Archived Medical Benefit Coverage Policies (BCP)

Archived PHP Medical Benefit Coverage Policies (BCP)

Ambulance Transport (BCP-10)
Effective Date: 01.01.2024
Ambulance Transport (BCP-10)
Effective Date: 01.01.2023
Ambulance Transport (BCP-10)
Effective Date: 01.01.2022
Ambulance Transport (BCP-10)
Effective Date: 01/01/2021
Ambulance Transport (BCP-10)
Effective Date: 01/01/2020
Ambulance Transport (BCP-10)
Effective Date: 01/01/2019
Ambulance Transport (BCP-10)
Effective Date: 4/1/18
Ambulatory EEG and Video Monitoring (BCP-80)
Effective Date: 01.01.2023
Ambulatory EEG and Video Monitoring (BCP-80)
Effective Date: 01.01.2022
Ambulatory EEG and Video Monitoring (BCP-80)
Effective Date: 10/01/2020
Ambulatory EEG and Video Monitoring (BCP-80)
Effective Date: 08/07/2020
Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)
Effective Date: 07.01.2023
Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)
Effective Date: 07.01.2023
Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)
Effective Date: 07.01.2022
Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)
Effective Date: 07/01/2021
Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)
Effective Date: 10/01/2020
Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)
Effective Date: 10/01/2019
Bariatric Surgery (BCP-32)
Effective Date: 07.01.2023
Bariatric Surgery (BCP-32)
Effective Date: 07.01.2022
Bariatric Surgery (BCP-32)
Effective Date: 07/01/2021
Bariatric Surgery (BCP-32)
Effective Date: 10/01/2020
Bariatric Surgery (BCP-32)
Effective Date: 10/01/2019
Bariatric Surgery (BCP-32)
Effective Date: 07/01/2018
CAR T-Cell Immunotherapy (BCP-77)
Effective Date: 10/01/2018
Complementary and Alternative Medicine (CAM) (BCP-29)
Effective Date: 10.01.2023
Complementary and Alternative Medicine (CAM) (BCP-29)
Effective Date: 10.01.2022
Complementary and Alternative Medicine (CAM) (BCP-29)
Effective Date: 10/01/2021
Complementary and Alternative Medicine (CAM) (BCP-29)
Effective Date: 08/07/2020
Complementary and Alternative Medicine (CAM) (BCP-29)
Effective Date: 07/01/20
Complementary and Alternative Medicine (CAM) (BCP-29)
Effective Date: 01/01/2020
Continuous Glucose Monitors and Supplies (BCP-64)
Effective Date: 01.01.2023
Continuous Glucose Monitors and Supplies (BCP-64)
Effective Date: 1/1/2022.
Continuous Glucose Monitors (BCP-64)
Effective Date: 01/01/2021.
Continuous Glucose Monitors (BCP-64)
Effective Date: 01/01/2020
Continuous Glucose Monitors (BCP-64)
Effective Date: 01/01/2019
Continuous Glucose Monitors (BCP-64)
Effective Date: 4/1/18
COVID-19 Testing and Treatment (BCP-15)
Effective Date: 05.11.2023
COVID-19 Testing and Treatment (BCP-15)
Effective Date: 01.01.2023
COVID-19 Testing and Treatment (BCP-15)
Effective Date: 10.01.2021
COVID-19 Testing and Treatment (BCP-15)
Effective Date: 03/20/2020
Dental-Related General Anesthesia and Facility Charges (BCP-16)
Effective Date: 04.01.2024
Dental-Related General Anesthesia and Facility Charges (BCP-16)
Effective Date: 04.01.2023
Dental-Related General Anesthesia and Facility Charges (BCP-16)
Effective Date: 04.01.2022
Dental-Related General Anesthesia and Facility Charges (BCP-16)
Effective Date: 04/01/2021
Dental-Related General Anesthesia and Facility Charges (BCP-16)
Effective Date: 04/01/2020
Dental-Related General Anesthesia (BCP-16)
Effective Date: 01/01/2019
Dental Services Requiring General Anesthesia (BCP-16)
Effective Date: 04/01/2018
Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)
Effective Date: 10.01.2022
Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)
Effective Date: 10.01.2021
Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)
Effective Date: 01/01/2020
Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)
Effective Date: 9/3/19
Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)
Effective Date: 01/01/2019
Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 04.01.2023
Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 04.01.2022
Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 1/1/2022
Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 07/01/2021
Facet Join Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 08/07/2020
Facet Join Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 07/01/2020
Facet Join Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 10/01/2019
Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)
Effective Date: 1/1/19
Fecal Bacteriotherapy (BCP-69)
Effective Date: 01.01.2023
Fecal Bacteriotherapy (BCP-69)
Effective Date: 1/1/2022
Fecal Bacteriotherapy (BCP-69)
Effective Date: 01/01/2021
Fecal Bacteriotherapy (BCP-69)
Effective Date: 1/1/20
Fecal Bacteriotherapy (BCP-69)
Effective Date: 10/01/2018
Femoro-Acetabular Impingement Hip Surgery (BCP-65)
Effective Date: 01.01.2023
Femoro-Acetabular Impingement Hip Surgery (BCP-65)
Effective Date: 1/1/2022
Femoro-Acetabular Impingement Hip Surgery (BCP-65)
Effective Date: 1/1/2020
Femoro-Acetabular Impingement Hip Surgery (BCP-65)
Effective Date: 1//1/2019
Femoro-Acetabular Impingement Hip Surgery (BCP-65)
Effective Date: 4/1/2018
Gender Reassignment Surgery (BCP-24)
Effective Date: 01.01.2023
Gender Reassignment Surgery (BCP-24)
Effective Date: 01.01.2022
Gender Reassignment Surgery (BCP-24)
Effective Date: 01/01/2021
Gender Reassignment Surgery (BCP-24)
Effective Date: 01/01/2019
Gender Reassignment Surgery (BCP-24)
Effective Date: 04/01/2018
Glaucoma Surgery iStent Trabecular Micro-Bypass Stent (BCP-68)
Effective Date: 04.01.2021
Glaucoma Surgery iStent Trabecular Micro-Bypass Stent (BCP-68)
Effective Date: 01/01/2020
Glaucoma Surgery iStent Trabecular Micro-Bypass Stent (BCP-68)
Effective Date: 07/01/2018
Hearing Aids and Services (BCP-21)
Effective Date: 10.01.2023
Hearing Aids and Services (BCP-21)
Effective Date: 10.01.2022
Hearing Aids and Services (BCP-21)
Effective Date: 10/01/2021
Hearing Aids and Services (BCP-21)
Effective Date: 08/07/2020
Hearing Aids and Services (BCP-21)
Effective Date: 01/01/2020
Cardiac Transplantation (BCP-66)
Effective Date: 04.01.2023
Cardiac Transplantation (BCP-66)
Effective Date: 04.01.2022
Cardiac Transplantation (BCP-66)
Effective Date: 04/01/2021
Heart Transplantation (BCP-66)
Effective Date: 01/01/2020
Heart Transplantation (BCP-66)
Effective Date: 10/01/2019
Heart Transplantation (BCP-66)
Effective Date: 04/01/2018
Hematopoietic Stem Cell Transplant (BCP-67)
Effective Date: 07.01.2022
Hematopoietic Stem Cell Transplant (BCP-67)
Effective Date: 7/1/21
Hematopoietic Stem Cell Transplant (BCP-67)
Effective Date: 10/01/2020
Hematopoietic Stem Cell Transplant (BCP-67)
Effective Date: 10/01/2019
Hematopoietic Stem Cell Transplant (BCP-67)
Effective Date: 07/01/2018
Home Health Care Services (BCP-26)
Effective Date: 01.01.2024
Home Health Care Services (BCP-26)
Effective Date: 01.01.2023
Home Health Care Services (BCP-26)
Effective Date: 1/1/22
Home Health Care Services (BCP-26)
Effective Date: 10/01/2020
