by Kristin Fleming | Feb 10, 2026 | Current
Link to PDF Status: Reaffirmed Effective Date: 09/01/2024 Doc ID: PAC03-0924.1-R0126 Last Review Date: 01/29/2026 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. Clinical Appropriateness...
by Kristin Fleming | Feb 10, 2026 | Current
Link to PDF Status: Reaffirmed Effective Date: 09/01/2024 Doc ID: PAC02-0924.1-R0126 Last Review Date: 01/29/2026 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. Clinical Appropriateness...
by Kristin Fleming | Dec 2, 2025 | Current
Link to PDF Status: Updated codes 01/01/2026 Effective Date: 11/17/2024 Doc ID: CAR06-1124.3- R0725-UC0126 Last Review Date: 07/17/2025 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details....
by Kristin Fleming | Dec 2, 2025 | Current
Link to PDF Status: Updated codes 01/01/2026 Effective Date: 10/20/2024 Doc ID: CAR04-1024.1-R0725-UC0126 Last Review Date: 07/17/2025 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details....
by Kristin Fleming | Nov 17, 2025 | Archived
Archive Date: 11/15/2025; 04/04/2026 for Healthy Blue Louisiana Medicaid This document has been archived because it has outdated information. It is for historical information only and should not be consulted for clinical use. Current versions of guidelines are...
