| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Artificial Intervertebral Disc: Cervical SpinePayerPolicy · BCBSKS-ARTIFICIAL-INTERVERTEBRAL-DISC-CERVICAL-SPINE | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Aqueous Shunts and Stents for GlaucomaPayerPolicy · BCBSKS-AQUEOUS-SHUNTS-AND-STENTS-FOR-GLAUCOMA | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Analysis of Human DNA or RNA in Stool Samples as a Technique for Colorectal Cancer ScreeningPayerPolicy · BCBSKS-ANALYSIS-OF-HUMAN-DNA-OR-RNA-IN-STOOL-SAMPLES-AS-A-TECHNIQUE-FOR-COLORECTAL-CANCER-SCREENING | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Amniotic Membrane and Amniotic FluidPayerPolicy · BCBSKS-AMNIOTIC-MEMBRANE-AND-AMNIOTIC-FLUID | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Ambulatory Event Monitors and Mobile Cardiac Outpatient TelemetryPayerPolicy · BCBSKS-AMBULATORY-EVENT-MONITORS-AND-MOBILE-CARDIAC-OUTPATIENT-TELEMETRY | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Adjustable Cranial Orthoses for Positional Plagiocephaly and CraniosynostosesPayerPolicy · BCBSKS-ADJUSTABLE-CRANIAL-ORTHOSES-FOR-POSITIONAL-PLAGIOCEPHALY-AND-CRANIOSYNOSTOSES | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early Stage Breast CancerPayerPolicy · BCBSKS-ACCELERATED-BREAST-IRRADIATION-AND-BRACHYTHERAPY-BOOST-AFTER-BREAST-CONSERVING-SURGERY-FOR-EARLY-STAGE-BREAST-CANCER | Metadata changed |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early Stage Breast CancerPayerPolicy · BCBSKS-ACCELERATED-BREAST-IRRADIATION-AND-BRACHYTHERAPY-BOOST-AFTER-BREAST-CONSERVING-SURGERY-FOR-EARLY-STAGE-BREAST-CANCER-FUTURE | New policy |
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| Sep 30, 2026 | Blue Cross and Blue Shield of Kansas | ACA Prevention Copay Waiver Criteria – Individual Marketplace, CommercialPayerPolicy · BCBSKS-ACA-PREVENTION-COPAY-WAIVER-CRITERIA-INDIVIDUAL-MARKETPLACE-COMMERCIAL | Metadata changed |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Maternal Serum Biomarkers for Prediction of Adverse Obstetric OutcomesPayerPolicy · ARKBLUE-MATERNAL-SERUM-BIOMARKERS-FOR-PREDICTION-OF-ADVE-F916890A7F | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Paliperidone Palmitate (e.g., Long-acting Injectables Invega Sustenna & Invega Trinza, Erzofri)PayerPolicy · ARKBLUE-PALIPERIDONE-PALMITATE-E-G-LONG-ACTING-INJECTABL-319D8B4C9E | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Mucopolysaccharidoses AgentsPayerPolicy · ARKBLUE-MUCOPOLYSACCHARIDOSES-AGENTS-325112FD7F | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Biofeedback as a Treatment of Urinary Incontinence in AdultsPayerPolicy · ARKBLUE-BIOFEEDBACK-AS-A-TREATMENT-OF-URINARY-INCONTINEN-48BDE81BFF | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Biofeedback as a Treatment of HeadachePayerPolicy · ARKBLUE-BIOFEEDBACK-AS-A-TREATMENT-OF-HEADACHE-E886239FB9 | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Biofeedback as a Treatment of Fecal Incontinence or ConstipationPayerPolicy · ARKBLUE-BIOFEEDBACK-AS-A-TREATMENT-OF-FECAL-INCONTINENCE-007674E6DA | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Biofeedback as a Treatment of Chronic PainPayerPolicy · ARKBLUE-BIOFEEDBACK-AS-A-TREATMENT-OF-CHRONIC-PAIN-39F519437B | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel SyndromePayerPolicy · ARKBLUE-PERCUTANEOUS-ELECTRICAL-NERVE-FIELD-STIMULATION-1FCFE861B1 | Retired |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPayerPolicy · ARKBLUE-MATERNAL-SERUM-TESTING-FOR-PREDICTION-OF-ADVERSE-OBSTETRIC-OUTCOMES | New policy |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Paliperidone Palmitate (e.g., Long-acting Injectables Invega Sustenna, Invega Trinza, Erzofri, Invega Hafyera)PayerPolicy · ARKBLUE-PALIPERIDONE-PALMITATE-E-G-LONG-ACTING-INJECTABLES-INVEGA-SUSTENNA-INVEGA-TRINZA-ERZOFRI-INVEGA-HAFYERA | New policy |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Mucopolysaccharidoses Agents [Laronidase (e.g., Aldurazyme), Idursulfase (e.g., Elaprase), Elosulfase alfa (e.g., Vimizim), Galsulfase (e.g., Naglazyme), and Vestronidase alfa (e.g., Mepsevii)]PayerPolicy · ARKBLUE-MUCOPOLYSACCHARIDOSES-AGENTS-LARONIDASE-E-G-ALDURAZYME-IDURSULFASE-E-G-ELAPRASE-ELOSULFASE-ALFA-E-G-VIMIZIM-GALSULFASE-E-G-NAGLAZYME-AND-VESTRONIDASE-ALFA-E-G-M | New policy |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Mammography-Based AI (Image-only) Risk Prediction ModelsPayerPolicy · ARKBLUE-MAMMOGRAPHY-BASED-AI-IMAGE-ONLY-RISK-PREDICTION-MODELS | New policy |
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| Sep 30, 2026 | Arkansas Blue Cross and Blue Shield | Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut Brain InteractionPayerPolicy · ARKBLUE-PERCUTANEOUS-ELECTRICAL-NERVE-FIELD-STIMULATION-FOR-DISORDERS-OF-GUT-BRAIN-INTERACTION | New policy |
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| Sep 30, 2026 | AmeriHealth | Ustekinumab for Intravenous UsePayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-042L-FB7F3D389D | Retired |
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| Sep 30, 2026 | AmeriHealth | Treatments for Complex Regional Pain Syndrome (CRPS)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-026N-FA11A0184F | Retired |
