Clinical Policy Updates
Ambetter of North Carolina Inc. continuously updates select clinical policies each month. This page reflects upcoming clinical policy changes. Please refer to this page for recent policy updates and reach out to your Provider Relations representative if you have any questions.
- Bariatric Surgery (CP.MP.37) (PDF)
- Disc Decompression Procedures (CP.MP.114) (PDF)
- Discography (CP.MP.115) (PDF)
- Concert Infectious Disease: Dermatologic Testing (CG.CP.MP.03) (PDF)
- Concert Infectious Disease: Gastroenterologic Testing (CG.CP.MP.04) (PDF)
- Concert Infectious Disease: Genitourinary Testing (CG.CP.MP.07) (PDF)
- Concert Infectious Disease: Multisystem Testing (CG.CP.MP.02) (PDF)
- Concert Infectious Disease: Primary Care & Preventative Screening (CG.CP.MP.05) (PDF)
- Concert Infectious Disease: Vector-Borne And Tropical Diseases Testing (CG.CP.MP.06) (PDF)
- Concert Laboratory Payment Policy (CG.CC.PP.01) (PDF)
- Heart-Lung Transplant (CP.MP.132) (PDF)
- Infectious Disease: Respiratory Lab Testing (HIM.NC.CG.CP.MP.01) (PDF)
- Intestinal and Multivisceral Transplant (CP.MP.58) (PDF)
- Leveling of Care: Emergency Department Evaluation and Management Overcoding for Professional Services (CC.PP.076) (PDF)
- Leveling of Care: Office-based Evaluation and Management Overcoding (CC.PP.066) (PDF)
- Liposuction for Lipedema (CP.MP.244) (PDF)
- Lysis of Epidural Lesions (CP.MP.116) (PDF)
- Multiple Sleep Latency Testing (CP.MP.24) (PDF)
- Newborn Inpatient Stays (CC.PP.075) (PDF)
- Pediatric Oral Function Therapy (CP.MP.188) (PDF)
- Repair of Nasal Valve Compromise (CP.MP.210) (PDF)
- Sacroiliac Joint Fusion (CP.MP.126) (PDF)
- Therapeutic Utilization of Inhaled Nitric Oxide (CP.MP.87) (PDF)
- Transcranial Magnetic Stimulation for Treatment Resistant Major Depression) (CP.BH.200) (PDF)
- Acupuncture (CP.MP.92) (PDF)
- Allogeneic Hematopoietic Progenitor Cell Therapy (CP.MP.249) (PDF)
- Bone-Anchored Hearing Aid (CP.MP.93) (PDF)
- Fecal Incontinence Treatments (CP.MP.137) (PDF)
- Physical, Occupational, and Speech Therapy Services (CP.MP.49) (PDF)
- Reduction Mammoplasty and Gynecomastia Surgery (CP.MP.51) (PDF)
- Sacroiliac Joint Interventions for Pain Management (CP.MP.166) (PDF)
- Skin and Soft Tissue Substitutes for Chronic Wounds (CP.MP.185) (PDF)
- Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections (CP.MP.165) (PDF)
- Total Artificial Heart (CP.MP.127) (PDF)
- Applied Behavior Analysis (CP.BH.104) (PDF)
- Durable Medical Equipment and Orthotics and Prosthetics Guidelines (CP.MP.107) (PDF)
- ApneaGender-Affirming Procedures (HIM.NC.CP.MP.95) (PDF)
- IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (CP.MP.61) (PDF)
- Orthognathic Surgery (CP.MP.202) (PDF)
- Radiation Therapy for Skin Cancer (CP.MP.251) (PDF)
- Applied Behavioral Analysis Documentation Requirements (CP.BH.105) (PDF)
- Biofeedback (CP.MP.168) (PDF)
- Concert Genetic Testing: Cardiovascular (V2.2025) (PDF)
- Concert Genetic Testing: Gastroenterology (V2.2025) (PDF)
- Concert Genetic Testing: Neurology (V2.2025) (PDF)
- Concert Genetic Testing: Toxicology and Pharmacogenetics (Version A) (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Algorithmic Assays (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Cancer Screening and Surveillance (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Hematologic Malignancy (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Hereditary Cancer (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Identity and Forensics (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Multisystem Genetic Conditions (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Nutrition and Metabolism (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Preimplantation Genetic Testing (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Prenatal Screening (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Solid Tumor Molecular Diagnostics (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Transplant (V2.2025) (PDF)
- Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180) (PDF)
- Obstetrical Home Care Programs (CP.MP.91) (PDF)
- Outpatient Oxygen Use (CP.MP.190) (PDF)
- Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (CP.MP.174) (PDF)
- Skin and Soft Tissue Substitutes for Diabetic Foot Ulcers and Venous Leg Ulcers (CP.MP.185) (PDF)
- Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (CP.MP.117) (PDF)
- Applied Behavior Analysis (CP.BH.104) (PDF)
- Applied Behavioral Analysis Documentation Requirements (CP.BH.105) (PDF)
- Assisted Reproductive Technology (CP.MP.55) (PDF)
- Concert Genetic Testing: Multisystem Genetic Conditions (V2.2025) (PDF)
- Deep Transcranial Magnetic Stimulation for the Treatment of Obsessive Compulsive Disorder (CP.BH.201) (PDF)
- Heart-Lung Transplant (CP.MP.132) (PDF)
- Home Births (CP.MP.136) (PDF)
- Home Ventilators (CP.MP.184) (PDF)
- Immobilized Lipase Cartridges (RELiZORB®) (CP.MP.252) (PDF)
- Lung Transplantation (CP.MP.57) (PDF)
- Pancreas Transplantation (CP.MP.102) (PDF)
- Tandem Transplant (CP.MP.162) (PDF)
- Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (CP.BH.200) (PDF)
- Behavioral Health Treatment Documentation Requirements (HIM.CP.BH.500) (PDF)
- Biofeedback for Behavioral Health Disorders (CP.BH.300) (PDF)
- Caudal or Interlaminar Epidural Steroid Injections (CP.MP.164) (PDF)
- Coverage for Gender-Affirming Procedures (HIM.CP.MP.395) (PDF)
- Fetal Surgery in Utero for Prenatally Diagnosed Malformations (CP.MP.129) (PDF)
- Hospice Services (CP.MP.54) (PDF)
- Liposuction for Lipodema (CP.MP.244) (PDF)
- Neonatal Abstinence Syndrome Guidelines (CP.MP.86) (PDF)
- Pediatric Liver Transplant (CP.MP.120) (PDF)
- Phototherapy for Neonatal Hyperbilirubinemia (CP.MP.150) (PDF)
- Physical, Occupational, and Speech Therapy Services (CP.MP.49) (PDF)
- Skin and Soft Tissue Substitutes (CP.MP.185) (PDF)