Home Health Care Services (BCP-26)
Effective Date: 10/01/2019
Home Infusion Therapy Services (BCP-27)
Effective Date: 10.01.2023
Home Infusion Therapy Services (BCP-27)
Effective Date: 10.01.2022
Home Infusion Therapy Services (BCP-27)
Effective Date: 10/01/2021
Home Infusion Therapy Services (BCP-27)
Effective Date: 10/01/2020
Home Infusion Therapy Services (BCP-27)
Effective Date: 10/01/2019
Hospice Care Services (BCP-22)
Effective Date: 01.01.2024
Hospice Care Services (BCP-22)
Effective Date: 01.01.2023
Hospice Care Services (BCP-22)
Effective Date: 10/1/22
Hospice Care Services (BCP-22)
Effective Date: 10/1/2021
Hospice Care Services (BCP-22)
Effective Date: 10/01/2020
Hospice Care Services (BCP-22)
Effective Date: 01/01/2020
Hospice Care Services (BCP-22)
Effective Date: 04/01/2018
Infertility Services (BCP-72)
Effective Date: 01.01.2024
Infertility Services (BCP-72)
Effective Date: 01.01.2023
Infertility Services (BCP-72)
Effective Date: 01.01.2022
Infertility Services (BCP-72)
Effective Date: 1/1/21
Infertility Services (BCP-72)
Effective Date: 10/1/19
Infertility Services (BCP-72)
Effective Date: 01/01/2018
Inpatient Rehabilitation (IPR) Services (BCP-23)
Effective Date: 10.01.2023
Inpatient Rehabilitation (IPR) Services (BCP-23)
Effective Date: 10.01.2022
Inpatient Rehabilitation (IPR) Services (BCP-23)
Effective Date: 10/1/2021
Inpatient Rehabilitation (IPR) Services (BCP-23)
Effective Date: 08/07/2020
Inpatient Rehabilitation (IPR) Services (BCP-23)
Effective Date: 01/01/2020
Renal Transplantation (BCP-51 v.7)
Effective Date: 04.01.2023
Renal Transplantation (BCP-51 v.6)
Effective Date: 07.01.2022
Renal Transplantation (BCP-51)
Effective Date: 04.01.2022
Renal Transplantation (BCP-51)
Effective Date: 7/1/21
Kidney Transplantation (BCP-51)
Effective Date: 4/1/20
Kidney Transplantation (BCP-51)
Effective Date: 04/01/2019
Kidney Transplantation (BCP-51)
Effective Date: 04/01/2018
Liver Transplantation (BCP-75 v.6)
Effective Date: 04.01.2023
Liver Transplantation (BCP-75 v.5)
Effective Date: 07.01.2022
Liver Transplantation (BCP-75)
Effective Date: 04.01.2022
Liver Transplantation (BCP-75)
Effective Date: 7/1/21
Liver Transplantation (BCP-75)
Effective Date: 10/01/2020
Liver Transplantation (BCP-75)
Effective Date: 10/01/2019
Liver Transplantation (BCP-75)
Effective Date: 10/01/2018
Lung Transplantation (BCP-70)
Effective Date: 07.01.2023
Lung Transplantation (BCP-70)
Effective Date: 07.01.2022
Lung Transplantation (BCP-70)
Effective Date: 7/1/21
Lung Transplantation (BCP-70)
Effective Date: 10/01/2020
Lung Transplantation (BCP-70)
Effective Date: 10/01/2019
Lung Transplantation (BCP-70)
Effective Date: 10/01/2018
Observation Care Services (BCP-04)
Effective Date: 01.01.2024
Observation Care Services (BCP-04)
Effective Date: 01.01.2023
Observation Care Services (BCP-04)
Effective Date: 1/1/22
Observation Care Services (BCP-04)
Effective Date: 1/1/21
Observation Care Services (BCP-04)
Effective Date: 01/01/2020
Observation Care Services (BCP-04)
Effective Date: 01/01/2019
Orthognathic Surgery (BCP-36)
Effective Date: 04.01.2024
Orthognathic Surgery (BCP-36)
Effective Date: 04.01.2023
Orthognathic Surgery (BCP-36)
Effective Date: 04.01.2022
Orthognathic Surgery (BCP-36)
Effective Date: 4/1/21
Orthognathic Surgery (BCP-36)
Effective Date: 4/1/20
Orthognathic Surgery (BCP-36)
Effective Date: 01/01/2019
Orthognathic Surgery (BCP-36)
Effective Date: 04/01/2018
Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)
Effective Date: 01.01.2024
Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)
Effective Date: 01.01.2023
Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)
Effective Date: 1/1/22
Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)
Effective Date: 1/1/21
Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)
Effective Date: 01/01/2020
Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)
Effective Date: 07/01/2018
Outpatient High Tech Radiology and Nuclear Medicine (BCP-39)
Effective Date: 01.01.2024
Outpatient High Tech Radiology and Nuclear Medicine (BCP-39)
Effective Date: 01.01.2023
Outpatient High Tech Radiology and Nuclear Medicine (BCP-39)
Effective Date: 1/1/22
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 04.01.2024
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 04.01.2023
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 04.01.2022
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 4/1/22 Retired as of 06.22.2022
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 8/7/20
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 1/1/2020
Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)
Effective Date: 7/1/2018
Outpatient Rehabilitative-Habilitative Services-Physical and Occupational Therapy (BCP-06)
Effective Date: 04.11.2023
Outpatient Rehabilitative-Habilitative Services-Physical and Occupational Therapy (BCP-06)
Effective Date: 10.01.2022
Outpatient Rehabilitative-Habilitative Services-Physical and Occupational Therapy (BCP-06)
Effective Date: 4/1/22
Outpatient Rehabilitative-Habilitative Services-Physical and Occupational Therapy (BCP-06)
Effective Date: 4/1/22 Retired as of 06.22.2022
Outpatient Rehabilitative-Habilitative Therapy Services-Physical and Occupational (BCP-06)
Effective Date: 4/1/21
Outpatient Rehabilitative-Habilitative Therapy Services-Physical and Occupational (BCP-06)
Effective Date: 8/7/2020
Outpatient Rehabilitative-Habilitative Therapy Services-Physical and Occupational (BCP-06)
Effective Date: 1/1/2020
Outpatient Rehabilitative-Habilitative Therapy Services-Physical and Occupational (BCP-06)
Effective Date: 4/1/2019
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 07.01.2023
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 07.01.2023
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57 v.5)
Effective Date: 07.01.2022
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 4/1/21
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 8/7/20
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 4/1/2020
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 10/1/2019
Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)
Effective Date: 1/1/2019
Pancreas Transplantation (BCP-71 v.6)
Effective Date: 04.01.2023
Pancreas Transplantation (BCP-71 v.5)
Effective Date: 07.01.2022
Pancreas Transplantation (BCP-71)
Effective Date: 04.01.2022
Pancreas Transplantation (BCP-71)
Effective Date: 7/1/21
Pancreas Kidney Transplant and Pancreas Transplant Alone (BCP-71)
Effective Date: 10/1/2019
Pancreas-Kidney Transplantation and Pancreas Alone Transplantation - Simultaneous (BCP-71)
Effective Date: 10/1/18
Pre-Transplant Services (BCP-33)
Effective Date: 01.01.2024
Pre-Transplant Services (BCP-33)
Effective Date: 01.01.2023
Pre-Transplant Services (BCP-33)
Effective Date: 1/1/22
Pre-Transplant Services (BCP-33)
Effective Date: 1/1/21
Preventive Health Services (BCP-45)
