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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.
- Wheelchair Seating CP.MP.99 (PDF)
- Infectious Disease: Respiratory Lab Testing - HIM.NC.CG.MP.01 (PDF)
- CP.MP.22- Stereotactic Body Radiation Therapy (PDF)
- CP.MP.62 Hyperhidrosis Treatments (PDF)
- CP.MP.82 NICU Apnea Bradycardia Guidelines (PDF)
- CP.MP.173 Implantable Intrathecal or Epidural Pain Pump (PDF)
- CP.MP.190 Outpatient Oxygen Use (PDF)
- CP.MP.243 Implantable Loop Recorder (PDF)
- CP.MP.248 Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF)
- CP.BH.104 Applied Behavioral Analysis (PDF)
- CP.MP.144 Mechanical Stretching Devices for Joint Stiffness (PDF)
- CP.MP.186 Burn Surgery (PDF)
- CP.MP.247 Transplant Service Documentation Requirements (PDF)
- CP.MP.91 OB Home Programs (PDF)
- CP.MP.40 Gastric Electrical Stimulation (PDF)
- CP.MP.132 Heart-Lung Transplant (PDF)
- CP.MP.141 Non-Myeloablative Allogeneic Stem Cell Transplants (PDF)
- Bariatric Surgery (CP.MP.37) (PDF)
- Behavioral Health Treatment Documentation Requirements (HIM.CP.BH.500) (PDF)
- Concert Genetic Oncology: Algorithmic Testing (V2.2024) (PDF)
- Concert Genetic Oncology: Cancer Screening (V2.2024) (PDF)
- Concert Genetic Oncology: Circulating Tumor Cells (Liquid Biopsy) (V2.2024) (PDF)
- Concert Genetic Oncology: Cytogenetic Testing (V2.2024) (PDF)
- Concert Genetic Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies (V2.2024) (PDF)
- Concert Genetic Testing: Aortopathies and Connective Tissue Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Cardiac Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Dermatologic Conditions (V2.2024) (PDF)
- Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions (V2.2024) (PDF)
- Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Eye Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous) (V2.2024) (PDF)
- Concert Genetic Testing: General Approach to Genetic and Molecular Testing (V2.2024) (PDF)
- Concert Genetic Testing: Hearing Loss (V2.2024) (PDF)
- Concert Genetic Testing: Hematologic Conditions (non-cancerous) (V2.2024) (PDF)
- Concert Genetic Testing: Hereditary Cancer Susceptibility (V2.2024) (PDF)
- Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Kidney Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Lung Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders (V2.2024) (PDF)
- Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (V2.2024) (PDF)
- Concert Genetic Testing: Non-invasive Prenatal Screening (NIPS) (V2.2024) (PDF)
- Concert Genetic Testing: Pharmacogenetics (V2.2024) (PDF)
- Concert Genetic Testing: Preimplantation Genetic Testing (V2.2024) (PDF)
- Concert Genetic Testing: Prenatal and Preconception Carrier Screening (V2.2024) (PDF)
- Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss (V2.2024) (PDF)
- Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders (V2.2024) (PDF)
- Deep Transcranial Magnetic Stimulation for the Treatment of Obsessive Compulsive Disorder (CP.BH.201) (PDF)
- Intensity-Modulated Radiotherapy (CP.MP.69) (PDF)
- Outpatient Cardiac Rehabilitation (CP.MP.176) (PDF)
- Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other Symptomatic Venous Disorders (CP.MP.146) (PDF)
- Skin and Soft Tissue Substitutes for Chronic Wounds (CP.MP.185) (PDF)
- Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (CP.BH.200) (PDF)
- Biofeedback for Behavioral Health Disorders (CP.BH.300) (PDF)
- Bone-Anchored Hearing Aid (CP.MP.93) (PDF)
- Disc Decompression Procedures (CP.MP.114) (PDF)
- Durable Medical Equipment and Orthotics and Prosthetics Guidelines (CP.MP.107) (PDF)
- Facet Joint Interventions (CP.MP.171) (PDF)
- Fetal Surgery in Utero for Prenatally Diagnosed Malformations (CP.MP.129) (PDF)
- Home Ventilators (CP.MP.184) (PDF)
- Hospice (CP.MP.54) (PDF)
- Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180) (PDF)
- Reduction Mammoplasty and Gynecomastia Surgery (CP.MP.51) (PDF)
- Sacroiliac Joint Fusion (CP.MP.126) (PDF)
- Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (CP.MP.117) (PDF)
- Vagus Nerve Stimulation (CP.MP.12) (PDF)