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 The MCPs are applicable to all lines of business Apple Health (Medicaid), Marketplace, and Medicare unless superseded by National Coverage Determination (Medicare) or Apple Health (Medicaid) Health Care Authority guidelines.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

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