| 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 |
| Alternative or Complementary Healing |
QCP.CP.018 |
Retired |
November 1, 2025 |
|
| Ambulance Services |
QCP.CP.045 |
Retired |
November 1, 2025 |
|
| Autism Spectrum Disorder Treatment |
QCP.CP.044 |
Retired |
November 1, 2025 |
|
| Corneal Topography |
QCP.CP.022 |
Retired |
November 1, 2025 |
|
| Habilitative Services |
QCP.CP.035 |
Retired |
November 1, 2025 |
|
| Obesity Management & Bariatric Surgery |
QCP.CP.041 |
Retired |
November 1, 2025 |
|
| TMJ Coverage |
QCP.CP.026 |
Retired |
November 1, 2025 |
|
| Hypnotherapy |
QCP.CP.014 |
Retired |
November 1, 2025 |
|
