 2025-UHC-478 | Obstructive and Central Sleep Apnea Treatment | 1/24/25 | 3/10/25 | Approved | Obstructive and Central Sleep Apnea Treatment |
| 2025-UHC-1063 | Temporomandibular Joint Disorder | 1/24/25 | 3/10/25 | Approved | Temporomandibular Joint Disorder |
| 2025-HUM-1561 | Multi-Systemic Therapy (MST) | 1/24/25 | 3/10/25 | Approved | Multi-Systemic Therapy (MST) |
| 2025-UHC-1762 | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery | 1/24/25 | 3/10/25 | Approved | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery |
| 2025-UHC-1830 | Hysterectomy | 1/24/25 | 3/10/25 | Approved | Hysterectomy |
| 2025-LHCC-1916 | Individual Placement and Support | 1/24/25 | 3/10/25 | Approved | Individual Placement and Support |
| 2025-ACLA-2221 | Provider Quality Monitoring Strategy | 1/24/25 | 3/10/25 | Approved | Provider Quality Monitoring Strategy |
| 2025-LHCC-2268 | Genetic and Molecular Testing | 1/24/25 | 3/10/25 | Approved | Genetic and Molecular Testing |
| 2025-UHC-2301 | Molecular Oncology Companion Diagnostic Testing | 1/24/25 | 3/10/25 | Approved | Molecular Oncology Companion Diagnostic Testing |
| 2025-HUM-2634 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2635 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2637 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2638 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2639 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2640 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2641 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2642 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2643 | Drugs & Biologicals HCPCS | 1/24/25 | 3/10/25 | Approved | Drugs & Biologicals HCPCS |
| 2025-HUM-2644 | Place of Service | 1/24/25 | 3/10/25 | Approved | Place of Service |
| 2025-LHCC-2646 | Concert Laboratory Payment Policy | 1/24/25 | 3/10/25 | Approved | Concert Laboratory Payment Policy |
| 2025-UHC-222 | Skin and Soft Tissue Substitutes | 1/13/25 | 2/27/25 | Approved | Skin and Soft Tissue Substitutes |
| 2025-LHCC-336 | Care Management Program Description | 1/13/25 | 2/27/25 | Approved | Care Management Program Description |
| 2025-UHC-524 | Durable Medical Equipment, Orthotics, Medical Supplies and Repairs/Replacements | 1/13/25 | 2/27/25 | Approved | Durable Medical Equipment, Orthotics, Medical Supplies and Repairs/Replacements |
| 2025-UHC-826 | Surgery of the Elbow | 1/13/25 | 2/27/25 | Approved | Surgery of the Elbow |
| 2025-UHC-948 | Catheter Ablation for Atrial Fibrillation | 1/13/25 | 2/27/25 | Approved | Catheter Ablation for Atrial Fibrillation |
| 2025-UHC-961 | Elective Inpatient Services | 1/13/25 | 2/27/25 | Approved | Elective Inpatient Services |
| 2025-UHC-1122 | Percutaneous Vertebroplasty and Kyphoplasty | 1/13/25 | 2/27/25 | Approved | Percutaneous Vertebroplasty and Kyphoplasty |
| 2025-UHC-1350 | Gender Dysphoria Treatment | 1/13/25 | 2/27/25 | Completed | Gender Dysphoria Treatment |
| 2025-HUM-1574 | Timeliness of UM Determinations and Notifications - Clinical Policy | 1/13/25 | 2/27/25 | Approved | Timeliness of UM Determinations and Notifications - Clinical Policy |
| 2025-UHC-1589 | Surgical Treatment of Lymphedema | 1/13/25 | 2/27/25 | Approved | Surgical Treatment of Lymphedema |
| 2025-HUM-1606 | Louisiana UM Program Description | 1/13/25 | 2/27/25 | Completed | Louisiana UM Program Description |
| 2025-UHC-1760 | Radiation Therapy | 1/13/25 | 2/27/25 | Approved | Radiation Therapy |
| 2025-UHC-2306 | Airway Clearance Devices | 1/13/25 | 2/27/25 | Completed | Airway Clearance Devices |
| 2025-ACLA-2520 | Care at Home In Lieu Of | 1/13/25 | 2/27/25 | Approved | Care at Home In Lieu Of |
| 2025-HUM-2597 | HCPCS | 1/13/25 | 2/27/25 | Approved | HCPCS |
| 2025-HUM-2599 | CPT | 1/13/25 | 2/27/25 | Approved | CPT |
| 2025-LHCC-2619 | Treatment at Home In Lieu of Service | 1/13/25 | 2/27/25 | Approved | Treatment at Home In Lieu of Service |
| 2025-HUM-2620 | Outpatient Facility | 1/13/25 | 2/27/25 | Approved | Outpatient Facility |
Medicaid Managed Care Policies & Procedures Archive (2025)
"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:
Related Info
- Managed Care Policies & Procedures - Archive (2024)
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- Managed Care Policies & Procedures - Archive (2022)
- Managed Care Policies & Procedures - Archive (2021)
- Managed Care Policies & Procedures - Archive (2020)
- Managed Care Policies & Procedures - Archive (2019)