Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Recorded changes
77,129 on record
Recorded policy changes, newest first| Recorded | Payer | Policy | Change |
|---|
| Oct 1, 2026 | Ambetter | Wheelchair SeatingPayerPolicy · AMBETTER-CP.MP.99 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Ultrasound in PregnancyPayerPolicy · AMBETTER-CP.MP.38 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Gastrointestinal Pathogen Nucleic Acid Detection Panel TestingPayerPolicy · AMBETTER-CP.MP.209 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Scanning Computerized Opthalmic Diagnostic ImagingPayerPolicy · AMBETTER-CP.VP.14 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Transcranial Magnetic Stimulation for Treatment Resistant Major DepressionPayerPolicy · AMBETTER-CP.BH.200 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Short Inpatient Hospital StayPayerPolicy · AMBETTER-CP.MP.182 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Sacroiliac Joint FusionPayerPolicy · AMBETTER-CP.MP.126 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Reduction Mammoplasty and Gynecomastia SurgeryPayerPolicy · AMBETTER-CP.MP.51 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Gender-Affirming ProceduresPayerPolicy · AMBETTER-CP.MP.95 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Skeletal Dysplasia and Rare Bone DisordersPayerPolicy · AMBETTER-CG-Skeletal-Dysplasias-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy LossPayerPolicy · AMBETTER-CG-Prenatl-Diag-via-Amn-etc.-Preg-Loss-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Prenatal Cell-Free DNA TestingPayerPolicy · AMBETTER-CG-Prenatal-Cell-Free-DNA-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Prenatal and Preconception Carrier ScreeningPayerPolicy · AMBETTER-CG-Prenatal-Carrier-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Preimplantation Genetic TestingPayerPolicy · AMBETTER-CG-Preimplantation-Testing-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Pharmacogenetics (Version B)PayerPolicy · AMBETTER-CG-Pharmacogenetics-2025.1-Version-B | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental DelayPayerPolicy · AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial DisordersPayerPolicy · AMBETTER-CG-Metab-Endo-Mito-DO-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Lung DisordersPayerPolicy · AMBETTER-CG-Lung-Disorders-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Kidney DisordersPayerPolicy · AMBETTER-CG-Kidney-Disorders-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid DisordersPayerPolicy · AMBETTER-CG-Immune.Auto.RA.DO-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Hereditary Cancer SusceptibilityPayerPolicy · AMBETTER-CG-Hered-CA-Suscep-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Hematologic Conditions (non-cancerous)PayerPolicy · AMBETTER-CG-Hema-Cond-(nonCA)--2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Hearing LossPayerPolicy · AMBETTER-CG-Hearing-Loss-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: General Approach to Genetic and Molecular TestingPayerPolicy · AMBETTER-CG-General-Approach-to-Gen-Molec-Test-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous)PayerPolicy · AMBETTER-CG-Gastro-Disorders-NonCa-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular ConditionsPayerPolicy · AMBETTER-CG-Epilepsy-Neurodegen-Neuromusc-DO-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Eye DisordersPayerPolicy · AMBETTER-CG-Eye-Disorders-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic