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Behavioral Health MP-001 Transcranial Magnetic Stimulation-Repetitive (rTMS) July 24, 2023 May 24, 2023 July 24, 2024
General Surgery mp-002 Gender Affirming Surgery January 17, 2024 January 17, 2024 January 17, 2025
Pediatrics MP-003 Chromosomal Microarray (CMA)/Comparative Genomic Hybridization (CGH) Testing for Developmental Delay and Fetal Demise January 17, 2024 January 17, 2024 January 17, 2025
Pulmonary MP-004 Hypoglossal Nerve Stimulator for Obstructive Sleep Apnea February 21, 2024 February 21, 2024 February 21, 2025
Ear, Nose, and Throat (ENT) MP-005 Balloon Dilation of the Eustachian Tube May 20, 2024 March 20, 2024 March 20, 2025
Gastroenterology MP-006 DNA Analysis of Stool for Colon Cancer Screening (Cologuard ®) June 21, 2023 June 21, 2023 June 21, 2024
Endocrinology MP-007 Ambulatory Insulin Pumps and Closed-Loop Insulin Delivery Systems December 25, 2023 October 25, 2023 October 25, 2024
Endocrinology MP-008 Continuous Glucose Monitor (CGM) September 28, 2023 July 28, 2023 July 28, 2024
Radiation Therapy MP-009 Proton Beam Therapy August 16, 2023 August 16, 2023 August 16, 2024
Cardiovascular mp-010 Enhanced External Counter Pulsation February 13, 2024 December 13, 2023 December 13, 2024
Dermatology MP-011 Benign Skin Lesion Removal October 25, 2023 October 25, 2023 October 25, 2024
Gastroenterology MP-012 Formulas and Other Enteral Nutrition July 01, 2024 April 24, 2024 April 24, 2025
Dermatology MP-014 Treatment of Congenital Hemangiomas (Port Wine Stains) October 25, 2023 October 25, 2023 October 25, 2024
Gastroenterology mp-015 Gastric Pacing November 27, 2023 September 27, 2023 September 27, 2024
Obstetrics and Gynecology MP-016 Infertility Testing and Treatment March 17, 2024 January 17, 2024 January 17, 2025
Radiation Therapy MP-017 Radioembolization/Selective Internal Radiation Therapy (SIRT) January 17, 2024 January 17, 2024 January 17, 2025
Genetics MP-018 Cell-free DNA (cfDNA) Testing for Fetal Aneuploidy August 16, 2023 August 16, 2023 August 16, 2024
Ophthalmology MP-019 Aqueous Shunts and Stents for Glaucoma June 21, 2023 June 21, 2023 June 21, 2024
Genetics MP-020 Methylenetetrahydrofolate Reductase (MTHFR) Mutation Testing October 25, 2023 October 25, 2023 October 25, 2024
Orthopedic MP-021 Vertical Expandable Prosthetic Titanium Rib for Spinal Disorders January 01, 2024 December 20, 2023 December 20, 2024
Radiology, diagnostic MP-022 Breast Tomosynthesis October 25, 2023 October 25, 2023 October 25, 2024
Physical Medicine mp-023 Chiropractic Care February 13, 2024 December 13, 2023 December 13, 2024
Ophthalmology MP-024 Corneal Cross-linking October 25, 2023 October 25, 2023 October 25, 2024
Genetics MP-025 Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases (e.g. Avise® CTD) April 28, 2024 February 28, 2024 February 28, 2025
Laboratory/Pathology mp-026 Drug Levels and Antibody Testing for Infliximab, Adalimumab, Vedolizumab and Ustekinumab May 15, 2024 May 15, 2024 May 15, 2025
Endocrinology MP-027 Vectra DA Blood Test for Rheumatoid Arthritis November 15, 2023 November 15, 2023 November 15, 2024
Physical Medicine mp-028 Infrared Therapy November 27, 2023 September 27, 2023 September 27, 2024
Ear, Nose, and Throat (ENT) MP-029 Vestibular Evoked Myogenic Potential (VEMP) Testing July 03, 2024 May 03, 2024 May 03, 2025
Behavioral Health MP-030 Pharmacogenomic Testing for Behavioral Health Disorders October 25, 2023 October 25, 2023 October 25, 2024
Pulmonary MP-031 High Frequency Chest Wall Compression (e.g. The Vest Airway Clearance System) January 17, 2024 January 17, 2024 January 17, 2025
Ear, Nose, and Throat (ENT) MP-032 Transtympanic Micropressure Treatment for Ménière’s Disease November 15, 2023 November 15, 2023 November 15, 2024
Genetics MP-033 Genetic Testing for Breast and/or Ovarian Cancer Susceptibility (BRCA1/BRCA2) January 17, 2024 January 17, 2024 January 17, 2025
Cardiovascular MP-035 Implantable Hemodynamic Monitor for Managing Patients with Heart Failure (e.g. CardioMEMS) January 01, 2024 December 20, 2023 December 20, 2024
