Medical and Pharmacy Coverage Policies

Effective Date	Policy Name	Reviewed Date
8/3/2026	Negative Pressure Wound Therapy - Medicare Advantage	7/14/2026
12/1/2025	Nerve Stimulation for Fecal Incontinence - Medicare Advantage	11/11/2025
4/1/2026	Nerve Stimulation for Urinary Incontinence - Medicare Advantage	3/10/2026
8/6/2026	Neuroablative Techniques for Chronic Pain - Medicare Advantage	2/10/2026
6/17/2026	Neurostimulators - MEDICAID - INDIANA	3/3/2026
7/22/2026	Neurostimulators - MEDICAID - KENTUCKY	3/3/2026
6/17/2026	Neurostimulators - MEDICAID - MICHIGAN	3/3/2026
6/17/2026	Neurostimulators - MEDICAID - SOUTH CAROLINA	3/3/2026
6/17/2026	Neurostimulators - MEDICAID - VIRGINIA	3/3/2026
6/29/2026	Nonemergency Ambulance Transportation - MEDICAID - KENTUCKY	1/6/2026
8/10/2026	Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage	5/12/2026
6/1/2026	Nuclear Imaging for Cancer Indications - Medicare Advantage	5/12/2026
7/1/2026	Nuclear Imaging for Noncancer Indications - Medicare Advantage	6/9/2026

Medical Coverage Policies