Clinical Coverage/Medical Policy Updates

QualChoice updates a select number of clinical coverage policies each month, ensuring the reviewal of all policies on an annual basis.

AR.CP.MP.14 - Cochlear Implanted Replacements (PDF)
AR.CP.MP.93 - Bone-Anchored Hearing Aids (PDF)
CC.PP.007 - Maximum Units (PDF)
CC.PP.009 - Unlisted Procedure Codes (PDF)
CC.PP.011 - Coding Overview (PDF)
CC.PP.015 - Moderate Conscious Sedation (PDF)
CC.PP.016 - Global Maternity Billing (PDF)
CC.PP.017 - Never Paid Events (PDF)
CC.PP.021 - Clean Claims (PDF)
CC.PP.024 - Cosmetic Procedures (PDF)
CC.PP.025 - Pulse Oximetry (PDF)
CC.PP.027 - Professional Component (PDF)
CC.PP.028 - Modifier to Procedure Code Validation (PDF)
CC.PP.029 - Assistant Surgeon (PDF)
CC.PP.030 - Add-On Code Billed Without Primary Code (PDF)
CC.PP.031 - NCCI Unbundling (PDF)
CC.PP.032 - Supplies Billed on Same Day As Surgery (PDF)
CC.PP.033 - Multiple CPT Code Replacement (PDF)
CC.PP.034 - Modifier DOS Validation (PDF)
CC.PP.036 - New Patient (PDF)
CC.PP.037 - Bilateral Procedures (PDF)
CC.PP.038 - Inpatient Consultation (PDF)
CC.PP.039 - Outpatient Consultation (PDF)
CC.PP.040 - Same Day Visits (PDF)
CC.PP.041 - Pre-Operative Visits (PDF)
CC.PP.042 - Post-Operative Visits (PDF)
CC.PP.043 - Unbundled Professional Services (PDF)
CC.PP.044 - Duplicate Primary Code Billing (PDF)
CC.PP.045 - Unbundled Surgical Procedures (PDF)
CC.PP.046 - Status "B" Bundled Services (PDF)
CC.PP.047 - Transgender Related Services (PDF)
CC.PP.049 - Status P Bundled Services (PDF)
CC.PP.050 - Robotic Surgery (PDF)
CC.PP.051 - E&M Medical Decision-Making (PDF)
CC.PP.052 - Problem Oriented Visits with Surgical Procedures (PDF)
CC.PP.054 - Physician’s Consultation Services (PDF)
CC.PP.056 - Urine Specimen Validity Testing (PDF)
CC.PP.057 - Problem Oriented Visits with Preventative Services (PDF)
CC.PP.061  - Non-Obstetrical Pelvic and Transabdominal Ultrasound (PDF)
CC.PP.063  - Place of Service Mismatch (PDF)
CC.PP.065 - Multiple Diagnostic Cardiovascular Procedure Payment Reduction (PDF)
CC.PP.067 - Renal Hemodialysis (PDF)
CC.PP.068 - Multiple Procedure Payment Reduction for Therapeutic Services (PDF)
CC.PP.069 - Multiple Procedure Reduction: Ophthalmology (PDF)
CC.PP.500 - 3-Day Payment Window (PDF)
CC.PP.502 - Wheelchair Accessories (PDF)
CP.BH.100 - Substance Use Disorders Treatment and Services (PDF)
CP.BH.104 - Applied Behavioral Analysis (PDF)
CP.BH.124 - Attention Deficit Hyperactivity Disorder Assessment and Treatment (PDF)
CP.BH.200 - Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (PDF)
CP.BH.201 - Deep Transcranial Magnetic Stimulation for the Treatment of Obsessive Compulsive Disorder (PDF)
CP.BH.300 - Biofeedback for Behavioral Health Disorders (PDF)
CP.BH.500 - Behavioral Health Treatment Documentation Requirements (PDF)
CP.MP.100 - Allergy Testing and Therapy (PDF)
CP.MP.101 - Donor Lymphocyte Infusion (PDF)
CP.MP.102 - Pancreas Transplantation (PDF)
CP.MP.105 - Digital EEG Spike Analysis (PDF)
CP.MP.106 - Endometrial Ablation (PDF)
CP.MP.107 - Durable Medical Equipment and Orthotics and Prosthetics Guidelines (PDF)