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| Sep 30, 2026 | AmeriHealth | Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-045Q-15811C2D8A | Retired |
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| Sep 30, 2026 | AmeriHealth | Tildrakizumab-asmn (Ilumya)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-098A-B6C7B88389 | Retired |
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| Sep 30, 2026 | AmeriHealth | Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-004Q-C5B9D73772 | Retired |
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| Sep 30, 2026 | AmeriHealth | Steroid-Eluting Sinus Stents and ImplantsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-107F-2041F675E5 | Retired |
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| Sep 30, 2026 | AmeriHealth | Spinal OrthosesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA05-030F-11A2FC388D | Retired |
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| Sep 30, 2026 | AmeriHealth | Sleep Disorder Testing and Positive Airway Pressure Therapy Services and SuppliesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-058M-ADE6C85689 | Retired |
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| Sep 30, 2026 | AmeriHealth | Remote Electrical Neuromodulation for MigrainesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA05-071-8A6593674D | Retired |
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| Sep 30, 2026 | AmeriHealth | Psychiatric Collaborative Care Management (CoCM)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-052B-1FF707C1AF | Retired |
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| Sep 30, 2026 | AmeriHealth | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-010AV-113AE127D3 | Retired |
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| Sep 30, 2026 | AmeriHealth | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-010AV-5B4EDCD063 | Retired |
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| Sep 30, 2026 | AmeriHealth | Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) TherapyPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA06-014E-6049C57577 | Retired |
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| Sep 30, 2026 | AmeriHealth | Peroral Endoscopic Myotomy (POEM) ProceduresPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-117A-AC35BDE7DD | Retired |
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| Sep 30, 2026 | AmeriHealth | Percutaneous Coronary Intervention, Coronary Angiography, and Arterial UltrasoundPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-113N-21C2C55945 | Retired |
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| Sep 30, 2026 | AmeriHealth | Pembrolizumab and berahyaluronidase alfa-pmph (KEYTRUDA QLEX)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-189A-CA24F3693A | Retired |
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| Sep 30, 2026 | AmeriHealth | Pembrolizumab (Keytruda)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-121F-0B1ADFE369 | Retired |
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| Sep 30, 2026 | AmeriHealth | Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA10-003J-D11141A12A | Retired |
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| Sep 30, 2026 | AmeriHealth | Otoplasty or Non-Surgical External Ear MoldingPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-058A-E49D2A7377 | Retired |
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| Sep 30, 2026 | AmeriHealth | Orthognathic SurgeryPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-083A-CB7287558D | Retired |
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| Sep 30, 2026 | AmeriHealth | Ocrelizumab (Ocrevus) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-088E-34BF4BA987 | Retired |
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| Sep 30, 2026 | AmeriHealth | Nusinersen (Spinraza)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-086D-54F9058120 | Retired |
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| Sep 30, 2026 | AmeriHealth | Non-Spinal Osteogenic Stimulators (Electrical and Ultrasonic)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA05-018D-CF394E4F91 | Retired |
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| Sep 30, 2026 | AmeriHealth | Nivolumab (Opdivo), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-120G-E40D29927E | Retired |
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| Sep 30, 2026 | AmeriHealth | Neuropsychological Testing for Neurologically Based ConditionsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-038K-1A6082FE77 | Retired |
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| Sep 30, 2026 | AmeriHealth | Musculoskeletal ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-047T-3F39C24AB1 | Retired |
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| Sep 30, 2026 | AmeriHealth | Multiple Surgery Payment ReductionPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-032H-91D1904680 | Retired |
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| Sep 30, 2026 | AmeriHealth | Mogamulizumab-kpkc (Poteligeo)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-102G-5A52F34C14 | Retired |
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