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Medical Policy Update October 29, 2025 October 29, 2025

Medical Guidelines

Reason for Update

Anesthesia Services

Description and references updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement. 

Artificial Intervertebral Disc

 

References updated.  Specialty Matched Consultant Review 10/2025. Medical Director review 10/2025.

Autonomic Nervous System Testing

Updated title of the Related Policy. References updated.  Specialty Matched Consultant Review 10/2025. Medical Director review 10/2025. 

Baroreflex Stimulation Devices

Description, Policy Guidelines and References updated. When Not Covered section updated to remove examples of hypertension and heart failure and now reads: “Baroreflex stimulation devices are considered investigational for all applications.” Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Cardiac Monitoring Devices in the Outpatient Setting

Description, Policy Guidelines and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Carotid Intimal-Medial Thickness

Policy Guidelines and References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Computed Tomography to Detect Coronary Artery Calcification

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)

Policy guidelines updated.  No change to policy intent.  References updated.  Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. 

Dental Criteria for use of Hospital Inpatient or Outpatient Facility Services or Ambulatory Surgery Center Facility Services

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement.

Dental Reconstructive Services

References updated. Updated Policy Guidelines #2 to include “xerostomia.” Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement. 

Electrodiagnostic Studies

Removed one Related Policy.  References updated.  Specialty Matched Consultant Advisory Panel review 10/2025.  Medical Director review 10/2025. 

Enhanced External Counterpulsation (EECP)

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Hyperbaric Oxygen Therapy

Description, policy guidelines, and references updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. No change to policy statement.

Injection Therapy for Headache (Migraine and Other) and Non-Spine Management

References updated.   Specialty Matched Consultant Advisory Panel review 10/2025.  Medical Director review 10/2025. 

MRI-guided Laser Interstitial Thermal Therapy for Neurological Indications

Related Policies added.  References updated.  Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. 

Orthodontics for Pediatric Patients

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement.

Orthognathic Surgery

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement.

Quantitative Sensory Testing

Updated references.  Medical Director review 10/2025.  Specialty Matched Consultant Advisory Panel review 10/2025. 

Sex Trait Modification Procedures For Gender Affirming Care

Policy title changed from “Gender Affirmation Surgery” to “Sex Trait Modification Procedures for Gender Affirming Care.” Description section updated to include statement clarity that Gender Affirmation Surgery falls under the regulatory definition of specified sex-trait modification procedures. CPT codes 19340, 21499, 54406, 54408, 54415, 55175 and 55180 removed from the Billing/Coding section. Medical Director review 8/2025.

 

Signal-Averaged ECG

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Spinal Cord and Dorsal Root Ganglion Stimulation

Description, Policy Guidelines and References updated.  No change to policy intent.  Specialty Matched Consultant Panel review 10/2025.  Medical Director review 10/2025. 

Spinal Manipulation Under Anesthesia

Description, policy guidelines, and references updated. Specialty Matched Consultant Advisory Panel Review 10/2025. Medical Director Review 10/2025. No change to policy statement.

Stem-cell Therapy for Peripheral Arterial Disease

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

Temporomandibular Joint Dysfunction (TMJD)

Description, regulatory status, policy guidelines, and references updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement.

Total Facet Arthroplasty

Policy Guidelines updated.  No change to policy intent.  References updated.  Specialty Matched Consultant Advisory Panel review 10/2025.  Medical Director review 10/2025.

Wearable Cardioverter Defibrillators

References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025.

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