CP.MP.108 - Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia (PDF)
CP.MP.109 - Panniculectomy (PDF)
CP.MP.110 - Bronchial Thermoplasty (PDF)
CP.MP.113 - Holter Monitors (PDF)
CP.MP.114 - Disc Decompression Procedures (PDF)
CP.MP.115 - Discography (PDF)
CP.MP.116 - Lysis of Epidural Lesions (PDF)
CP.MP.117 - Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (PDF)
CP.MP.12 - Vagus Nerve Stimulation (PDF)
CP.MP.120 - Pediatric Liver Transplant (PDF)
CP.MP.121 - Homocysteine Testing (PDF)
CP.MP.123 - Laser Therapy for Skin Conditions (PDF)
CP.MP.126 - Sacroiliac Joint Fusion (PDF)
CP.MP.127 - Total Artificial Heart (PDF)
CP.MP.129 - Fetal Surgery in Utero for Prenatally Diagnosed Malformations (PDF)
CP.MP.130 - Fertility Preservation (PDF)
CP.MP.132 - Heart-Lung Transplant (PDF)
CP.MP.133 - Posterior Tibial Nerve Stimulation for Voiding Dysfunction (PDF)
CP.MP.134 - Evoked Potential Testing (PDF)
CP.MP.136 - Home Births (PDF)
CP.MP.137 - Fecal Incontinence Treatments (PDF)
CP.MP.138 - Pediatric Heart Transplant (PDF)
CP.MP.139 - Low-frequency Ultrasound and Noncontact Normothermic Wound Therapy (PDF)
CP.MP.141 - Nonmyeloablative Allogeneic Stem Cell Transplants (PDF)
CP.MP.142 - Urinary Incontinence Devices and Treatments (PDF)
CP.MP.143 - Wireless Motility Capsule (PDF)
CP.MP.144 - Mechanical Stretch devices for joint stiffness or contractures (PDF)
CP.MP.145 - Electric Tumor Treating Fields (Optune) (PDF)
CP.MP.146 - Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other Symptomatic Venous Disorders (PDF)
CP.MP.147 - Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF)
CP.MP.150 - Phototherapy for Neonatal Hyperbilirubinemia (PDF)
CP.MP.151 - Transcatheter Closure of Patent Foramen Ovale (PDF)
CP.MP.152 - Measurement of Serum 1,25-dihydroxyvitamin D (PDF)
CP.MP.153 - Helicobacter Pylori Serology TestingPDF)
CP.MP.154 - Thyroid Hormones and Insulin Testing in Pediatrics (PDF)
CP.MP.155 - EEG in the Evaluation of Headache(PDF)
CP.MP.156 - Cardiac Biomarker Testing (PDF)
CP.MP.157 - 25-hydroxyvitamin D Testing in Children and Adolescents (PDF)
CP.MP.160 - Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF)
CP.MP.162 - Tandem Transplant (PDF)
CP.MP.163 - Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (PDF)
CP.MP.164 - Caudal or Interlaminar Epidural Steroid Injections (PDF)
CP.MP.165 - Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections (PDF)
CP.MP.166 - Sacroiliac Joint Interventions for Pain Management (PDF)
CP.MP.167 - Intradiscal Steroid Injections for Pain Management (PDF)
CP.MP.168 - Biofeedback (PDF)
CP.MP.169 - Trigger Point Injections for Pain Management (PDF)
CP.MP.170 - Nerve Blocks for Pain Management (PDF)
CP.MP.171 - Facet Joint Interventions (PDF)
CP.MP.173 - Implantable Intrathecal or Epidural Pain Pump (PDF)
CP.MP.174 - Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (PDF)
CP.MP.176 - Outpatient Cardiac Rehabilitation (PDF)
CP.MP.180 - Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (PDF)
CP.MP.181 - Polymerase Chain Reaction Respiratory Viral Panel Testing (PDF)
CP.MP.184 - Home Ventilators (PDF)
CP.MP.185 - Skin and Soft Tissue Substitutes for Chronic Wounds (PDF)
