| News & Announcements | 04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products | | | | | | 4/1/2025 | | | |
| News & Announcements | Updated Preventive Coverage for Hepatitis B Vaccine and Colorectal Cancer Screening (Retroactively Effective) | | | | | | 4/29/2025 | | | |
| Notifications | Walkers | MA05.037a | 4/12/2025 11:00 AM | 5/12/2025 | | | 4/12/2025 | Medical Necessity Criteria;Medical Coding | | |
| New Policies | Zolbetuximab-clzb (Vyloy®) | MA08.181 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management | MA11.119 | | 1/13/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Nogapendekin alfa inbakicept-pmln (Anktiva®) | MA08.175 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Tarlatamab-dlle (Imdelltra™) for intravenous use | MA08.176 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Zanidatamab-hrii (Ziihera®) | MA08.182 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| Updated Policies | Hyperbaric Oxygen Therapy | MA07.001c | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Canes and Crutches | MA05.052c | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Commode Chairs | MA05.036c | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Heating Pads and Heat Lamps | MA05.029d | | 4/21/2025 | | | 4/21/2025 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Surgical Treatment of Nails | MA11.036e | | 4/21/2025 | | | 4/21/2025 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Ventricular Assist Devices (VADs) | MA11.011h | | 4/21/2025 | | | 4/21/2025 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | MA07.005d | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents | MA08.016h | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Botulinum Toxin Agents | MA08.017l | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) | MA07.004j | | 4/21/2025 | | | 4/21/2025 | Medical Coding | | |
| Updated Policies | Pembrolizumab (Keytruda®) | MA08.121f | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™) | MA08.088d | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Intravenous Infliximab and Related Biosimilars | MA08.019o | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Reissue Policies | External Breast Prostheses | MA05.033d | | 5/20/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Tracheostomy Care Supplies | MA05.034a | | 5/6/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Spinal Orthoses | MA05.030f | | 8/12/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Orthopedic Footwear | MA05.012c | | 1/1/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Chiropractic Services | MA10.004i | | 10/23/2023 | 4/2/2025 | | 4/3/2025 | | | |
| Reissue Policies | Home-Based Sleep Studies | MA07.028 | | 1/1/2024 | 4/2/2025 | | 4/3/2025 | | | |
| Reissue Policies | Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis | MA11.097e | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) | MA10.008d | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Manual Wheelchairs | MA05.026d | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Seat Lift Mechanisms | MA05.011b | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Patient Lifts | MA05.031c | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Wheelchair Cushions and Seating | MA05.023d | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Standing Frames | MA05.055 | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Cochlear Implantation | MA11.039e | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | MA11.014g | | 10/1/2021 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Percutaneous Left Atrial Appendage (LAA) Closure for Non-Valvular Atrial Fibrillation (NVAF) | MA11.013c | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | MA05.005g | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Leadless Pacemakers | MA05.067f | | 7/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Wheelchair Options and Accessories | MA05.046j | | 4/1/2025 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | MA11.100f | | 10/21/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | MA10.002f | | 3/11/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Edge-to-Edge Repair (TEER) of the Mitral Valve | MA11.027e | | 9/9/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery | MA11.056h | | 4/8/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Steroid-Eluting Sinus Stents and Implants | MA11.107f | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Pulmonary Rehabilitation | MA10.001c | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia | MA05.027d | | 3/25/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Teclistamab-cqyv (Tecvayli®) | MA08.156c | | 4/8/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Biofeedback Therapy | MA07.010c | | 4/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Enteral Nutritional Therapy | MA08.003h | | 5/6/2024 | | | 4/4/2025 | | | |
