BCBS Arkansas Medical Policy Updates – February 2019

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

February 2019 BCBS Arkansas Medical Policy Updates:

• Amniocentesis and/or Chorionic Villus Sampling to Detect Fetal Hereditary or Chromosomal Abnormalities
• Antigen Leukocyte Antibody Test (ALCAT)
• Antithrombin III Replacement
• Aqueous Shunts and Devices for Glaucoma
• Arthroereisis for Pes Planus (Flat Feet) (Subtalar stabilization)
• Autism Spectrum Disorder, Early Behavioral Intervention
• Balloon Dilation of the Eustachian Tube
• Blood/Platelet-Derived Growth Factors for Wound Healing
• Bone Growth Stimulation, Electrical, Appendicular Skeleton
• Cardiac Event Recorder, Mobile Telemetry
• Copanlisib (Aliqopa)
• Cryosurgical Ablation of Primary or Metastatic Liver Tumors
• Digital Imaging Systems for the Detection of Diabetic Retinopathy
• Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome
• Functional Anesthetic Discography
• Genetic Test: Head and Neck Cancer, EGFR Mutation Analysis to Predict Sensitivity to Chemotherapy
• Genetic Test: Heart Transplantation Rejection, AlloMap Testing
• Genetic Test: Prenatal Analysis of Fetal DNA in Maternal Blood to Detect Fetal Aneuploidy
• Genetic Test: Uveal Melanoma, Gene Expression Profile To Predict Risk Of Metastasis
• Growth Hormone, Human
• HDC & Allogeneic or Autologous Hematopoietic Stem Cell Support for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
• Homocysteine Measurement
• Immune Globulin, Intravenous and Subcutaneous
• Intensity Modulated Radiation Therapy (IMRT), Anus, Anal Canal
• Intravitreal Implant, Fluocinolone Acetonide (Retisert™, Iluvien®)
• Letermovir (Prevymis)
• Magnetic Resonance Imaging (MRI), Breast
• Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate the Diagnosis and Management of Asthma and Other Respiratory Disorders
• Mepolizumab (Nucala)
• Nerve Conduction Studies (NCS), Electromyography (EMG) and Surface EMG (SEMG)
• Ocriplasmin (Jetrea®) for Symptomatic Vitreomacular Adhesion
• Patient-actuated End Range Motion Stretching Devices
• Pharmacy: Lutetium Lu 177 Dotatate (Lutathera®)
• Photodynamic Therapy for Malignancy
• Phototherapy for Psoriasis
• Physician Assistants
• Pilot Policy: Balloon Ostial Dilation (Balloon Sinuplasty) for the Treatment of Chronic Sinusitis
• Pilot Policy: Total Hip Arthroplasty (THA)
• Platelet-Rich Plasma (Autologous Growth Factors), Orthopedic Applications
• Pneumatic Compression Device, Intermittent, for Home Use following Hip and Knee Arthroplasty, Hip Fracture Repair
• 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: Autism Screening
• Preventive Services for Non-Grandfathered (PPACA) Plans: Colorectal Cancer Screening
• PREVENTIVE SERVICES FOR NON-GRANDFATHERED (PPACA) PLANS: DEPRESSION SCREENING IN ADOLESCENTS
• Preventive Services For Non-Grandfathered (Ppaca) Plans: Depression Screening, Adults
• Preventive Services for Non-Grandfathered (PPACA) Plans: High Blood Pressure Screening in Adults
• Preventive Services for Non-Grandfathered (PPACA) Plans: Overview
• Preventive Services for Non-Grandfathered (PPACA) Plans: Well-Child Visits, Newborn, Infant, Children, Adoloscents & Ages 18-21
• Pulsed Pressure, Treatment for Meniere’s Disease
• Radioactive Seed Localization of Nonpalpable Breast Lesions
• Sacroiliac Joint Fusion, Minimally Invasive
• Screening for Vertebral Fracture with Dual X-ray Absorptiornetry (DEXA)
• Spinal Cord Neurostimulation for Treatment of Intractable Pain
• Testing for Drugs of Abuse or Drugs at Risk of Abuse including Controlled Substances
• Testosterone Replacement Therapy
• Tocolysis, Acute and Maintenance Therapy
• Transplant, Composite Tissue Allotransplantation, Hand and/or Face
• Triamcinolone Acetonide Extended Release (Zilretta)
• Ultrasonic Ablation of Soft Tissue, Percutaneous

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

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