CP.MP.186 - Burn Surgery (PDF)
CP.MP.188 - Pediatric Oral Function Therapy (PDF)
CP.MP.190 - Outpatient Oxygen Use (PDF)
CP.MP.194 - Osteogenic Stimulation (PDF)
CP.MP.202  - Orthognathic Surgery (PDF)
CP.MP.203 - Diaphragmatic/Phrenic Nerve Stimulation (PDF)
CP.MP.209 - Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing (PDF)
CP.MP.210 - Repair of Nasal Valve Compromise (PDF)
CP.MP.22 - Stereotactic Body Radiation Therapy (PDF)
CP.MP.24 - Multiple Sleep Latency Testing (PDF)
CP.MP.242 - Pulmonary Function Testing (PDF)
CP.MP.243 - Implantable Loop Recorder (PDF)
CP.MP.244 - Liposuction for Lipedema (PDF)
CP.MP.246 - Pediatric Kidney Transplant (PDF)
CP.MP.247 - Transplant Service Documentation Requirements (PDF)
CP.MP.248 - Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF)
CP.MP.249 - Omisirge (omidubicel): Nicotinamide-modified allogeneic hematopoietic progenitor cell therapy (PDF)
CP.MP.250 - Lantidra (donislecel) Allogenic Pancreatic Islet Cellular Therapy (PDF)
CP.MP.26 - Articular Cartilage Defect Repairs (PDF)
CP.MP.31 - Cosmetic and Reconstructive Procedures (PDF)
CP.MP.36 - Experimental Technologies (PDF)
CP.MP.38 - Ultrasound in Pregnancy (PDF)
CP.MP.40 - Gastric Electrical Stimulation (PDF)
CP.MP.43 - Functional MRI (PDF)
CP.MP.46 - Ventricular Assist Devices (PDF)
CP.MP.48 - Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES) (PDF)
CP.MP.49 - Physical, Occupational, and Speech Therapy Services (PDF)
CP.MP.50 - Drugs of Abuse: Definitive Testing (PDF)
CP.MP.51 - Reduction Mammoplasty and Gynecomastia Surgery (PDF)
CP.MP.53 - Ferriscan R2-MRI (PDF)
CP.MP.54 - Hospice Services (PDF)
CP.MP.54 - Hospice Services (PDF)
CP.MP.55 - Assisted Reproductive Technology (PDF)
CP.MP.57 - Lung Transplantation (PDF)
CP.MP.58 - Intestinal and Multivisceral Transplant (PDF)
CP.MP.61 - IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (PDF)
CP.MP.62 - Hyperhidrosis Treatments (PDF)
CP.MP.69 - Intensity-Modulated Radiotherapy (PDF)
CP.MP.70 - Proton and Neutron Beam Therapies (PDF)
CP.MP.81 - NICU Discharge Guidelines (PDF)
CP.MP.82 - NICU Apnea Bradycardia Guidelines (PDF)
CP.MP.85 - Neonatal Sepsis Management (PDF)
CP.MP.86 - Neonatal Abstinence Syndrome Guidelines (PDF)
CP.MP.87 - Therapeutic Utilization of Inhaled Nitric Oxide (PDF)
CP.MP.91 - Obstetrical Home Care Programs (PDF)
CP.MP.92 - Acupuncture (PDF)
CP.MP.94 - Clinical Trials (PDF)
CP.MP.95 - Gender Affirming Procedures (PDF)
CP.MP.96 - Ambulatory EEG (PDF)
CP.MP.97 - Testing for Select Genitourinary Conditions (PDF)
CP.MP.98 - Urodynamic Testing (PDF)
CP.MP.99 - Wheelchair Seating (PDF)
CP.PHAR.103 - Immune Globulins (PDF)
CP.PHAR.108 - Omacetaxine (Synribo) (PDF)
CP.PHAR.11 - Burosumab-twza (Crysvita) (PDF)
CP.PHAR.115 - Pegloticase (Krystexxa) (PDF)
CP.PHAR.119 - Ramucirumab (Cyramza) (PDF)
CP.PHAR.121 - Nivolumab (Opdivo) (PDF)
CP.PHAR.139 - Mogamulizumab-kpkc (Poteligeo) (PDF)
CP.PHAR.140 - Pegvaliase-pqpz (Palynziq) (PDF)
CP.PHAR.146 - Deferoxamine (Desferal) (PDF)
CP.PHAR.151 - Levoleucovorin (Fusilev, Khapzory) (PDF)
CP.PHAR.152 - Laronidase (Aldurazyme) (PDF)
CP.PHAR.154 - Imiglucerase (Cerezyme) (PDF)
