| Policy Title |
Policy Number |
Status |
Effective Date |
Retire Date |
| Acupuncture (PDF) |
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 |
| Autism Spectrum Disorder Treatment (PDF) |
QCP.CP.044 |
Retired |
May 1, 2024 |
November 1, 2025 |
| Bariatric Surgery: Federal Employees Health Benefits (PDF) |
QCP.CP.029 |
Retired |
January 1, 2010 |
January 1, 2026 |
Corneal Remodeling (f.n.a.Refractive Surgical Procedures) (PDF)
|
QCP.CP.021 |
Retired |
September 18, 1995 |
January 1, 2026 |
Cosmetic and Reconstructive Procedures (PDF)
|
CP.MP.31 |
Retired |
May 1, 2024 |
January 1, 2026 |
| Corneal Topography (PDF) |
QCP.CP.022 |
Retired |
May 1, 2024 |
November 1, 2025 |
| DME (PDF) |
ar.cp.mp.107 |
Retired |
June 1, 2009 |
January 1, 2026 |
| FEHB Fertility Preservation (PDF) |
QCP.CP.042 |
Retired |
January 1, 2023 |
January 1, 2026 |
FEHBP Gender Reassignment Surgery (PDF)
|
QCP.CP.037 |
Retired |
January 1, 2015 |
January 1, 2026 |
| Ferriscan R2-MRI - RETIRE (PDF) |
CP.MP.53 |
Retired |
|
October 1, 2024 |
| Habilitative Services (PDF) |
QCP.CP.035 |
Retired |
May 1, 2024 |
November 1, 2025 |
| Home Ventilators (PDF) |
CP.MP.184 |
Retired |
May 1, 2024 |
August 1, 2025 |
| Hypnotherapy (PDF) |
QCP.CP.014 |
Retired |
May 1, 2024 |
November 1, 2025 |
| Intraoperative Neurophysiological Monitoring (PDF) |
QCP.CP.033 |
Retired |
January 1, 2013 |
January 1, 2026 |
Prosthetics (PDF)
|
QCP.CP.028 |
Retired |
May 1, 2009 |
January 1, 2026 |
| SNF Leveling (PDF) |
CP.MP.206 |
Retired, changed to cc.pp.206 |
May 1, 2024 |
December 1, 2024
|
| Transcatheter Closure of Patent Foramen Ovale (PDF) |
CP.MP.151 |
Retired |
May 1, 2024 |
December 1, 2024 |
| Obesity Management & Bariatric Surgery (PDF) |
QCP.CP.041 |
Retired |
May 1, 2024 |
November 1, 2025 |
| TMJ Coverage (PDF) |
QCP.CP.026 |
Retired |
May 1, 2024 |
November 1, 2025 |
