Medical and Pharmacy Coverage Policies

Effective Date	Policy Name	Reviewed Date
5/18/2026	Bariatric Surgery - MEDICAID - LOUISIANA	9/2/2025
2/2/2026	Bariatric Surgery - Medicare Advantage	1/13/2026
9/1/2026	Benign Prostatic Hyperplasia Treatments - Medicare Advantage	8/11/2026
9/1/2026	Blepharoplasty, Blepharoptosis Repair and Brow Lift - Medicare Advantage	8/11/2026
2/2/2026	Bone Graft Substitutes - Medicare Advantage	1/13/2026
3/2/2026	Brachytherapy - Medicare Advantage	2/10/2026
1/2/2026	Brain Functional Magnetic Resonance Imaging (fMRI) - Medicare Advantage	12/9/2025
11/3/2025	Brain Stimulation Treatments - Medicare Advantage	10/14/2025
8/3/2026	Breast Excision and Mastectomy - Medicare Advantage	7/14/2026
7/1/2026	Breast Imaging - Medicare Advantage	6/9/2026
12/15/2025	Breast Procedures - MEDICAID - FLORIDA	8/5/2025
5/13/2026	Breast Procedures - MEDICAID - INDIANA	8/5/2025
6/24/2026	Breast Procedures - MEDICAID - KENTUCKY	8/5/2025
4/10/2026	Breast Procedures - MEDICAID - OHIO	8/5/2025
1/9/2026	Breast Procedures - MEDICAID - OKLAHOMA	8/5/2025
9/3/2025	Breast Procedures - MEDICAID - SOUTH CAROLINA	8/5/2025
12/3/2025	Breast Procedures - MEDICAID - VIRGINIA	8/5/2025
8/3/2026	Breast Reconstruction - Medicare Advantage	7/14/2026
5/18/2026	Breast Surgery - MEDICAID - LOUISIANA	9/2/2025

Medical Coverage Policies