CP.PHAR.156 - Idursulfase (Elaprase) (PDF)
CP.PHAR.157 - Taliglucerase Alfa (Elelyso) (PDF)
CP.PHAR.158 - Agalsidase Beta (Fabrazyme) (PDF)
CP.PHAR.159 - Sebelipase Alfa (Kanuma) (PDF)
CP.PHAR.16 - Palivizumab (Synagis) (PDF)
CP.PHAR.160 - Alglucosidase Alfa (Lumizyme) (PDF)
CP.PHAR.161 - Galsulfase (Naglazyme) (PDF)
CP.PHAR.162 - Elosulfase Alfa (Vimizim) (PDF)
CP.PHAR.163 - Velaglucerase Alfa (VPRIV) (PDF)
CP.PHAR.165 - Ferumoxytol (Feraheme) (PDF)
CP.PHAR.170 - Degarelix Acetate (Firmagon) (PDF)
CP.PHAR.171 - Goserelin Acetate (Zoladex) (PDF)
CP.PHAR.172 - Histrelin Acetate (Vantas, Supprelin LA) (PDF)
CP.PHAR.173 - Leuprolide Acetate (Eligard, Fensolvi, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped), Leuprolide mesylate (Camcevi) (PDF)
CP.PHAR.175 - Triptorelin Pamoate (Trelstar, Triptodur) (PDF)
CP.PHAR.176 - Paclitaxel, Protein-Bound (Abraxane) (PDF)
CP.PHAR.177 - Ecallantide (Kalbitor) (PDF)
CP.PHAR.179 - Romiplostim (Nplate) (PDF)
CP.PHAR.181 - Hemin (Panhematin) (PDF)
CP.PHAR.184 - Aflibercept (Eylea, Eylea HD) (PDF)
CP.PHAR.186 - Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) (PDF)
CP.PHAR.187 - Verteporfin (Visudyne) (PDF)
CP.PHAR.189 - Ibandronate Injection (Boniva) (PDF)
CP.PHAR.192 - Epoprostenol (Flolan, Veletri) (PDF)
CP.PHAR.201 - Belatacept (Nulojix) (PDF)
CP.PHAR.203 - Cosyntropin (Cortrosyn) (PDF)
CP.PHAR.204 - Trabectedin (Yondelis) (PDF)
CP.PHAR.215 - Factor VIII (Human, Recombinant) (PDF)
CP.PHAR.216 - Factor VIII/von Willebrand Factor Complex (Human – Alphanate, Humate-P, Wilate); von Willebrand Factor (Recombinant – Vonvendi) (PDF)
CP.PHAR.217 - Anti-Inhibitor Coagulant Complex, Human (Feiba) (PDF)
CP.PHAR.218 - Factor IX (Human, Recombinant) (PDF)
CP.PHAR.219 - Factor IX Complex, Human (Profilnine) (PDF)
CP.PHAR.220 - Factor VIIa, Recombinant (NovoSeven RT, SevenFact) (PDF)
CP.PHAR.221 - Factor XIII, Human (Corifact) (PDF)
CP.PHAR.222 - Factor XIII A-Subunit, Recombinant (Tretten) (PDF)
CP.PHAR.223 - Reslizumab (Cinqair) (PDF)
CP.PHAR.227 - Pertuzumab (Perjeta) (PDF)
CP.PHAR.228 - Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase (PDF)
CP.PHAR.229 - Ado-Trastuzumab Emtansine (Kadcyla) (PDF)
CP.PHAR.230 - AbobotulinumtoxinA (Dysport) (PDF)
CP.PHAR.231 - IncobotulinumtoxinA (Xeomin) (PDF)
CP.PHAR.232 - OnabotulinumtoxinA (Botox) (PDF)
CP.PHAR.233 - RimabotulinumtoxinB (Myobloc) (PDF)
CP.PHAR.234 - Ferric Carboxymaltose (Injectafer) (PDF)
CP.PHAR.235 - Atezolizumab (Tecentriq) (PDF)
CP.PHAR.237 - Epoetin Alfa (Epogen, Procrit), Epoetin Alfa-epbx (Retacrit) (PDF)
CP.PHAR.243 - Alemtuzumab (Lemtrada) (PDF)
CP.PHAR.246 - Canakinumab (Ilaris) (PDF)
CP.PHAR.258 - Mitoxantrone (PDF)
CP.PHAR.259 - Natalizumab (Tysabri) (PDF)
CP.PHAR.260 - Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) (PDF)
CP.PHAR.266 - Rilonacept (Arcalyst) (PDF)
CP.PHAR.270 - Paricalcitol Injection (Zemplar) (PDF)
CP.PHAR.277 - Cytomegalovirus Immune Globulin (Cytogam) (PDF)
CP.PHAR.288 - Eteplirsen (Exondys 51) (PDF)
CP.PHAR.289 - Buprenorphine Injection (Sublocade, Brixadi) (PDF)
CP.PHAR.290 - Aripiprazole Long-Acting Injections (Abilify Maintena, Abilify Asimtufii, Aristada, Aristada Initio) (PDF)
