Provider Policy Notifications
This page contains notifications for clinical policies that have future effective dates. For current policies, visit the Clinical Policies page.
Policies effective 8/1/2026
- Air Ambulance (PDF) (CP.MP.175)
- Disc Decompression Procedures (PDF) (CP.MP.114)
- Discography (PDF) (CP.MP.115)
- Drugs of Abuse: Definitive Testing (PDF) (CP.MP.50)
- Immobilized Lipase Cartridges (RELiZORB®) (PDF) (CP.MP.252)
- Liposuction of Lipedema (PDF) (CP.MP.244)
- Lysis of Epidural Lesions (PDF) (CP.MP.116)
- Multiple Sleep Latency Testing (PDF) (CP.MP.24)
- Neuromuscular Electrical Stimulation (NMES) (PDF) (CP.MP.48)
- Omisirge (omidubicel): Nicotinamide-modified allogeneic hematopoietic progenitor cell therapy (PDF) (CP.MP.249)
- Pediatric Oral Function Therapy (PDF) (CP.MP.188)
- Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF) (CP.MP.147)
- Pulmonary Function Testing (PDF) (CP.MP.242)
- Repair of Nasal Valve Compromise (PDF) (CP.MP.210)
- Skilled Nursing Facility Leveling (PDF) (CC.PP.206)
- Therapeutic Utilization of Inhaled Nitric Oxide (PDF) (CP.MP.87)
- Transplant Service Documentation Requirements (PDF) (CP.MP.247)
Policies effective 10/1/2026
Policies effective 8/1/2026
- Disc Decompression Procedures (PDF) (CP.MP.114)
- Discography (PDF) (CP.MP.115)
- Drugs of Abuse: Definitive Testing (PDF) (CP.MP.50)
- Lysis of Epidural Lesions (PDF) (CP.MP.116)
- Multiple Sleep Latency Testing (PDF) (CP.MP.24)
- Omisirge (omidubicel): Nicotinamide-modified allogeneic hematopoietic progenitor cell therapy (PDF) (CP.MP.249)
- Pediatric Oral Function Therapy (PDF) (CP.MP.188)
- Pulmonary Function Testing (PDF) (CP.MP.242)
- Repair of Nasal Valve Compromise (PDF) (CP.MP.210)
- Skilled Nursing Facility Leveling (PDF) (CC.PP.206)
- Therapeutic Utilization of Inhaled Nitric Oxide (PDF) (CP.MP.87)
- Transplant Service Documentation Requirements (PDF) (CP.MP.247)
Policies effective 10/1/2026