| Policy Title | Policy Number | Status | Effective Date | Retire Date |
|---|---|---|---|---|
| Acupuncture | CP.MP.92 | Retired | May 1, 2024 | August 1, 2025 |
| Ferriscan R2-MRI - RETIRE | CP.MP.53 | Retired | May 1, 2024 | 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 |
| Policy Title | Policy Number | Status | Retire Date |
|---|---|---|---|
| Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir (Viekira Pak) | HIM.PA.SP61 | Retired | October 1, 2025 |