CP.PHAR.291 - Paliperidone Long-Acting Injections (Invega Hafyera, Invega Sustenna, Invega Trinza) (PDF)
CP.PHAR.292 - Olanzapine Long-Acting Injection (Zyprexa Relprevv) (PDF)
CP.PHAR.293 - Risperidone Long-Acting Injection (Perseris, Risperdal Consta, Rykindo, Uzedy) (PDF)
CP.PHAR.295 - Sargramostim (Leukine) (PDF)
CP.PHAR.300 - Bezlotoxumab (Zinplava) (PDF)
CP.PHAR.301 - Erwinia Asparaginase (Erwinaze, Rylaze) (PDF)
CP.PHAR.303 - Brentuximab Vedotin (Adcetris) (PDF)
CP.PHAR.304 - Irinotecan Liposome (Onivyde) (PDF)
CP.PHAR.305 - Obinutuzumab (Gazyva) (PDF)
CP.PHAR.306 - Ofatumumab (Arzerra, Kesimpta) (PDF)
CP.PHAR.307 - Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta) (PDF)
CP.PHAR.308 - Elotuzumab (Empliciti) (PDF)
CP.PHAR.309 - Carfilzomib (Kyprolis) (PDF)
CP.PHAR.310 - Daratumumab (Darzalex), Daratumumab/Hyaluronidase-fihj (Darzalex Faspro) (PDF)
CP.PHAR.311 - Belinostat (Beleodaq) (PDF)
CP.PHAR.312 - Blinatumomab (Blincyto) (PDF)
CP.PHAR.313 - Pralatrexate (Folotyn) (PDF)
CP.PHAR.314 - Romidepsin (Istodax) (PDF)
CP.PHAR.315 - Vincristine Sulfate Liposome Injection (Marqibo) (PDF)
CP.PHAR.316 - Cabazitaxel (Jevtana) (PDF)
CP.PHAR.317 - Cetuximab (Erbitux) (PDF)
CP.PHAR.318 - Eribulin Mesylate (Halaven) (PDF)
CP.PHAR.319 - Ipilimumab (Yervoy) (PDF)
CP.PHAR.320 - Necitumumab (Portrazza) (PDF)
CP.PHAR.321 - Panitumumab (Vectibix) (PDF)
CP.PHAR.322 - Pembrolizumab (Keytruda) (PDF)
CP.PHAR.323 - Plerixafor (Mozobil) (PDF)
CP.PHAR.324 - Temsirolimus (Torisel) (PDF)
CP.PHAR.325 - Ziv-aflibercept (Zaltrap) (PDF)
CP.PHAR.327 - Nusinersen (Spinraza) (PDF)
CP.PHAR.329 - Siltuximab (Sylvant) (PDF)
CP.PHAR.330 - Protein C Concentrate, Human (Ceprotin) (PDF)
CP.PHAR.332 - Pasireotide (Signifor, Signifor LAR) (PDF)
CP.PHAR.333 - Avelumab (Bavencio) (PDF)
CP.PHAR.335 - Ocrelizumab (Ocrevus) (PDF)
CP.PHAR.338 - Cerliponase alfa (Brineura) (PDF)
CP.PHAR.339 - Durvalumab (Imfinzi) (PDF)
CP.PHAR.343 - Edaravone (Radicava, Radicava ORS) (PDF)
CP.PHAR.351 - Daptomycin (Cubicin, Cubicin RF, Dapzura RT) (PDF)
CP.PHAR.352 - Daunorubicin/Cytarabine (Vyxeos) (PDF)
CP.PHAR.353 - Pegaspargase (Oncaspar), Calaspargase Pegol-mknl (Asparlas) (PDF)
CP.PHAR.354 - Testosterone (Testopel, Jatenzo, Kyzatrex, Tlando) (PDF)
CP.PHAR.357 - Copanlisib (Aliqopa) (PDF)
CP.PHAR.358 - Gemtuzumab Ozogamicin (Mylotarg) (PDF)
CP.PHAR.359 - Inotuzumab Ozogamicin (Besponsa) (PDF)
CP.PHAR.361 - Tisagenlecleucel (Kymriah) (PDF)
CP.PHAR.362 - Axicabtagene Ciloleucel (Yescarta) (PDF)
CP.PHAR.367 - Letermovir (Prevymis) (PDF)
CP.PHAR.368 - Pemetrexed (Alimta, Pemfexy) (PDF)
CP.PHAR.371 - Triamcinolone ER Injection (Zilretta) (PDF)
CP.PHAR.372 - Voretigene Neparvovec-rzyl (Luxturna) (PDF)
CP.PHAR.373 - Benralizumab (Fasenra) (PDF)
CP.PHAR.374 - Vestronidase Alfa-vjbk (Mepsevii) (PDF)
CP.PHAR.378 - Ibalizumab-uiyk (Trogarzo) (PDF)
CP.PHAR.379 - Etelcalcetide (Parsabiv) (PDF)
CP.PHAR.384 - Lutetium Lu 177 dotatate (Lutathera) (PDF)
CP.PHAR.385 - Corticosteroids for Ophthalmic Injection (Dextenza, Iluvien, Ozurdex, Retisert, Xipere, Yutiq) (PDF)
CP.PHAR.387 - Azacitidine (Onureg, Vidaza) (PDF)
CP.PHAR.388 - Chloramphenicol Sodium Succinate (PDF)
