Clinical Policy Annual Review

Date: 07/31/25

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
• Upcoming changes: https://www.ambettermeridian.com/provider-resources/clinical-payment-policies/clinical-policy-updates
  • CP.MP.58 Intestinal and Multivisceral Transplant
  • CP.MP.87 Therapeutic Utilization of Inhaled Nitric Oxide
  • CP.MP.132 Heart-Lung Transplant