April 2025 Medical Policy Updates

Published April 2025

Below is a recap of Medical Policy updates that went into effect recently. All policies are reviewed at least once annually. For more detailed information on the changes, please review our Provider FastFax Library or review all MVP Health Care Medical Policies.

Effective February 1, 2025 

• Air Medical Transport
• Autism Spectrum Disorders NYS
• Children’s Family Treatment and Support Services (CFTSS)
• Court Ordered Services
• Early Childhood Developmental Disorders VT
• Electroconvulsive Therapy (ECT)
• Home Care Services
• Investigational Procedures, Devices, Medical Treatments and Tests
• Mechanical Stretching Devices
• Oxygen and Oxygen Equipment
• Surgical Procedures for Glaucoma
• Treatment for Addictions

Effective April 1, 2025 

• Alopecia Treatment
• Breast Reduction Surgery (Reduction Mammaplasty)
• Cranial Orthotics
• Deep Brain Stimulation
• Durable Medical Equipment (Includes Prosthetics & Orthotics)
• Electrical Stimulation Devices & Therapies
• High Frequency Chest Wall Oscillation Devices
• Hospital Beds
• Hospital Inpatient Level of Care
• Imaging Procedures
• Indirect Handheld Calorimeter
• InterQual Criteria Medical Policies
• Obstructive Sleep Apnea: Diagnosis and Other Sleep Disorders
• Pectus Deformity Repair
• Prostate Cancer Interventions
• Prosthetic Devices (Upper and Lower Limb)
• Speech Generating Devices
• Spinal Cord Stimulator
• Temporomandibular Joint Dysfunction (TMJ) New York
• Temporomandibular Joint Dysfunction (TMJ) (Vermont)
• Transcranial Magnetic Stimulation for Treatment-Resistant Depression
• Vagus Nerve Stimulator
• Ventricular Assist Devices (VADs) and Total Artificial Heart
• Wheelchairs (Manual)