Clinical Policy Annual Review

Date: 01/03/25

The following clinical policies have undergone an annual review with some added criteria requirements that may impact the prior authorization process. Please see the revision log within each policy to review the changes.

Clinical policies: https://www.ambettermeridian.com/provider-resources/clinical-payment-policies.html

Upcoming changes: https://www.ambettermeridian.com/provider-resources/clinical-payment-policies/clinical-policy-updates.html

• CP.MP.145 Electric Tumor Treating Fields
• CP.MP.248 Facility Based Sleep Studies for Obstructive Sleep Apnea
• V.2025.1 Concert Genetic Testing: Pharmacogenetics (Version A)
• V.2025.1 Concert Genetic Testing: Aortopathies and Connective Tissue Disorders
• V.2025.1 Concert Genetic Testing: Cardiac Disorders
• V.2025.1 Concert Genetic Testing: Dermatologic Conditions
• V.2025.1 Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions
• V.2025.1 Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders
• V.2025.1 Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders
• V.2025.1 Concert Genetic Testing: Eye Disorders
• V.2025.1 Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous)
• V.2025.1 Concert Genetic Testing: General Approach to Genetic and Molecular Testing
• V.2025.1 Concert Genetic Testing: Hearing Loss
• V.2025.1 Concert Genetic Testing: Hematologic Conditions (non-cancerous)
• V.2025.1 Concert Genetic Testing: Hereditary Cancer Susceptibility
• V.2025.1 Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders
• V.2025.1 Concert Genetic Testing: Kidney Disorders
• V.2025.1 Concert Genetic Testing: Lung Disorders
• V.2025.1 Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders
• V.2025.1 Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
• V.2025.1 Concert Genetic Testing: Non-invasive Prenatal Screening (NIPS) / Prenatal Cell-Free DNA Testing
• V.2025.1 Concert Genetic Testing: Preimplantation Genetic Testing
• V.2025.1 Concert Genetic Testing: Prenatal and Preconception Carrier Screening
• V.2025.1 Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss
• V.2025.1 Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders
• V.2025.1 Concert Genetics Oncology: Algorithmic Testing
• V.2025.1 Concert Genetics Oncology: Cancer Screening
• V.2025.1 Concert Genetics Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy)
• V.2025.1 Concert Genetics Oncology: Cytogenetic Testing
• V.2025.1 Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies