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Clinical Policy Updates
Ambetter of Tennessee 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.
- 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)
- Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections (CP.MP.165) (PDF)
- Total Artificial Heart (CP.MP.127) (PDF)
- Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia (CP.MP.108) (PDF)
- Applied Behavior Analysis (CP.BH.104) (PDF)
- Bariatric Surgery (CP.MP.37) (PDF)
- Cosmetic and Reconstructive Procedures (CP.MP.31) (PDF)
- Durable Medical Equipment and Orthotics and Prosthetics Guidelines (CP.MP.107) (PDF)
- IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (CP.MP.61) (PDF)
- Orthognathic Surgery (CP.MP.202) (PDF)
- Pediatric Heart Transplant (CP.MP.138) (PDF)
- Radiation Therapy for Skin Cancer (CP.MP.251) (PDF)
- Electric Tumor Treating Fields (CP.MP.145) (PDF)
- Facility Based Sleep Studies for Obstructive Sleep Apnea (CP.MP.248) (PDF)
- Pediatric Oral Function Therapy (CP.MP.188) (PDF)
- Skin and Soft Tissue Substitutes for Chronic Wounds (CP.MP.185) (PDF)
- Transplant Service Documentation Requirements (CP.MP.247) (PDF)
- Applied Behavior Analysis (CP.BH.104) (PDF)
- Applied Behavioral Analysis Documentation Requirements (CP.BH.105) (PDF)
- Assisted Reproductive Technology (CP.MP.55) (PDF)
- Biofeedback (CP.MP.168) (PDF)
- Concert Genetic Testing Oncology: Algorithmic Assays (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Cancer Screening and Surveillance (V2.2025) (PDF)
- Concert Genetic Testing: Cardiovascular (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Hematologic Malignancy (V2.2025) (PDF)
- Concert Genetic Testing Oncology: Solid Tumor Molecular Diagnostics (V2.2025) (PDF)
- Concert Genetic Testing: Multisystem Genetic Conditions (V2.2025) (PDF)
- Concert Genetic Testing: Gastroenterology (V2.2025) (PDF)
- Concert Genetic Testing: Hereditary Cancer (V2.2025) (PDF)
- Concert Genetic Testing: Identity and Forensics (V2.2025) (PDF)
- Concert Genetic Testing: Neurology (V2.2025) (PDF)
- Concert Genetic Testing: Nutrition and Metabolism (V2.2025) (PDF)
- Concert Genetic Testing: Preimplantation Genetic Testing (V2.2025) (PDF)
- Concert Genetic Testing: Prenatal Screening (V2.2025) (PDF)
- Concert Genetic Testing: Transplant (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)
- Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180) (PDF)
- Lung Transplantation (CP.MP.57) (PDF)
- Obstetrical Home Care Programs (CP.MP.91) (PDF)
- Outpatient Oxygen Use (CP.MP.190) (PDF)
- Pancreas Transplant (CP.MP.102) (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)
- Tandem Transplant (CP.MP.162) (PDF)
- Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (CP.BH.200) (PDF)