CP.PHAR.389 - Pegvisomant (Somavert) (PDF)
CP.PHAR.391 - Lanreotide (Somatuline Depot and Unbranded) (PDF)
CP.PHAR.393 - Leucovorin Injection (PDF)
CP.PHAR.395 - Patisiran (Onpattro) (PDF)
CP.PHAR.397 - Cemiplimab-rwlc (Libtayo) (PDF)
CP.PHAR.398 - Moxetumomab pasudotox-tdfk (Lumoxiti) (PDF)
CP.PHAR.40 - Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa) (PDF)
CP.PHAR.402 - Emapalumab-lzsg (Gamifant) (PDF)
CP.PHAR.41 - Enfuvirtide (Fuzeon) (PDF)
CP.PHAR.410 - Bortezomib (Velcade) (PDF)
CP.PHAR.415 - Ravulizumab-cwvz (Ultomiris) (PDF)
CP.PHAR.416 - Caplacizumab-yhdp (Cablivi) (PDF)
CP.PHAR.417 - Brexanolone (Zulresso) (PDF)
CP.PHAR.418 - Dexrazoxane (Totect) (PDF)
CP.PHAR.419 - Elapegademase-lvlr (Revcovi) (PDF)
CP.PHAR.421 - Onasemnogene Abeparvovec (Zolgensma) (PDF)
CP.PHAR.424 - Fulvestrant (Faslodex Injection) (PDF)
CP.PHAR.433 - Polatuzumab Vedotin-piiq (Polivy) (PDF)
CP.PHAR.439 - Valrubicin (Valstar) (PDF)
CP.PHAR.444 - Afamelanotide (Scenesse) (PDF)
CP.PHAR.445 - Brolucizumab-dbll (Beovu) (PDF)
CP.PHAR.448 - Mometasone Furoate (Sinuva) (PDF)
CP.PHAR.449 - Crizanlizumab-tmca (Adakveo) (PDF)
CP.PHAR.450 - Luspatercept-aamt (Reblozyl) (PDF)
CP.PHAR.453 - Golodirsen (Vyondys 53) (PDF)
CP.PHAR.455 - Enfortumab Vedotin-ejfv (Padcev) (PDF)
CP.PHAR.456 - Fam-Trastuzumab Deruxtecan-nxki (Enhertu) (PDF)
CP.PHAR.457 - Givosiran (Givlaari) (PDF)
CP.PHAR.458 - Inebilizumab-cdon (Uplizna) (PDF)
CP.PHAR.459 - Iobenguane I-131 (Azedra) (PDF)
CP.PHAR.461 - Nadofaragene Firadenovec-vncg (Adstiladrin) (PDF)
CP.PHAR.463 - Satralizumab-mwge (Enspryng) (PDF)
CP.PHAR.465 - Teprotumumab (Tepezza) (PDF)
CP.PHAR.466 - Valoctocogene Roxaparvovec-rvox (Roctavian) (PDF)
CP.PHAR.468 - Aducanumab-avwa (Aduhelm) (PDF)
CP.PHAR.469 - Belantamab Mafodotin-blmf (Blenrep) (PDF)
CP.PHAR.470 - Casimersen (Amondys 45) (PDF)
CP.PHAR.471 - Fosdenopterin (Nulibry) (PDF)
CP.PHAR.472 - Brexucabtagene Autoleucel (Tecartus) (PDF)
CP.PHAR.473 - Lumasiran (Oxlumo) (PDF)
CP.PHAR.475 - Sacituzumab Govitecan-hziy (Trodelvy) (PDF)
CP.PHAR.477 - Risdiplam (Evrysdi) (PDF)
CP.PHAR.480 - Ferric Derisomaltose (Monoferric) (PDF)
CP.PHAR.481 - Idecabtagene Vicleucel (Abecma) (PDF)
CP.PHAR.482 - Isatuximab-irfc (Sarclisa) (PDF)
CP.PHAR.483 - Lisocabtagene Maraleucel (Breyanzi) (PDF)
CP.PHAR.484 - Viltolarsen (Viltepso) (PDF)
CP.PHAR.486 - Bimatoprost Implant (Durysta) (PDF)
CP.PHAR.492 - Teplizumab-mzwv (Tzield) (PDF)
CP.PHAR.495 - Mitomycin for Pyelocalyceal Solution (Jelmyto) (PDF)
CP.PHAR.500 - Lurbinectedin (Zepzelca) (PDF)
CP.PHAR.501 - Pertuzumab/Trastuzumab/Hyaluronidase-zzxf (Phesgo) (PDF)
CP.PHAR.503 - Sutimlimab-jome (Enjaymo) (PDF)
CP.PHAR.506 - Antithymocyte Globulin (Atgam, Thymoglobulin) (PDF)
CP.PHAR.508 - Tafasitamab-cxix (Monjuvi) (PDF)
CP.PHAR.512 - Pegunigalsidase Alfa-iwxj (Elfabrio) (PDF)
CP.PHAR.513 - Plasminogen, human-tvmh (Ryplazim) (PDF)
CP.PHAR.52 - Interferon Gamma- 1b (Actimmune) (PDF)
CP.PHAR.521 - Avalglucosidase Alfa-ngpt (Nexviazyme) (PDF)
CP.PHAR.522 - Margetuximab-cmkb (Margenza) (PDF)
CP.PHAR.523 - Naxitamab-gqgk (Danyelza) (PDF)
CP.PHAR.524 - Pegcetacoplan (Empaveli, APL-2) (PDF)
