Abortion Hysterectomy and Sterilization Policy

Air Ambulance Transportation Clinical Coverage Policy

Bariatric Surgery Clinical Coverage Policy

Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage Policy

Breast Surgery Clinical Coverage Policy

Care at Home - In Lieu of Service

Chisholm Policy

Cochlear Implant Clinical Coverage Policy

Continuity of Care and Care Transitions

Continuous Subcutaneous Insulin External Infusion Pump Clinical Coverage Policy

Covered Benefits and Services Policy

Doula Services

EPSDT Personal Care Services (PCS) Clinical Coverage

Gender Affirmation Surgery Clinical Coverage Policy

Genetic Testing for Breast and Ovarian Cancer, Familial Adenomatous Polyposis (FAP) and Lynch Syndrome Clinical Coverage Policy

Hearing Aids Clinical Coverage Policy

High Frequency Chest Wall Oscillation Devices Clinical Coverage Policy

Homebuilders Clinical Coverage Policy

Home Health Clinical Coverage Policy

Hospital Based Care Coordination of Pregnant Members with Substance Use Disorder

Hospital Bed Clinical Coverage Policy

Inhaled Nitric Oxide Clinical Coverage Policy

Intrathecal Baclofen Therapy Clinical Coverage Policy

Inter-rater Reliability Testing

Louisiana Utilization Management Program Description - 2025

Louisiana Utilization Management Program Description - 2024

Louisiana Utilization Management Program Description  – 2023

Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy

Non MCO Covered Codes and Services

Observation Policy 

Osteogenic Bone Growth Stimulators Clinical Coverage Policy

Out of Network/Out of State Provider Prior Authroization

Outpatient Lactation Support Provider

Pediatric Day Health Care (PDHC) Clinical Coverage Policy

Rapid Whole Genome Sequencing (rWGS) of Critically Ill Infants

Timeliness of UM Determinations and Notifications Policy

Transcranial Magnetic Stimulation (TMS)

UM Program Description Policy- Description

Wheelchair, Wheelchair Repairs, Standing Frame, Patient Lifts Clinical Coverage Policy

Wound Care Clinical Coverage Policy

Upcoming clinical coverage policies

Skin and Tissue Substitutes – effective November 12, 2025 

Applied Behavioral Analysis Clinical Coverage

Assertive Community Treatment Policy

Community Brief Crisis Support (CBCS)

Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR)

Crisis Intervention — Follow Up Policy

Crisis Stabilization for Adults Coverage Policy

Crisis Stabilization for Children and Adolescents

Functional Family Therapy Clinical Coverage Policy

Individual Placement and Support Policy

Multi Systemic Therapy Policy

Permanent Supportive Housing (PSH) Services

Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI) Clinical Coverage Policy

Therapeutic Group Therapy