Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Recorded changes
82,180 on record
Recorded policy changes, newest first| Recorded | Payer | Policy | Change |
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| Sep 30, 2026 | Molina Healthcare | HospicePayerPolicy · MOLINA-WA-MARKETPLACE-CLINICAL-HOSPICE | Retired |
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| Sep 30, 2026 | Molina Healthcare | Facility Emergency Department Evaluation and Management levelingPayerPolicy · MOLINA-WA-MARKETPLACE-CLINICAL-FACILITY-EMERGENCY-DEPARTMENT-EVALUATION-AND | Retired |
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| Sep 30, 2026 | Molina Healthcare | Unspecified Codes in an Inpatient SettingPayerPolicy · MOLINA-WA-MARKETPLACE-UNSPECIFIED-CODES-IN-AN-INPATIENT-SETTING | Retired |
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| Sep 30, 2026 | Molina Healthcare | Tendon Injections Missing DiagnosisPayerPolicy · MOLINA-WA-MARKETPLACE-TENDON-INJECTIONS-MISSING-DIAGNOSIS | Retired |
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| Sep 30, 2026 | Molina Healthcare | G2181 Colorectal Cancer Screening Prior VariancePayerPolicy · MOLINA-WA-MEDICARE-LAB-G2181-COLORECTAL-CANCER-SCREENING-PRIOR-VARIANCE | Retired |
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| Sep 30, 2026 | Molina Healthcare | Reduced Services and Discontinued ProceduresPayerPolicy · MOLINA-WA-MARKETPLACE-REDUCED-SERVICES-AND-DISCONTINUED-PROCEDURES | Retired |
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| Sep 30, 2026 | Molina Healthcare | Global Surgical Packages for Professional ProvidersPayerPolicy · MOLINA-WA-MARKETPLACE-GLOBAL-SURGICAL-PACKAGES-FOR-PROFESSIONAL | Retired |
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| Sep 30, 2026 | Molina Healthcare | Emergency EM Codes and Place of ServicePayerPolicy · MOLINA-WA-MARKETPLACE-EMERGENCY-EM-CODES-AND-PLACE-OF-SERVICE | Retired |
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| Sep 30, 2026 | Molina Healthcare | Diagnosis Code CodingPayerPolicy · MOLINA-WA-MARKETPLACE-CODING-DIAGNOSIS-CODE-CODING | Retired |
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| Sep 30, 2026 | Molina Healthcare | Condition Codes 49, 50, and 53PayerPolicy · MOLINA-WA-MARKETPLACE-CONDITION-CODES-49-50-AND-53 | Retired |
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| Sep 30, 2026 | Oscar Health | Zynteglo (betibeglogene autotemcel) (CG073)PayerPolicy · OSCAR-ZYNTEGLO-BETIBEGLOGENE-AUTOTEMCEL-CG073-C54796FA04 | Retired |
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| Sep 30, 2026 | Oscar Health | Rosuvastatin (Crestor) (PG006, Ver. 8)PayerPolicy · OSCAR-ROSUVASTATIN-CRESTOR-PG006-VER-8-8DE749E1C7 | Retired |
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| Sep 30, 2026 | Oscar Health | Roctavian (valoctocogene roxaparvovec-rvox) (PG163)PayerPolicy · OSCAR-ROCTAVIAN-VALOCTOCOGENE-ROXAPARVOVEC-RVOX-PG1-A8862B4932 | Retired |
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| Sep 30, 2026 | Oscar Health | Modafinil (Provigil) (PG035, Ver. 7)PayerPolicy · OSCAR-MODAFINIL-PROVIGIL-PG035-VER-7-0FCCD48CE3 | Retired |
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| Sep 30, 2026 | Oscar Health | Memantine (Namenda) (PG213, Ver. 2)PayerPolicy · OSCAR-MEMANTINE-NAMENDA-PG213-VER-2-F6D49CA891 | Retired |
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| Sep 30, 2026 | Oscar Health | Luxturna (voretigene neparvovec-rzyl) (CG060)PayerPolicy · OSCAR-LUXTURNA-VORETIGENE-NEPARVOVEC-RZYL-CG060-FA3E023521 | Retired |
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| Sep 30, 2026 | Oscar Health | Lurasidone (Latuda) (PG057, Ver. 8)PayerPolicy · OSCAR-LURASIDONE-LATUDA-PG057-VER-8-E9E490410C | Retired |
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| Sep 30, 2026 | Oscar Health | Lamotrigine Orally Disintegrating Tablet (PG083, Ver. 7)PayerPolicy · OSCAR-LAMOTRIGINE-ORALLY-DISINTEGRATING-TABLET-PG08-2F3851D1CD | Retired |
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| Sep 30, 2026 | Oscar Health | lamotrigine extended release (Lamictal XR) (PG055, Ver7)PayerPolicy · OSCAR-LAMOTRIGINE-EXTENDED-RELEASE-LAMICTAL-XR-PG05-338BFF31F5 | Retired |
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| Sep 30, 2026 | Oscar Health | Lacosamide (Vimpat) (PG056, Ver. 7)PayerPolicy · OSCAR-LACOSAMIDE-VIMPAT-PG056-VER-7-12C1B1D361 | Retired |
