Medical Guidelines | Reason for Update |
|---|---|
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. |
Updated title of the Related Policy. References updated. Specialty Matched Consultant Review 10/2025. Medical Director review 10/2025. | |
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. | |
Description, Policy Guidelines and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
Policy Guidelines and References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
Policy guidelines updated. No change to policy intent. References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement. | |
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. | |
Removed one Related Policy. References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
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. |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement. | |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director Review 10/2025. No change to policy statement. | |
Updated references. Medical Director review 10/2025. Specialty Matched Consultant Advisory Panel review 10/2025. | |
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.
| |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
Description, Policy Guidelines and References updated. No change to policy intent. Specialty Matched Consultant Panel review 10/2025. Medical Director review 10/2025. | |
Description, policy guidelines, and references updated. Specialty Matched Consultant Advisory Panel Review 10/2025. Medical Director Review 10/2025. No change to policy statement. | |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
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. | |
Policy Guidelines updated. No change to policy intent. References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. | |
References updated. Specialty Matched Consultant Advisory Panel review 10/2025. Medical Director review 10/2025. |
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