Effective Policies Ambetter from Superior HealthPlan and Ambetter Health Solutions (ICHRA) Policies Air Ambulance (CP.MP.175) (PDF) ADHD Assessment and Treatment (CP.BH.124) (PDF) Allergy Testing and Therapy (TX.CP.MP.100) (PDF) Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and Beta-Thalassemia (CP.MP.108) (PDF) Allogeneic Hematopoietic Progenitor Cell Therapy (CP.MP.249) (PDF) Applied Behavioral Analysis (CP.BH.104) (PDF) Applied Behavior Analysis Documentation Requirements (CP.BH.105) (PDF) Assisted Reproductive Technology (CP.MP.55) (PDF) Bone-anchored Hearing Aid (CP.MP.93) (PDF) Burn Surgery (CP.MP.186) (PDF) Caudal or Interlaminar Epidural Steroid Injections (CP.MP.164) (PDF) Clinical Trials (CP.MP.94) (PDF) Cosmetic and Reconstructive Procedures (CP.MP.31) (PDF) Deep Transcranial Magnetic Stimulation For OCD (CP.BH.201) (PDF) IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (CP.MP.61) (PDF) Diaphragmatic/Phrenic Nerve Stimulation (CP.MP.203) (PDF) Discography (CP.MP.115) (PDF) Donor Lymphocyte Infusion (CP.MP.101) (PDF) Drugs of Abuse: Definitive Testing (CP.MP.50) (PDF) Durable Medical Equipment and Orthotics and Prosthetics Guidelines (CP.MP.107) (PDF) Electric Tumor Treating Fields (Optune) (CP.MP.145) (PDF) Experimental Technologies (CP.MP.36) (PDF) Evoked Potential Testing (CP.MP.134) (PDF) Facet Joint Interventions (CP.MP.171) (PDF) Facility-based Sleep Studies for Obstructive Sleep Apnea (CP.MP.248) (PDF) Fecal Incontinence Treatments (CP.MP.137) (PDF) Fertility Preservation (CP.MP.130) (PDF) Fetal Surgery in Utero for Prenatally Diagnosed Malformations (CP.MP.129) (PDF) Gastric Electrical Stimulation (CP.MP.40) (PDF) Heart-Lung Transplant (CP.MP.132) (PDF) Home Ventilators (CP.MP.184) (PDF) Hospice Services (CP.MP.54) (PDF) Hyperhidrosis Treatments (CP.MP.62) (PDF) Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180) (PDF) Implantable Intrathecal or Epidural Pain Pump (CP.MP.173) (PDF) Implantable Loop Recorder (CP.MP.243) (PDF) Implantable Wireless Pulmonary Artery Pressure Monitoring (CP.MP.160) (PDF) Intestinal and Multivisceral Transplant (CP.MP.58) (PDF) Intradiscal Steroid Injections for Pain Management (CP.MP.167) (PDF) IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (CP.MP.61) (PDF) Kidney Disorders (CP.MP.227) Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy (CP.MP.250) (PDF) Liposuction for Lipedema (CP.MP.244) Lung Transplantation (CP.MP.57) (PDF) Lysis of Epidural Lesions (CP.MP.116) (PDF) Mechanical Stretching Devices for Joint Stiffness (CP.MP.144) Multiple Sleep Latency Testing (CP.MP.24) (PDF) NICU Apnea Bradycardia Guidelines (CP.MP.82) (PDF) NICU Discharge Guidelines (CP.MP.81) (PDF) Neonatal Abstinence Syndrome Guidelines (CP.MP.86) (PDF) Neonatal Sepsis Management (CP.MP.85) (PDF) Nerve Blocks and Neurolysis for Pain Management (CP.MP.170) (PDF) Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES) (CP.MP.48) Non-myeloablative Allogeneic Stem Cell Transplants (CP.MP.141) (PDF) Obstetrical Home Care Programs (CP.MP.91) (PDF) Orthognathic Surgery (CP.MP.202) (PDF) Osteogenic Stimulation (CP.MP.194) Outpatient Oxygen Use (CP.MP.190) (PDF) Pancreas Transplantation (CP.MP.102) (PDF) Panniculectomy (CP.MP.109) (PDF) Pediatric Heart Transplant (CP.MP.138) (PDF) Pediatric Kidney Transplant (CP.MP.246) (PDF) Pediatric Liver Transplant (CP.MP.120) (PDF) Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (CP.MP.147) (PDF) Phototherapy for Neonatal Hyperbilirubinemia (CP.MP.150) (PDF) Physical, Occupational, and Speech Therapy Services (CP.MP.49) (PDF) Polymerase Chain Reaction Respiratory Viral Panel Testing (CP.MP.181) (PDF) Posterior Tibial Nerve Stimulation for Voiding Dysfunction (CP.MP.133) (PDF) Proton and Neutron Beam Therapies (CP.MP.70) (PDF) Reduction Mammoplasty and Gynecomastia Surgery (CP.MP.51) (PDF) Repair of Nasal Valve Compromise (CP.MP.210) (PDF) Sacroiliac Joint Interventions for Pain Management (CP.MP.166) (PDF) Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins (CP.MP.146) (PDF) Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections (CP.MP.165) (PDF) Short Inpatient Hospital Stay (CP.MP.182) (PDF) Skin and Soft Tissue Substitutes for Diabetic Foot Ulcers and Venous Leg Ulcers (CP.MP.185) (PDF) Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (CP.MP.117) (PDF) Stereotactic Body Radiation Therapy (CP.MP.22) (PDF) Tandem Transplant (CP.MP.162) (PDF) Therapeutic Utilization of Inhaled Nitric Oxide (CP.MP.87) (PDF) Therapy Services (PT/OT/ST) (CP.MP.49) (PDF) Total Artificial Heart (CP.MP.127) (PDF) Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (CP.MP.163) (PDF) Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (CP.BH.200) (PDF) Transplant Service Documentation Requirements (CP.MP.247) (PDF) Trigger Point Injections for Pain Management (CP.MP.169) (PDF) Urinary Incontinence Devices and Treatments (CP.MP.142) (PDF) Vagus Nerve Stimulation (CP.MP.12) (PDF) Please Note: The date in the link name is either the most recent revision date, or the effective date of the policy if no clinically significant changes have been made since September 1, 2019
Patient Population The majority of patients who can tolerate semaglutide would be expected to have at least some weight loss from taking the drug, and according to the clinical expert, patients who report significant hunger and difficulty reducing portion sizes tend to be the patients who respond the most to the drug, although some weight loss is also seen in patients who do not report significant hunger or overeating
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These references are for informational catalog context only
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