Effective Date: 01.01.2024
Preventive Health Services (BCP-45)
Effective Date: 01.01.2023
Preventive Health Services (BCP-45)
Effective Date: 01.01.2022
Preventive Health Services (BCP-45)
Effective Date: 10/01/21
Preventive Health Services (BCP-45)
Effective Date: 7/1/2021
Preventive Health Services (BCP-45)
Effective Date: 1/1/2021
Preventive Health Services (BCP-45)
Effective Date: 7/1/2020
Preventive Health Services (BCP-45)
Effective Date: 1/1/2019
Preventative Health Services (BCP-45)
Effective Date: 4/1/2018
Repair of Brow Ptosis (BCP-76)
Effective Date: 07.01.2022
Repair of Brow Ptosis (BCP-76)
Effective Date: 7/1/21
Repair of Brow Ptosis (BCP-76)
Effective Date: 10/1/2020
Repair of Brow Ptosis (BCP-76)
Effective Date: 10/1/2019
Repair of Brow Ptosis (BCP-76)
Effective Date: 1/1/2019
Retransplantation and Pediatric Transplantation (BCP-17 v.4)
Effective Date: 04.01.2024
Retransplantation and Pediatric Transplantation (BCP-17 v.3)
Effective Date: 04.01.2023
Retransplantation and Pediatric Transplantation (BCP-17 v.2)
Effective Date: 07.01.2022
Retransplantation and Pediatric Transplantation (BCP-17)
Effective Date: 04.01.2022
Retransplantation and Pediatric Transplantation (BCP-17)
Effective Date: 4/1/21
Sacral Nerve Stimulation for Urinary and Fecal Incontinence (BCP-81)
Effective Date: 07.01.2023
Telemedicine Services (BCP-50)
Effective Date: 07.01.2023
Telemedicine Services (BCP-50)
Effective Date: 01.01.2023
Telemedicine Services (BCP-50)
Effective Date: 01.01.2022
Telemedicine Services (BCP-50)
Effective Date: 1/1/2021
Telemedicine Services (BCP-50)
Effective Date: 3/1/2020
Telemedicine Services (BCP-50)
Effective Date: 1/1/2020
Spinal Cord Stimulation for Pain Management (BCP-73)
Effective Date: 07.01.2023
Spinal Cord Stimulation for Pain Management (BCP-73)
Effective Date: 07.01.2022
Spinal Cord Stimulation for Pain Management (BCP-73)
Effective Date: 7/1/21
Spinal Cord Stimulation for Pain Management (BCP-73)
Effective Date: 10/1/20
Spinal Cord Stimulation for Pain Management (BCP-73)
Effective Date: 10/1/2019
Spinal Cord Stimulation for Pain Management (BCP-73)
Effective Date: 1/1/2019
Sub-Acute Rehabilitation (SAR) Services (BCP-61)
Effective Date: 10.01.2022
Sub-Acute Rehabilitation (SAR) Services (BCP-61)
Effective Date: 10/1/21
Sub-Acute Rehabilitation (SAR) Services (BCP-61)
Effective Date: 8/7/2020
Sub-Acute Rehabilitation (SAR) Services (BCP-61)
Effective Date: 1/1/2020
Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)
Effective Date: 01.01.2024
Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)
Effective Date: 01.01.2023
Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)
Effective Date: 1/1/22
Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)
Effective Date: 10/1/2020
Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)
Effective Date: 10/1/2019
Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)
Effective Date: 10/1/2018
Varicose Vein Treatment (BCP-63)
Effective Date: 01.01.2023
Varicose Vein Treatment (BCP-63)
Effective Date: 04.01.2022
Varicose Vein Treatment (BCP-63)
Effective Date: 1/1/21
Varicose Vein Treatment (BCP-63)
Effective Date: 04/1/2020
Varicose Vein Treatment (BCP-63)
Effective Date: 1/1/2019
Varicose Vein Treatment (BCP-63)
Effective Date: 4/1/2018
Weight Management Services (BCP-60)
Effective Date: 07.01.2022
Weight Management Services (BCP-60)
Effective Date: 7/1/2021
Weight Management Services (BCP-60)
Effective Date: 4/1/2020

