Policy Title Policy Number Status  Effective Date Retire Date
Acupuncture CP.MP.92 Retired May 1, 2024 August 1, 2025
Alternative or Complementary Healing (PDF) QCP.CP.018 Retired May 1, 2024 November 1, 2025
Ambulance Services (PDF) QCP.CP.045 Retired May 1, 2024 November 1, 2025
         
Ferriscan R2-MRI - RETIRE CP.MP.53 Retired   October 1, 2024
Home Ventilators CP.MP.184 Retired May 1, 2024 August 1, 2025
SNF Leveling CP.MP.206 Retired, changed to cc.pp.206 May 1, 2024

December 1, 2024 

Transcatheter Closure of Patent Foramen Ovale CP.MP.151 Retired May 1, 2024 December 1, 2024
Alternative or Complementary Healing QCP.CP.018 Retired May 1, 2024  November 1, 2025
Ambulance Services QCP.CP.045 Retired  May 1, 2024  November 1, 2025 
Autism Spectrum Disorder Treatment QCP.CP.044 Retired May 1, 2024  November 1, 2025 
Corneal Topography QCP.CP.022 Retired May 1, 2024  November 1, 2025 
Habilitative Services QCP.CP.035 Retired May 1, 2024  November 1, 2025 
Obesity Management & Bariatric Surgery QCP.CP.041 Retired May 1, 2024  November 1, 2025 
TMJ Coverage QCP.CP.026 Retired May 1, 2024  November 1, 2025 
Hypnotherapy QCP.CP.014 Retired May 1, 2024  November 1, 2025 
         
Policy Title Policy Number Status  Retire Date
Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir (Viekira Pak) HIM.PA.SP61 Retired October 1, 2025