| Reissue Policies | Natalizumab (Tysabri®) and Related Biosimilars | MA08.029c | | 4/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Alemtuzumab (Lemtrada®) | MA08.015d | | 5/4/2020 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Non-Spinal Osteogenic Stimulators (Electrical and Ultrasonic) | MA05.018d | | 9/9/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Cryosurgical Ablation of the Prostate Gland | MA11.022a | | 4/7/2015 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Urological Supplies | MA05.054j | | 8/12/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Ultraviolet Light Therapy for the Treatment of Dermatological Conditions | MA07.002i | | 10/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Solid Organ Transplantation and Procurement Cost of Organs and Tissues | MA11.033c | | 6/17/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth | MA04.002 | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Pulse Oximetry Device in the Home Setting | MA05.042d | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Compression Garments | MA05.045e | | 6/3/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Hospital Beds and Accessories | MA05.002f | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Lower Limb Prostheses | MA05.024i | | 10/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Enfortumab vedotin-ejfv (Padcev®) | MA08.113f | | 4/8/2024 | 4/2/2025 | | 4/7/2025 | | | |
| Reissue Policies | Elranatamab-bcmm (Elrexfio™) | MA08.168 | | 4/22/2024 | 4/2/2025 | | 4/7/2025 | | | |
| Reissue Policies | Negative Pressure Wound Therapy Systems | MA05.008d | | 1/22/2024 | 4/2/2025 | | 4/7/2025 | | | |
| Reissue Policies | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | MA03.001b | | 6/21/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56) | MA03.017c | | 10/25/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional | MA03.007b | | 6/21/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents | MA00.051f | | 4/1/2024 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances | MA00.022 | | 1/1/2024 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Routine Foot Care for Certain Medical Conditions | MA07.009i | | 10/1/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Neuropsychological Testing for Neurologically Based Conditions | MA07.038k | | 10/1/2023 | 11/26/2024 | | 4/30/2025 | | | |
| Reissue Policies | Trigger Point Injections | MA11.017j | | 4/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Triamcinolone Acetonide ER Injectable (Zilretta®) | MA08.097a | | 1/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Ankle-Foot/Knee-Ankle-Foot Orthoses | MA05.010k | | 4/8/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Percutaneous Intradiscal Annuloplasty (IDET/PIRFT) | MA11.025 | | 1/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Lipectomy and Liposuction | MA11.070d | | 10/9/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Reduction Mammoplasty | MA11.069f | | 6/3/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Therapeutic Shoes | MA05.020h | | 1/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy | MA11.077h | | 9/9/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Inebilizumab-cdon (Uplizna) | MA08.126b | | 8/9/2021 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Pegloticase (Krystexxa®) | MA08.060g | | 1/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Nucleoplasty | MA11.101 | | 1/1/2015 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices Policy #MA05.032c | MA05.032c | | 1/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Coding Update | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | MA00.001e | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Hematopoietic Stem Cell Transplantation | MA11.002n | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Ankle-Foot/Knee-Ankle-Foot Orthoses | MA05.010k | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | MA05.043d | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Upper-Limb Prostheses | MA05.057d | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Lower Limb Prostheses | MA05.024i | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Trigger Point Injections | MA11.017j | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | MA00.002r | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | External Breast Prostheses | MA05.033d | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®) | MA08.130h | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Wheelchair Options and Accessories | MA05.046j | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Wheelchair Cushions and Seating | MA05.023d | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | MA08.044k | | | | | 4/1/2025 | | | |
| Coding Update | Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds | MA11.015ac | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | MA08.127e | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors | MA08.073r | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Coagulation Factors | MA08.004x | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Gender-Affirming Interventions | MA11.106k | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Durable Medical Equipment (DME) | MA05.044t | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | MA03.003q | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Reimbursement for Radiopharmaceutical Agents for Professional Providers | MA09.009x | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | MA00.030ah | | 4/1/2025 | | | 4/4/2025 | | | |
| Coding Update | Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices | MA05.062l | | | | | 4/9/2025 | | | |
| Coding Update | Compression Garments | MA05.045f | | 4/1/2025 | 4/2/2025 | | 4/14/2025 | | | |
| Coding Update | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services | MA00.010at | | 4/1/2025 | | | 4/15/2025 | | | |
