Clinical Policy Annual Review

Date: 09/19/24

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 can be found here: https://www.ambettermeridian.com/provider-resources/clinical-payment-policies.html and upcoming changes can be found here:  https://www.ambettermeridian.com/provider-resources/clinical-payment-policies/clinical-policy-updates.html. 

• CP.MP.107 Durable Medical Equipment and Orthotics and Prosthetics Guidelines
• CP.MP.114 Disc Decompression Procedures
• CP.MP.117 Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation
• CP.MP.126 Sacroiliac Joint Fusion
• CP.MP.184 Home Ventilators
• CP.MP.51 Reduction Mammoplasty and Gynecomastia Surgery
• CP.MP.54 Hospice
• CP.MP.93 Bone-Anchored Hearing Aid
• CP.MP.129 Fetal Surgery in Utero for Prenatally Diagnosed Malformations
• CP.MP.171 Facet Joint Interventions
• CP.BH.300 Biofeedback for Behavioral Health Disorders