CP.PHAR.526 - Fibrinogen Concentrate [Human] (Fibryga, RiaSTAP) (PDF)
CP.PHAR.533 - Ciltacabtagene Autoleucel (Carvykti) (PDF)
CP.PHAR.534 - Insulin Delivery Systems (V-Go, Omnipod, InPen) (PDF)
CP.PHAR.535 - Melphalan flufenamide (Pepaxto) (PDF)
CP.PHAR.539 - Loncastuximab Tesirine-lpyl (Zynlonta) (PDF)
CP.PHAR.540 - Dostarlimab-gxly (Jemperli) (PDF)
CP.PHAR.542 - Talimogene laherepvec (Imlygic) (PDF)
CP.PHAR.544 - Amivantamab-vmjw (Rybrevant) (PDF)
CP.PHAR.545 - Betibeglogene Autotemcel (Zynteglo) (PDF)
CP.PHAR.551 - Anifrolumab-fnia (Saphnelo) (PDF)
CP.PHAR.555 - Efgartigimod Alfa-fcab, Efgartigimod/-Hyaluronidase-qvfc (Vyvgart, Vyvgart Hytrulo) (PDF)
CP.PHAR.556 - Elivaldogene Autotemcel (Skysona) (PDF)
CP.PHAR.561 - Tisotumab Vedotin-tftv (Tivdak) (PDF)
CP.PHAR.562 - Allogeneic Cultured Keratinocytes and Dermal Fibroblasts in Murine Collagen-dsat (StrataGraft) (PDF)
CP.PHAR.563 - Allogenic Processed Thymus Tissue-agdc (Rethymic) (PDF)
CP.PHAR.564 - Antithrombin III (ATryn, Thrombate III) (PDF)
CP.PHAR.567 - Cipaglucosidase Alfa/Miglustat (AT-GAA) (PDF)
CP.PHAR.568 - Inclisiran (Leqvio) (PDF)
CP.PHAR.570 - Ropeginterferon Alfa-2b-njft (BESREMi) (PDF)
CP.PHAR.573 - Cabotegravir (Apretude), Cabotegravir/Rilpivirine (Cabenuva) (PDF)
CP.PHAR.574 - Sirolimus Protein-Bound Particles (Fyarro), Topical Gel (Hyftor) (PDF)
CP.PHAR.575 - Tebentafusp-tebn (Kimmtrak) (PDF)
CP.PHAR.576 - Tezepelumab-ekko (Tezspire) (PDF)
CP.PHAR.58 - Denosumab (Prolia, Xgeva) (PDF)
CP.PHAR.580 - Etranacogene Dezaparvovec-drlb (Hemgenix) (PDF)
CP.PHAR.581 - Faricimab-svoa (Vabysmo) (PDF)
CP.PHAR.582 - Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) (PDF)
CP.PHAR.586 - Olipudase Alfa-rpcp (Xenpozyme) (PDF)
CP.PHAR.588 - Nivolumab and Relatlimab-rmbw (Opdualag) (PDF)
CP.PHAR.59 - Zoledronic Acid (Reclast) (PDF)
CP.PHAR.591 - Tofersen (Qalsody) (PDF)
CP.PHAR.592 - Beremagene geperpavec-svdt (Vyjuvek) (PDF)
CP.PHAR.593 - Delandistrogene Moxeparvovec-rokl (Elevidys) (PDF)
CP.PHAR.595 - Eladocagene Exuparvovec (Upstaza) (PDF)
CP.PHAR.596 - Lecanemab-irmb (Leqembi) (PDF)
CP.PHAR.601 - Velmanase Alfa-tycv (Lamzede) (PDF)
CP.PHAR.606 - Spesolimab-sbzo (Spevigo) (PDF)
CP.PHAR.610 - Sodium thiosulfate (Pedmark) (PDF)
CP.PHAR.611 - Teclistamab-cqyv (Tecvayli) (PDF)
CP.PHAR.612 - Tremelimumab-actl (Imjudo) (PDF)
CP.PHAR.614 - Nirsevimab-alip (Beyfortus) (PDF)
CP.PHAR.617 - Mirvetuximab soravatansine-gynx (Elahere) (PDF)
CP.PHAR.618 - Mosunetuzumab-axgb (Lunsumio) (PDF)
CP.PHAR.619 - Nedosiran (Rivfloza) (PDF)
CP.PHAR.621 - Ublituximab-xiiy (Briumvi) (PDF)
CP.PHAR.622 - Lenacapavir (Sunlenca) (PDF)
CP.PHAR.624 - Ferric Pyrophosphate (Triferic, Triferic Avnu ) (PDF)
CP.PHAR.626 - Pozelimab-bbfg (Veopoz) (PDF)
CP.PHAR.628 - Daprodustat (Jesduvroq) (PDF)
CP.PHAR.629 - Retifanlimab-dlwr (Zynyz) (PDF)
CP.PHAR.630 - Zavegepant (Zavzpret) (PDF)
CP.PHAR.634 - Epcoritamab-bysp (Epkinly) (PDF)
CP.PHAR.635 - Apadamtase alfa (TAK-755) (PDF)
CP.PHAR.636 - Glofitamab-gxbm (Columvi) (PDF)
CP.PHAR.637 - Mesenchymal Stem Cell-NTF Cells (NurOwn) (PDF)
CP.PHAR.64 - Topotecan (Hycamtin) (PDF)
CP.PHAR.641 - Avacincaptad pegol (Izervay) (PDF)
