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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)
- Dermatologic Lab Testing 2024.1 (CG.CP.MP.03) (PDF)
- Infectious Disease: Gastroenterologic Lab Testing 2024.1 (CG.CP.MP.04) (PDF)
- Infectious Disease: Genitourinary Lab Testing 2024.1 (CG.CP.MP.07) (PDF)
- Infectious Disease: Multisystem Lab Testing 2024.1 (CG.CP.MP.02) (PDF)
- Infectious Disease: Primary Care & Preventive Lab Screening 2024.1 (CG.CP.MP.05) (PDF)
- Infectious Disease: Respiratory Lab Testing 2024.1 (HIM.NC.CG.CP.MP.01) (PDF)
- Infectious Disease: Vector-borne and Tropical Diseases Lab Testing 2024.1 (CG.CP.MP.06) (PDF)
- CG.CC.PP.01 Concert Laboratory Payment Policy 2024.1 (PDF)
- Electric Tumor Treating Fields (CP.MP.145) (PDF)
- Facility Based Sleep Studies for Obstructive Sleep Apnea (CP.MP.248) (PDF)
- Stereotactic Body Radiation Therapy (CP.MP.22) (PDF)
- Concert Genetic Testing: Pharmacogenetics (Version A) (V1.2025) (PDF)
- Concert Genetic Testing: Aortopathies and Connective Tissue Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Cardiac Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Dermatologic Conditions (V1.2025) (PDF)
- Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions (V1.2025) (PDF)
- Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Eye Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous) (V1.2025) (PDF)
- Concert Genetic Testing: General Approach to Genetic and Molecular Testing (V1.2025) (PDF)
- Concert Genetic Testing: Hearing Loss (V1.2025) (PDF)
- Concert Genetic Testing: Hematologic Conditions (non-cancerous) (V1.2025) (PDF)
- Concert Genetic Testing: Hereditary Cancer Susceptibility (V1.2025) (PDF)
- Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Kidney Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Lung Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders (V1.2025) (PDF)
- Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (V1.2025) (PDF)
- Concert Genetic Testing: Non-invasive Prenatal Screening (NIPS) (V1.2025) (PDF)
- Concert Genetic Testing: Preimplantation Genetic Testing (V1.2025) (PDF)
- Concert Genetic Testing: Prenatal and Preconception Carrier Screening (V1.2025) (PDF)
- Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss (V1.2025) (PDF)
- Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders (V1.2025) (PDF)
- Concert Genetics Oncology: Algorithmic Testing (V1.2025) (PDF)
- Concert Genetics Oncology: Cancer Screening (V1.2025) (PDF)
- Concert Genetics Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) (V1.2025) (PDF)
- Concert Genetics Oncology: Cytogenetic Testing (V1.2025) (PDF)
- Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies (V1.2025) (PDF)
- Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing (CP.MP.209) (PDF)
- Polymerase Chain Reaction Respiratory Viral Panel Testing (CP.MP.181) (PDF)
- Testing for Select Genitourinary Conditions (CP.MP.97) (PDF)
- Applied Behavior Analysis (CP.BH.104) (PDF)
- Applied Behavioral Analysis Documentation Requirements (CP.BH.105) (PDF)
- Biofeedback (CP.MP.168) (PDF)
- Burn Surgery (CP.MP.186) (PDF)
- DME (CP.MP.107) (PDF)
- Hyperhidrosis Treatments (CP.MP.62) (PDF)
- Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180) (PDF)
- Implantable Intrathecal or Epidural Pain Pump (CP.MP.173) (PDF)
- Implantable Loop Recorder (CP.MP.243) (PDF)
- Obstetrical Home Care Program (CP.MP.91) (PDF)
- Outpatient Oxygen Use (CP.MP.190) (PDF)
- Proton and Neutron Beam Therapies (CP.MP.70) (PDF)
- Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (CP.MP.174) (PDF)
- Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (CP.MP.117) (PDF)
- Therapeutic Utilization of Inhaled Nitric Oxide (CP.MP.87) (PDF)
- Urinary Incontinence Devices and Treatments (CP.MP.142) (PDF)
- Ventricular Assist Devices (CP.MP.46) (PDF)
- Articular Cartilage Defect Repairs (CP.MP.26)
- Functional MRI (CP.MP.43)
- Air Ambulance (CP.MP.175) (PDF)
- Assisted Reproductive Technology (CP.MP.55) (PDF)
- Bariatric Surgery (CP.MP.37) (PDF)
- Behavioral Health Treatment Documentation Requirements (HIM.CP.BH.500) (PDF)
- Concert Genetic Testing: Hereditary Cancer Susceptibility (CG 2025.1) (PDF)
- CPG Grid (PDF)
- Deep Transcranial Magnetic Stimulation for Treatment of Obsessive Compulsive Disorder (CP.BH.201) (PDF)
- Donor Lymphocyte Infusion (CP.MP.101) (PDF)
- Experimental Technologies (CP.MP.36) (PDF)
- Fertility Preservation (CP.MP.130) (PDF)
- Gastric Electrical Stimulation (CP.MP.40) (PDF)
- Heart-Lung Transplant (CP.MP.132) (PDF)
- Home Births (CP.MP.136) (PDF)
- Home Ventilators (CP.MP.184) (PDF)
- Implantable Wireless Pulmonary Artery Pressure Monitoring (CP.MP.160) (PDF)
- Intensity-Modulated Radiotherapy (CP.MP.69) (PDF)
- Long Term Care Placement (CP.MP.71) (PDF)
- Lung Transplantation (CP.MP.57) (PDF)
- Mechanical Stretching Devices for Joint Stiffness and Contracture (CP.MP.144) (PDF)
- Neonatal Abstinence Syndrome Guidelines (CP.MP.86) (PDF)
- Neonatal Sepsis Management (CP.MP.85) (PDF)
- Nerve Blocks and Neurolysis for Pain Management (CP.MP.170) (PDF)
- NICU Apnea Bradycardia Guidelines (CP.MP.82) (PDF)
- NICU Discharge Guidelines (CP.MP.81) (PDF)
- Nonmyeloablative Allogeneic Stem Cell Transplants (CP.MP.141) (PDF)
- Outpatient Cardiac Rehabilitation (CP.MP.176) (PDF)
- Pancreas Transplantation (CP.MP.102) (PDF)
- Pediatric Kidney Transplant (CP.MP.246) (PDF)
- Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (CP.MP.147) (PDF)
- Phototherapy for Neonatal Hyperbilirubinemia (CP.MP.150) (PDF)
- Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins (CP.MP.146) (PDF)
- Skin and Soft Tissue Substitutes for Chronic Wounds With changes (CP.MP.185) (PDF)
- SNF Leveling (CC.PP.206) (PDF)
- Tandem Transplant (CP.MP.162) (PDF)
- Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (CP.MP.163) (PDF)
- Transcranial Magnetic Stimulation for Treatment of Major Depression (CP.BH.200) (PDF)
- Transplant Service Documentation Requirements (CP.MP.247) (PDF)