DisordersPayerPolicy · AMBETTER-CG-Exome-Genome-Gntc-DO-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Dermatologic ConditionsPayerPolicy · AMBETTER-CG-Derm-Conditions-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Cardiac DisordersPayerPolicy · AMBETTER-CG-Cardiac-Disorders-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Oncology: Cytogenetic TestingPayerPolicy · AMBETTER-CG-Onc-Cytogenetics-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Testing: Aortopathies and Connective Tissue DisordersPayerPolicy · AMBETTER-CG-Aorto-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Oncology: Molecular Analysis of Solid Tumors and Hematologic MalignanciesPayerPolicy · AMBETTER-CG-Onc-Tumor-Hemat.-Malig.-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Oncology: Circulating Tumor Cells (Liquid Biopsy)PayerPolicy · AMBETTER-CG-Onc-Liquid-Biopsy-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Oncology: Cancer ScreeningPayerPolicy · AMBETTER-CG-Onc-Cancer-Screen-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Concert Genetic Oncology: Algorithmic TestingPayerPolicy · AMBETTER-CG-Onc-Algo-2025.1 | Retired |
|---|
| Oct 1, 2026 | Ambetter | Cochlear Implant ReplacementsPayerPolicy · AMBETTER-CP.MP.14 | Retired |
|---|
| Oct 1, 2026 | Priority Health | Stem Cell or Bone Marrow TransplantationPayerPolicy · PRIORITY_HEALTH-STEM-CELL-OR-BONE-MARROW-TRANSPLANTATION-A89141F514 | Retired |
|---|
| Oct 1, 2026 | Priority Health | Neuroablation for pain managementPayerPolicy · PRIORITY_HEALTH-NEUROABLATION-FOR-PAIN-MANAGEMENT-9162DAD231 | Retired |
|---|
| Sep 30, 2026 | UnitedHealthcare | Maximum Frequency Per DayPayerPolicy · UHC-COMM-RP-UHCCP-MAXIMUM-FREQUENCY-PER-DAY-POLICY | Metadata changed |
|---|
| Sep 30, 2026 | Health Net Oregon | Rituximab/Hyaluronidase (Rituxan Hycela); CP.PHAR.260PayerPolicy · HEALTHNET_OR-HNOR-RITUXIMAB-HYALURONIDASE-RITUXAN-HYCELA-CP-PHAR-260-3F0FFBE55D | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | Daratumumab-Haluronidase-fihj (Darzalex Faspro); CP.PHAR.310PayerPolicy · HEALTHNET_OR-HNOR-DARATUMUMAB-HALURONIDASE-FIHJ-DARZALEX-FASPRO-CP-PHAR-31-5FAB920C23 | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | Rituximab (Rituxan and biosimilars); CP.PHAR.260PayerPolicy · HEALTHNET_OR-HNOR-RITUXIMAB-RITUXAN-AND-BIOSIMILARS-CP-PHAR-260-2AB07480B9 | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | Daratumumab (Darzalex); CP.PHAR.310PayerPolicy · HEALTHNET_OR-HNOR-DARATUMUMAB-DARZALEX-CP-PHAR-310-2184946AFF | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | Rituximab (Rituxan and biosimilars); CP.PHAR.260PayerPolicy · HEALTHNET_OR-CP-PHAR-260 | New policy |
|---|
| Sep 30, 2026 | Health Net Oregon | Daratumumab (Darzalex); CP.PHAR.310PayerPolicy · HEALTHNET_OR-CP-PHAR-310 | New policy |
|---|
| Sep 30, 2026 | Health Net Oregon | Trastuzumab/hyaluonidase-oysk (Heceptin Hylecta); CP.PHAR.228PayerPolicy · HEALTHNET_OR-HNOR-TRASTUZUMAB-HYALUONIDASE-OYSK-HECEPTIN-HYLECTA-CP-PHAR-2-0B0E1076FA | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | Diclofenac potassium (Cambia); CP.PCH.28PayerPolicy · HEALTHNET_OR-HNOR-DICLOFENAC-POTASSIUM-CAMBIA-CP-PCH-28-E735BEC864 | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | Desloratadine/pseudoephedrine (Clarinex-D 12-Hour); CP.CPA.123PayerPolicy · HEALTHNET_OR-HNOR-DESLORATADINE-PSEUDOEPHEDRINE-CLARINEX-D-12-HOUR-CP-CPA-8EB66C7CD7 | Retired |
|---|
| Sep 30, 2026 | Health Net Oregon | ; CP.PHAR.529PayerPolicy · HEALTHNET_OR-HNOR-CP-PHAR-529-054D035E53 | Retired |
|---|