Medical and Pharmacy Coverage Policies

Effective Date	Policy Name	Reviewed Date
5/1/2026	Tecelra (afamitresgene autoleucel) - Medicare Advantage	4/14/2026
6/22/2026	Temporomandibular Disorders - MEDICAID - FLORIDA	2/3/2026
5/22/2026	Temporomandibular Disorders - MEDICAID - MICHIGAN	2/3/2026
5/25/2026	Temporomandibular Disorders - MEDICAID - SOUTH CAROLINA	2/3/2026
5/27/2026	Temporomandibular Disorders - MEDICAID - VIRGINIA	2/3/2026
2/2/2026	Temporomandibular Disorders - Medicare Advantage	1/13/2026
8/26/2026	Therapeutic Group Home - MEDICAID - LOUISIANA	10/7/2025
7/22/2026	Thiopurine S-Methyltransferase Enzyme Activity Testing - MEDICAID - INDIANA	4/7/2026
7/22/2026	Thiopurine S-Methyltransferase Enzyme Activity Testing - MEDICAID - VIRGINIA	4/7/2026
8/3/2026	Transcatheter and Device-Based Hemodynamic Management Procedures - Medicare Advantage	7/14/2026
2/2/2026	Transcatheter Peripheral Vascular Stents - Chest, Abdomen and Pelvis - Medicare Advantage	1/13/2026
9/10/2026	Transcatheter Valve Procedures - Medicare Advantage	1/13/2026
5/18/2026	Transcranial Magnetic Stimulation (TMS) - MEDICAID - LOUISIANA	10/7/2025
6/1/2026	Transesophageal and Transthoracic Echocardiography - Medicare Advantage	5/12/2026
3/2/2026	Treatment of Achalasia, Gastroesophageal Reflux Disease and Hiatal Hernia - Medicare Advantage	2/10/2026

Medical Coverage Policies