Medical and Pharmacy Coverage Policies

Effective Date	Policy Name	Reviewed Date
3/2/2026	Diagnostic and Therapeutic Esophagogastroduodenoscopy or Esophagoscopy - Medicare Advantage	2/10/2026
7/29/2026	Documentation Requirements for Hysterectomy and Sterilization - MEDICAID - LOUISIANA	10/7/2025
7/1/2025	Doula Services - MEDICAID - VIRGINIA	7/1/2025
7/29/2026	Durable Medical Equipment Maintenance and Repair - MEDICAID - LOUISIANA	12/2/2025
9/1/2026	Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage	8/11/2026
5/1/2026	Dysphagia Imaging Evaluation - Medicare Advantage	4/14/2026

Medical Coverage Policies