CP.PHAR.648 - Rozanolixizumab-noli (Rystiggo) (PDF)
CP.PHAR.649 - Talquetamab-tgvs (Talvey) (PDF)
CP.PHAR.651 - DaxibotulinumtoxinA-lanm (Daxxify) (PDF)
CP.PHAR.652 - Elranatamab-bcmm (Elrexfio) (PDF)
CP.PHAR.653 - Melphalan (Hepzato) (PDF)
CP.PHAR.655 - Motixafortide (Aphexda) (PDF)
CP.PHAR.658 - Respiratory syncytial virus vaccine (Abrysvo) (PDF)
CP.PHAR.77 - Temozolomide (Temodar) (PDF)
CP.PHAR.82 - Collagenase Clostridium Histolyticum (Xiaflex) (PDF)
CP.PHAR.88 - Belimumab (Benlysta) (PDF)
CP.PHAR.93 - Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) (PDF)
CP.PHAR.94 - Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) (PDF)
CP.PHAR.95 - Thyrotropin alfa (Thyrogen) (PDF)
CP.PHAR.97 - Eculizumab (Soliris) (PDF)
CP.PMN.115 - Delafloxacin (Baxdela) (PDF)
CP.PMN.154 - Isavuconazonium (Cresemba) (PDF)
CP.PMN.188 - Omadacycline (Nuzyra) (PDF)
CP.PMN.199 - Esketamine (Spravato) (PDF)
CP.PMN.219 - Lefamulin (Xenleta) (PDF)
CP.PMN.236 - Amisulpride (Barhemsys) (PDF)
CP.PMN.62 - Tedizolid (Sivextro) (PDF)
HIM.PA.166 - Evinacumab-dgnb (Evkeeza) (PDF)
HIM.PA.17 - Methoxsalen (Uvadex) (PDF)
HIM.PA.170 - C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (PDF)
HIM.PA.172 - Lanadelumab-fylo (Takhzyro) (PDF)
HIM.PA.SP64 - Eptinezumab-jjmr (Vyepti) (PDF)
MP.PP.018 - Inpatient Only Procedures (PDF)
V2.2023 - Concert Genetics Oncology: Algorithmic Testing (PDF)
V2.2023 - Concert Genetics Oncology: Cancer Screening (PDF)
V2.2023 - Concert Genetics Oncology: Circulating Tumor DNA and Circulating
V2.2023 - Concert Genetics Oncology: Cytogenetic Testing (PDF)
V2.2023 - Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF)
V2.2023 - Concert Genetic Testing: Aortopathies and Connective Tissue Disorders (PDF)
V2.2023 - Concert Genetic Testing: Cardiac Disorders (PDF)
V2.2023 - Concert Genetic Testing: Dermatologic Conditions (PDF)
V2.2023 - Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions (PDF)
V2.2023 - Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF)
V2.2023 - Concert Genetic Testing: Eye Disorders (PDF)
V2.2023 - Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous) (PDF)
V2.2023 - Concert Genetic Testing: General Approach to Genetic Testing (PDF)
V2.2023 - Concert Genetic Testing: Hearing Loss (PDF)
V2.2023 - Concert Genetic Testing: Hematologic Conditions (non-cancerous) (PDF)
V2.2023 - Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders (PDF)
V2.2023 - Concert Genetic Testing: Kidney Disorders (PDF)
V2.2023 - Concert Genetic Testing: Lung Disorders (PDF)
V2.2023 - Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders (PDF)
V2.2023 - Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (PDF)
V2.2023 - Concert Genetic Testing: Non-invasive Prenatal Screening (NIPS) (PDF)
V2.2023 - Concert Genetic Testing: Pharmacogenetics (PDF)
V2.2023 - Concert Genetic Testing: Preimplantation Genetic Testing (PDF)
V2.2023 - Concert Genetic Testing: Prenatal and Preconception Carrier Screening (PDF)
V2.2023 - Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss (PDF)
V2.2023 - Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders (PDF)
V2.2023  - Concert Genetic Testing: Hereditary Cancer Susceptibility (PDF)