Medical Benefit Coverage Policies (BCP)

Please check back often as we add new Medical Policies and edit existing Medical Policies on a regular basis.

Current PHP Medical Benefit Coverage Policies (BCP)




• Ambulance Transport (BCP-10)

  Effective Date: 01.01.2024

• Ambulatory EEG and Video Monitoring (BCP-80)

  Effective Date: 01.01.2024

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

  Effective Date: 07.01.2023

• Bariatric Surgery (BCP-32)

  Effective Date: 07.01.2023

• Cardiac Transplantation (BCP-66)

  Effective Date: 04.01.2024

• Clinical Trials (BCP-83)

  Effective Date: 04.01.2024

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

  Effective Date: 10.01.2023

• Continuous Glucose Monitors and Supplies (BCP-64)

  Effective Date: 01.01.2024

• Continuous Passive Motion (CPM) Machine (BCP-82)

  Effective Date: 10.01.2023

• COVID-19 Testing and Treatment (BCP-15)

  Effective Date: 05.11.2023

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

  Effective Date: 04.01.2024

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

  Effective Date: 10.01.2023

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

  Effective Date: 04.01.2024

• Fecal Bacteriotherapy (BCP-69)

  Effective Date: 01.01.2024

• Femoro-Acetabular Impingement Hip Surgery (BCP-65)

  Effective Date: 01.01.2024

• Gender Reassignment Surgery (BCP-24)

  Effective Date: 01.01.2023

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

  Effective Date: 07.01.2023

• Hearing Aids and Services (BCP-21)

  Effective Date: 10.01.2023

• Hematopoietic Stem Cell Transplant (BCP-67)

  Effective Date: 07.01.2023

• Home Health Care Services (BCP-26)

  Effective Date: 01.01.2024

• Home Infusion Therapy Services (BCP-27)

  Effective Date: 10.01.2023

• Hospice Care Services (BCP-22)

  Effective Date: 01.01.2024

• Infertility Services (BCP-72)

  Effective Date: 01.01.2024

• Inpatient Rehabilitation (IPR) Services (BCP-23)

  Effective Date: 10.01.2023

• Liver Transplantation (BCP-75 v.7)

  Effective Date: 04.01.2024

• Lung Transplantation (BCP-70)

  Effective Date: 07.01.2023

• Observation Care Services (BCP-04)

  Effective Date: 01.01.2024

• Orthognathic Surgery (BCP-36)

  Effective Date: 04.01.2024

• Outpatient Cardiac Rehabilitation Therapy Services (BCP-08)

  Effective Date: 01.01.2024

• Outpatient High Tech Radiology and Nuclear Medicine (BCP-39)

  Effective Date: 01.01.2024

• Outpatient Pulmonary Rehabilitation Therapy Services (BCP-07)

  Effective Date: 04.01.2024

• Outpatient Rehabilitative-Habilitative Services-Physical and Occupational Therapy (BCP-06)

  Effective Date: 04.11.2023

• Outpatient Rehabilitation-Habilitation Services-Speech Therapy (BCP-57)

  Effective Date: 07.01.2023

• Pancreas Transplantation (BCP-71 v.7)

  Effective Date: 04.01.2024

• Preventive Health Services (BCP-45)

  Effective Date: 01.01.2023

• Pre-Transplant Services (BCP-33)

  Effective Date: 01.01.2024

• Renal Transplantation (BCP-51 v.8)

  Effective Date: 04.01.2024

• Repair of Brow Ptosis (BCP-76)

  Effective Date: 07.01.2023

• Retransplantation and Pediatric Transplantation (BCP-17 v.4)

  Effective Date: 04.01.2024

• Sacral Nerve Stimulation for Urinary and Fecal Incontinence (BCP-81)

  Effective Date: 07.01.2023

• Spinal Cord Stimulation for Pain Management (BCP-73)

  Effective Date: 07.01.2023

• Sub-Acute Rehabilitation (SAR) Services in a Skilled Nursing Facility (SNF) (BCP-61)

  Effective Date: 10.01.2023

• Telemedicine Services (BCP-50)

  Effective Date: 07.01.2023

• Therapeutic Shoes and Inserts for Diabetic Patients (BCP-03)

  Effective Date: 01.01.2024

• Varicose Vein Treatment (BCP-63)

  Effective Date: 01.01.2024

• Weight Management Services (BCP-60)

  Effective Date: 07.01.2023