Molina Clinical Policy (MCP)
Molina has established Molina Clinical Policy (MCP) that function as one of the sets of guidelines for coverage decisions or determinations. Please know that these MCPs do not constitute plan authorization, nor is it an explanation of benefits. The MCPs are applicable to all lines of business Apple Health (Medicaid), Marketplace, and Medicare unless superseded by National Coverage Determination (Medicare) or Apple Health (Medicaid) Health Care Authority guidelines.
In this site, the MCPs with information specific to Washington State are made accessible to you to guide you in your medical decisions. All other MCPs are available at MolinaClinicalPolicy.com.
| Category | MCP | Last Approved Date | Original Effective Date |
|---|---|---|---|
| Genetic Testing | MCP-051 Genetic Testing | 4/12/2022 | 5/22/2008 |
| Surgery | MCP-091 Pediatric Bariatric Surgery | 11/9/2021 | 4/2/2014 |
| Medical | MCP-160 Implanted Intrathecal Pain Pumps Chronic Pain | 11/9/2021 | 4/2/2014 |
| Medical | MCP-171 Bronchial Thermoplasty | 11/9/2021 | 6/12/2014 |
| Medical | MCP-269 Speech Therapy | 1/11/2022 | 3/24/2016 |
| Medical | MCP-347 Autologous Chondrocyte Implantation for Knee Cartilage Lesions | 11/9/2021 | 9/18/2019 |
| Medical | MCP-406 Enteral Nutrition | 11/9/2021 | 10/13/2021 |
| Medical | MCP-407 Wound Care | 1/11/2022 | 12/8/2021 |