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| Sep 30, 2026 | Oscar Health | Fesoterodine (Toviaz) (PG102, Ver. 6)PayerPolicy · OSCAR-FESOTERODINE-TOVIAZ-PG102-VER-6-8CBB033AC3 | Retired |
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| Sep 30, 2026 | Oscar Health | Ezetimibe (Zetia) (PG073, Ver. 7)PayerPolicy · OSCAR-EZETIMIBE-ZETIA-PG073-VER-7-81E0CEE063 | Retired |
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| Sep 30, 2026 | Oscar Health | Caremark Prior Authorization CriteriaPayerPolicy · OSCAR-CAREMARK-PRIOR-AUTHORIZATION-CRITERIA-DC9AB0ACEA | Retired |
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| Sep 30, 2026 | Oscar Health | Budesonide 3mg Delayed-Release Capsule (Entocort EC) (PG082, Ver. 7)PayerPolicy · OSCAR-BUDESONIDE-3MG-DELAYED-RELEASE-CAPSULE-ENTOCO-9BB8ACF94E | Retired |
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| Sep 30, 2026 | Oscar Health | Beqvez (fidanacogene elaparvovec) (CG118)PayerPolicy · OSCAR-BEQVEZ-FIDANACOGENE-ELAPARVOVEC-CG118-50D6909A9E | Retired |
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| Sep 30, 2026 | Oscar Health | Autoimmune Conditions Exception Criteria (2026, Ver. 7)PayerPolicy · OSCAR-AUTOIMMUNE-CONDITIONS-EXCEPTION-CRITERIA-2026-AF223E3C79 | Retired |
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| Sep 30, 2026 | Oscar Health | Antidiabetic Agent - SymlinPen (pramlintide acetate) (PG156, Ver. 5)PayerPolicy · OSCAR-ANTIDIABETIC-AGENT-SYMLINPEN-PRAMLINTIDE-ACET-B46A992FFC | Retired |
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| Sep 30, 2026 | Oscar Health | paroxetine 7.5 mg capsule (PG272, Ver. 2)PayerPolicy · OSCAR-PG272-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | azelaic acid 15% gel (PG059, Ver. 8)PayerPolicy · OSCAR-PG059-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Vyvanse (lisdexamfetamine) (PG098, Ver. 8)PayerPolicy · OSCAR-PG098-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Velphoro (sucroferric oxyhydroxide) (PG179, Ver. 4)PayerPolicy · OSCAR-PG179-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Sublingual Allergy Immunotherapy (SLIT) (PG093, Ver. 7)PayerPolicy · OSCAR-PG093-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Sancuso (granisetron) Patch (PG007, Ver. 9)PayerPolicy · OSCAR-PG007-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Rezzayo (rezafungin) (PG145, Ver. 3)PayerPolicy · OSCAR-PG145-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Prescription Drugs for Serious Mental Illnesses-REG (PG171, Ver. 4)PayerPolicy · OSCAR-PG171-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Prenatal Vitamins Zero Copay Exception-REG (PG258, Ver. 2)PayerPolicy · OSCAR-PG258-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Pedmark (sodium thiosulfate) (PG133, Ver. 5)PayerPolicy · OSCAR-PG133-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Orladeyo (PG090, Ver. 8)PayerPolicy · OSCAR-PG090-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Orilissa (elagolix) (PG261, Ver. 2)PayerPolicy · OSCAR-PG261-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Onasemnogene abeparvovec (Zolgensma [-xioi]; Itvisma, [-brve]) (CG061, Ver. 6)PayerPolicy · OSCAR-CG061-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Mesalamine DR 800 mg (Asacol HD) (PG024, Ver. 8)PayerPolicy · OSCAR-PG024-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Medical Necessity Prior Authorization Criteria for Formulary Products (PG076, Ver. 8)PayerPolicy · OSCAR-PG076-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Lyfgenia (lovotibeglogene autotemcel) (CG114, Ver. 3)PayerPolicy · OSCAR-CG114-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Livtencity (maribavir) (PG113, Ver. 5)PayerPolicy · OSCAR-PG113-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Lenmeldy (atidarsagene autotemcel) (CG117, Ver. 3)PayerPolicy · OSCAR-CG117-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Kerendia (finerenone) (PG263, Ver. 2)PayerPolicy · OSCAR-PG263-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Icosapent ethyl (Vascepa) (PG125, Ver. 5)PayerPolicy · OSCAR-PG125-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Fleqsuvy (baclofen oral suspension) (PG112, Ver. 5)PayerPolicy · OSCAR-PG112-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Filsuvez (birch triterpenes) (PG211, Ver. 3)PayerPolicy · OSCAR-PG211-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Eucrisa (crisaborole) (PG023, Ver. 8)PayerPolicy · OSCAR-PG023-PHARMACY | Metadata changed |
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