Lists of new, revised, and clarified medical policies and pharmacy medical policies effective in April 2023 are now available.
Summaries of medical and pharmacy policy updates are listed on the Policy Updates & Feedback page of our medical policy website. Each month’s summary is organized in sections for medical and pharmacy policies that are new, revised, clarified, or retired.
For members enrolled in our Medicare Advantage plans, we are required to make coverage determinations for services through the CMS National Coverage Determination (NCD) policies and benefit manuals. In addition, we follow Local Coverage Determination (LCD) policies established by the Massachusetts Medicare Administrative Contractors. When there is no NCD or LCD, we follow our commercial medical policies for Medicare Advantage members. Refer to medical policy 132, Medicare Advantage Management, for a directory of commercial and Medicare policies or to the Medicare Advantage section of our medical policy site.
To view Federal Employee Program medical policies, visit fepblue.org and search for Medical Policies.