Medical and Pharmacy Coverage Policies

Effective Date	Policy Name	Reviewed Date
9/23/2026	Ablation (Cancer and Noncancer Indications) - MEDICAID - FLORIDA	3/3/2026
6/17/2026	Ablation (Cancer and Noncancer Indications) - MEDICAID - ILLINOIS	3/3/2026
6/17/2026	Ablation (Cancer and Noncancer Indications) - MEDICAID - INDIANA	3/3/2026
6/17/2026	Ablation (Cancer and Noncancer Indications) - MEDICAID - MICHIGAN	3/3/2026
6/17/2026	Ablation (Cancer and Noncancer Indications) - MEDICAID - SOUTH CAROLINA	3/3/2026
6/17/2026	Ablation (Cancer and Noncancer Indications) - MEDICAID - VIRGINIA	3/3/2026
6/1/2026	Advanced Imaging of the Abdomen and Pelvis - Medicare Advantage	5/12/2026
6/1/2026	Advanced Imaging of the Chest - Medicare Advantage	5/12/2026
9/1/2026	Advanced Imaging of the Head and Neck - Medicare Advantage	8/11/2026
5/1/2026	Advanced Imaging of the Spine - Medicare Advantage	4/14/2026
11/25/2023	Air Ambulance Transportation (AAT) - MEDICAID - LOUISIANA	10/16/2024
9/1/2026	Ambulatory Cardiac Monitoring Devices - Medicare Advantage	8/11/2026
7/1/2026	Ambulatory Withdrawal Management - MEDICAID - OHIO	6/2/2026
8/3/2026	Amtagvi (lifileucel) - Medicare Advantage	7/14/2026
9/16/2026	Applied Behavior Analysis - MEDICAID - OKLAHOMA	5/5/2026
9/23/2026	Applied Behavior Analysis - MEDICAID - SOUTH CAROLINA	6/2/2026
2/11/2026	Applied Behavioral Analysis - MEDICAID - LOUISIANA	5/6/2025
4/1/2026	Artificial Intervertebral Disc Replacement - Medicare Advantage	3/10/2026
2/24/2023	Assertive Community Treatment (ACT/FACT) - MEDICAID - LOUISIANA	5/26/2023
5/1/2026	Autonomic Nerve Function Testing - Medicare Advantage	4/14/2026

Medical Coverage Policies

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