Archived Medical Benefit Coverage Policies (BCP)

Archived PHP Medical Benefit Coverage Policies (BCP)

Ambulance Transport (BCP-10)

Ambulance Transport (BCP-10)

Ambulance Transport (BCP-10)

Ambulance Transport (BCP-10)

Ambulance Transport (BCP-10)

Ambulance Transport (BCP-10)

Ambulance Transport (BCP-10)

Ambulatory EEG and Video Monitoring (BCP-80)

Ambulatory EEG and Video Monitoring (BCP-80)

Ambulatory EEG and Video Monitoring (BCP-80)

Ambulatory EEG and Video Monitoring (BCP-80)

Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)

Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)

Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)

Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)

Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)

Applied Behavioral Analysis (ABA) Therapy for Treatment of Autism Spectrum Disorders (BCP-12)

Bariatric Surgery (BCP-32)

Bariatric Surgery (BCP-32)

Bariatric Surgery (BCP-32)

Bariatric Surgery (BCP-32)

Bariatric Surgery (BCP-32)

Bariatric Surgery (BCP-32)

CAR T-Cell Immunotherapy (BCP-77)

Complementary and Alternative Medicine (CAM) (BCP-29)

Complementary and Alternative Medicine (CAM) (BCP-29)

Complementary and Alternative Medicine (CAM) (BCP-29)

Complementary and Alternative Medicine (CAM) (BCP-29)

Complementary and Alternative Medicine (CAM) (BCP-29)

Complementary and Alternative Medicine (CAM) (BCP-29)

Continuous Glucose Monitors and Supplies (BCP-64)

Continuous Glucose Monitors and Supplies (BCP-64)

Continuous Glucose Monitors (BCP-64)

Continuous Glucose Monitors (BCP-64)

Continuous Glucose Monitors (BCP-64)

Continuous Glucose Monitors (BCP-64)

COVID-19 Testing and Treatment (BCP-15)

COVID-19 Testing and Treatment (BCP-15)

COVID-19 Testing and Treatment (BCP-15)

COVID-19 Testing and Treatment (BCP-15)

Dental-Related General Anesthesia and Facility Charges (BCP-16)

Dental-Related General Anesthesia and Facility Charges (BCP-16)

Dental-Related General Anesthesia and Facility Charges (BCP-16)

Dental-Related General Anesthesia and Facility Charges (BCP-16)

Dental-Related General Anesthesia and Facility Charges (BCP-16)

Dental-Related General Anesthesia (BCP-16)

Dental Services Requiring General Anesthesia (BCP-16)

Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)

Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)

Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)

Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)

Drug Testing in Pain Management and Substance Use Disorders Treatment (BCP-78)

Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Join Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Join Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Join Injections and Facet Neurotomy for Pain Management (BCP-74)

Facet Joint Injections and Facet Neurotomy for Pain Management (BCP-74)

Fecal Bacteriotherapy (BCP-69)

Fecal Bacteriotherapy (BCP-69)

Fecal Bacteriotherapy (BCP-69)

Fecal Bacteriotherapy (BCP-69)

Fecal Bacteriotherapy (BCP-69)

Femoro-Acetabular Impingement Hip Surgery (BCP-65)

Femoro-Acetabular Impingement Hip Surgery (BCP-65)

Femoro-Acetabular Impingement Hip Surgery (BCP-65)

Femoro-Acetabular Impingement Hip Surgery (BCP-65)

Femoro-Acetabular Impingement Hip Surgery (BCP-65)

Gender Reassignment Surgery (BCP-24)

Gender Reassignment Surgery (BCP-24)

Gender Reassignment Surgery (BCP-24)

Gender Reassignment Surgery (BCP-24)

Gender Reassignment Surgery (BCP-24)

Glaucoma Surgery iStent Trabecular Micro-Bypass Stent (BCP-68)

Glaucoma Surgery iStent Trabecular Micro-Bypass Stent (BCP-68)

Glaucoma Surgery iStent Trabecular Micro-Bypass Stent (BCP-68)