BCBS Arkansas Medical Policy Updates – December 2018

Click here to view the Blue Cross Blue Shield Arkansas Medical Policy Updates »

December 2018 BCBS Arkansas Medical Policy Updates:

• Ablation Therapy, Radiofrequency and Cryoablation of Pulmonary Tumors
• Adoptive Immunotherapy
• Allergen Specific IgE In Vitro Testing
• Amniotic Membrane and Amniotic Fluid Injections
• Anti-PD-1 (programmed death receptor-1)Therapy (Pembrolizumab)(Nivolumab)
• Artificial Heart, Total
• Artificial Vertebral Disc, Cervical Spine
• Autism Spectrum Disorder, Early Behavioral Intervention
• Automated Whole Breast Ultrasound
• Avelumab (Bavencio™)
• Balloon Sinuplasty
• BCBS Arkansas Medical Policies
• Benralizumab (Fasenra)
• Bevacizumab (Avastin™) for Oncologic Indications
• Biomarker Test, PreDx, Diabetes Risk Score
• Biomarkers for Liver Disease
• Brachytherapy, Brain Tumors
• Brachytherapy, Breast
• Brachytherapy, Prostate, High-Dose Rate Temporary
• Brentuximab (Adcetris™)
• Bronchial Thermoplasty
• Cerliponase Alfa (Brineura™)
• Continuous Local Anesthetic Infusion Pumps (Disposable Pain Pumps)
• Continuous Passive Motion Device In the Home Setting
• Copanlisib (Aliqopa)
• Dopamine Transporter Imaging with Single Photon Emission Computed Tomography (DAT-SPECT)
• Edaravone
• Etelcalcetide
• Eteplirsen (Exondys-51)
• Gemtuzumab Ozogamicin (Mylotarg™)
• Gene Therapy for Inherited Retinal Dystrophy-Voretigene (Luxturna)
• Genetic Test: Alpha Thalessemia
• Genetic Test: BRCA1 or BRCA2 Mutations
• Genetic Test: Breast Ca; Risk Recurrence to Determine Need for Adjuvant Therapy (Oncotype DX)
• Genetic Test: Cancer Susceptibility Panels Using Next Generation Sequencing
• Genetic Test: Chromosomal Microarray Analysis (CMA) and Next-Generation Sequencing (NGS) Panels for the Genetic Evaluation of Patients with Developmental Delay/Intellectual Disability or Autism Spectrum Disorder
• Genetic Test: Colon Cancer, Gene Expression Profiling (Oncotype DX, Colon PRS, Onco Defender-CRC, ColoPrint)
• Genetic Test: Fecal DNA to Detect Colorectal Cancer, Screening
• Genetic Test: Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
• Genetic Test: Heart Transplantation Rejection, AlloMap Testing
• Genetic Test: Hemochromatosis
• Genetic Test: Hereditary Pancreatitis
• Genetic Test: KIT (c-KIT, CD117)
• Genetic Test: Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients with Cancer
• Genetic Test: Lynch Syndrome and Inherited Intestinal Polyposis Syndromes
• Genetic Test: Molecular Markers in Fine Needle Aspirates of the Thyroid
• Genetic Test: Pharmacogenetic Testing for Pain Management
• Genetic Test: Statin-Induced Myopathy (SLCO1B1)
• Genetic Test: Uveal Melanoma, Gene Expression Profile To Predict Risk Of Metastasis
• Glucose Monitoring, Continuous
• Guselkumab
• HDC & Allogeneic Stem &/or Progenitor Cell Support for Primitive Neuroectodermal Tumors (PNET) & Ependymoma
• HDC & Autologous Stem &/or Progenitor Cell Support-Hodgkin’s Disease
• Hereditary Angioedema (HAE), Prophylaxis and Acute Treatment
• Immobilized lipase cartridge for enteral feedings (Relizorb)
• Immune Cell Function Assay
• Infliximab (Remicade)
• Inotuzumab Ozogamicin (Besponsa™)
• Lab Test: Fecal Calprotectin Testing
• Meniscal Allograft Transplantation and Synthetic Meniscal Implants
• Metabolite Testing, Monitor Antimetabolite Therapy for Inflammatory Bowel & Collagen Vascular Disease, Acute Lymphoblastic Leukemia
• Metreleptin
• Mutation Molecular Analysis for Targeted Therapy in Patients With Non-Small-Cell Lung Cancer
• Myoelectric Prosthesis for the Upper Limb
• Ocrelizumab (Ocrevus)
• Olaratumab (LARTRUVO™)
• Pasireotide (Signifor or Signifor LAR)
• PET Scans (Positron Emission Tomography)
• Pharmacy: Lutetium Lu 177 Dotatate (Lutathera®)
• Photodynamic Therapy for Dermatologic Conditions
• Pilot Policy: Balloon Ostial Dilation (Balloon Sinuplasty) for the Treatment of Chronic Sinusitis
• Pilot Policy: Total Hip Arthroplasty (THA)
• Plugs for Anal Fistula Repair
• Preimplantation Genetic Diagnosis, Testing or Treatment
• Preventive Services for Non-Grandfathered (PPACA) Plans: Aspirin for the Prevention of Morbidity and Morality from Preeclampsia in High Risk Pregnant Women
• Preventive Services for Non-Grandfathered (PPACA) Plans: BRCA Testing; Genetic Counseling and Evaluation
• Preventive Services For Non-Grandfathered (Ppaca) Plans: Cervical Cancer Screening
• Preventive Services for Non-Grandfathered (PPACA) Plans: Colorectal Cancer Screening
• Preventive Services for Non-Grandfathered (PPACA) Plans: Human Papillomavirus (HPV), Screening for Sexually Active Women
• Preventive Services for Non-Grandfathered (PPACA) Plans: RH Incompatability Screening
• PREVENTIVE SERVICES FOR NON-GRANDFATHERED (PPACA) PLANS: SYPHILIS SCREENING
• Procalcitonin
• Prostate Cancer Predicting Risk of Recurrence, Systems Pathology
• Rituximab (Rituxan), Off-label Use
• Serum Antibodies for Diagnosis of Inflammatory Bowel Disease
• Site of Care or Site of Service Review
• Skin and Soft Tissue Substitutes, Bio-Engineered Products
• Subconjunctival Retinal Prosthesis
• Surgery for Morbid Obesity
• Synthetic Cartilage Implant for Joint Pain
• Testing for Drugs of Abuse or Drugs at Risk of Abuse including Controlled Substances
• Tocolysis, Acute and Maintenance Therapy
• Transanal Endoscopic Microsurgery (TEMS/TAMIS)
• Transplant, Heart/Lung
• Treatment of Varicose Veins/Venous Insufficiency
• Triamcinolone Acetonide Extended Release (Zilretta)
• Under Heavy Sedation or General Anesthesia as a Technique of Opioid Detoxification
• Ventricular Assist Devices
• Viscosupplementation for the Treatment of Osteoarthritis of the Hip, Knee, and All Other Joints

Click here to view the Blue Cross Blue Shield Arkansas Medical Policy Updates »

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