Neurology/Neurosurgery MP-036 Transcutaneous (Non-implantable) Vagus Nerve Stimulation (e.g. gammaCore-S ®) May 15, 2024 May 15, 2024 May 15, 2025
Gastroenterology MP-037 Chromoendoscopy as an Adjunct to Colonoscopy March 20, 2024 March 20, 2024 March 20, 2025
Hematology/Oncology MP-038 Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy) March 20, 2024 March 20, 2024 March 20, 2025
Radiology, diagnostic MP-039 MRI Guided Focused Ultrasound (MRgFUS) May 15, 2024 May 15, 2024 May 15, 2025
Radiology, diagnostic MP-040 Low-Dose Computed Tomography for Lung Cancer Screening February 21, 2024 February 21, 2024 February 21, 2025
Hematology/Oncology MP-042 Electric Tumor Treatment Field Therapy for the Treatment of Glioblastoma Multiforme May 15, 2024 May 15, 2024 May 15, 2025
Hematology/Oncology MP-044 Flow Cytometry June 21, 2023 June 21, 2023 June 21, 2024
Genetics mp-045 General Policy for Genetic Testing May 15, 2024 May 15, 2024 May 15, 2025
Genetics MP-046 Carrier Screening for Genetic Diseases January 17, 2024 January 17, 2024 January 17, 2025
Ophthalmology MP-047 Flicker Fusion June 24, 2024 April 24, 2024 April 24, 2025
Dermatology MP-048 Phototherapy, Photochemotherapy or PUVA, and Excimer Laser Therapy for Dermatologic Conditions January 17, 2024 January 17, 2024 January 17, 2025
Ophthalmology MP-051 Electroretinography November 15, 2023 November 15, 2023 November 15, 2024
General Surgery MP-052 Bariatric Surgery June 21, 2023 June 21, 2023 June 21, 2024
Physical Medicine MP-053 Vertebral Axial Decompression January 01, 2024 December 20, 2023 December 20, 2024
Laboratory/Pathology MP-055 Homocysteine Level Testing July 19, 2023 July 19, 2023 July 19, 2024
Laboratory/Pathology MP-056 Vitamin D Testing May 15, 2024 May 15, 2024 May 15, 2025
Dermatology, Genetics MP-057 Genetic Testing for Melanoma August 21, 2023 August 16, 2023 August 16, 2024
Neurology/Neurosurgery MP-058 Intraoperative Neuromonitoring (IONM) October 01, 2023 July 31, 2023 July 31, 2024
Physical Medicine MP-059 Dry Needling July 19, 2023 July 19, 2023 July 19, 2024
Dermatology MP-060 CO2 (Carbon Dioxide) Fractional Ablative Laser Treatment for Burn Scars August 16, 2023 August 16, 2023 August 16, 2024
Neurology/Neurosurgery MP-061 Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation July 19, 2023 July 19, 2023 July 19, 2024
Gastroenterology MP-062 Fecal Microbiota Transplant September 10, 2023 July 10, 2023 July 10, 2024
Allergy/Immunology MP-064 Sublingual Immunotherapy (SLIT) March 20, 2024 March 20, 2024 March 20, 2025
Behavioral Health mp-065 Eye Movement Desensitization and Reprocessing (EMDR) Therapy February 13, 2024 December 13, 2023 December 13, 2024
Cardiovascular MP-066 Myocardial Strain Imaging March 20, 2024 March 20, 2024 March 20, 2025
Durable Medical Equipment (DME) mp-067 Speech Generating Devices June 21, 2023 June 21, 2023 June 21, 2024
Orthopedic MP-068 Intraosseous Basivertebral Nerve Ablation Procedure (Intracept) February 13, 2024 December 13, 2023 December 13, 2024
Laboratory/Pathology MP-069 Serologic Testing for Liver Fibrosis February 21, 2024 February 21, 2024 February 21, 2025
General Surgery mp-071 Therapeutic Nerve Blocks for Post-Operative Pain Management November 15, 2023 November 15, 2023 November 15, 2024
Genitourinary mp-073 Prostatic Urethral Lift (UroLift®) for Benign Prostatic Hypertrophy January 01, 2024 December 20, 2023 December 20, 2024
Orthopedic MP-074 Platelet-Rich Plasma (PRP) for Orthopedic Indications January 01, 2024 December 20, 2023 December 20, 2024
Orthopedic MP-075 Autologous Chondrocyte Implantation March 20, 2024 March 20, 2024 March 20, 2025
Genitourinary MP-076 Sacral Nerve Stimulation for Pelvic Floor Dysfunction March 20, 2024 March 20, 2024 March 20, 2025
Orthopedic mp-078 Dynamic Splint Devices November 27, 2023 September 27, 2023 September 27, 2024
Orthopedic mp-079 Arthroereisis and Subtalar Implants November 27, 2023 September 27, 2023 September 27, 2024
Behavioral Health mp-080 Transcranial Magnetic Stimulation-Single Pulse (e.g. eNeura SAVI Dual™) January 06, 2024 November 06, 2023 November 06, 2024