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MPDocType
Title
MPPolicyNumber
MPNotificationIssuedDate
MPEffectiveDate
MPReissuedDate
MPArchiveNotifEffDate
MPSALogCreatedOn
MPPolicyChangeTypeslt
MPRevisionDate
MPSiteActivityRemovedDate
Notifications
Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
MA00.050c
8/29/2025 10:00 AM
12/1/2025
8/29/2025
Coverage and/or Reimbursement Position
Notifications
Reporting and Documentation Requirements for Anesthesia Services
MA00.009i
8/29/2025 10:00 AM
12/1/2025
8/29/2025
Coverage and/or Reimbursement Position;Medical Necessity Criteria
New Policies
Tislelizumab-jsgr (Tevimbra®)
MA08.173
8/25/2025
8/25/2025
This is a New Policy.
Updated Policies
Ramucirumab (Cyramza®)
MA08.075i
8/18/2025
8/18/2025
Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated Policies
patisiran (Onpattro®) and vutrisiran (Amvuttra®)
MA08.100e
8/18/2025
8/18/2025
Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated Policies
Tafasitamab-cxix (Monjuvi®)
MA08.138e
8/18/2025
8/18/2025
Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated Policies
Toripalimab-tpzi (Loqtorzi™)
MA08.170a
8/18/2025
8/18/2025
Medical Necessity Criteria;Medical Coding
Updated Policies
Octreotide Acetate (Sandostatin® LAR Depot)
MA08.065k
8/18/2025
8/18/2025
Medical Necessity Criteria;Medical Coding
Updated Policies
Sentinel Lymph Node Biopsy and Mapping
MA11.068f
8/25/2025
8/25/2025
Medical Necessity Criteria
Updated Policies
In Vivo Allergy Sensitivity Testing
MA06.004d
8/25/2025
8/25/2025
Medical Necessity Criteria
Updated Policies
Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™)
MA08.127f
8/25/2025
8/25/2025
Medical Necessity Criteria
Updated Policies
Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)
MA08.085j
8/25/2025
8/25/2025
Medical Necessity Criteria
Reissue Policies
Tezepelumab-ekko (Tezspire®)
MA08.144b
1/2/2024
8/6/2025
8/6/2025
Reissue Policies
Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
MA01.008c
10/1/2024
8/6/2025
8/6/2025
Reissue Policies
Home Prothrombin Time Monitoring
MA05.016i
10/1/2024
8/6/2025
8/6/2025
Reissue Policies
Intravenous Chelation Therapy
MA07.016c
1/1/2024
8/6/2025
8/6/2025
Reissue Policies
Medical and Surgical Treatment of Temporomandibular Joint Disorder
MA07.024g
2/26/2024
8/6/2025
8/6/2025
Reissue Policies
Golimumab (Simponi Aria®) Intravenous (IV) Injection
MA08.070f
1/1/2024
8/6/2025
8/6/2025
Reissue Policies
Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests
MA00.001e
4/1/2025
8/6/2025
8/6/2025
Reissue Policies
Orthognathic Surgery
MA11.083a
6/30/2017
8/6/2025
8/6/2025
Reissue Policies
Nebulizers and Inhalation Solutions
MA05.007f
1/1/2024
8/6/2025
8/6/2025
Reissue Policies
Hair Transplants and Cranial Prostheses (Wigs)
MA11.046c
10/1/2024
8/6/2025
8/6/2025
Coding Update
External Infusion Pumps
MA05.060d
7/1/2025
8/14/2025
Archived Policies
Gender-Affirming Interventions
MA11.106k
8/22/2025 11:00 AM
9/22/2025
8/22/2025
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