BCBS Arkansas Medical Policy Updates – January 2019

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

January 2019 BCBS Arkansas Medical Policy Updates:

• Abatacept (Orencia) for Rheumatoid Arthritis
• Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
• Adoptive Immunotherapy
• Alpha-1 Proteinase Inhibitor Therapy
• Ambulatory Blood Pressure Monitoring
• Amniotic Membrane and Amniotic Fluid Injections
• Antineoplaston Cancer Therapy
• Anti-PD-1 (programmed death receptor-1)Therapy (Pembrolizumab)(Nivolumab)
• Apheresis, Therapeutic (Plasma Exchange Transfusion)
• Arthroereisis for Pes Planus (Flat Feet) (Subtalar stabilization)
• Asfotase alfa (Strensiq®)
• Atezolizumab (Tecentriq)
• Autism Spectrum Disorder, Early Behavioral Intervention
• BCBS Arkansas Medical Policies
• Biofeedback as a Treatment of Fecal Incontinence or Constipation
• Biomarkers for Liver Disease
• Brachytherapy, Brain Tumors
• Brachytherapy, Breast
• Brachytherapy, Endobronchial
• Brachytherapy, Prostate, High-Dose Rate Temporary
• Brachytherapy, Prostate, Low-dose Rate
• Cardiac Event Recorder, External Loop or Continuous Recorder
• Cardiac Event Recorder, Insertable Loop Recorder
• Cardiovascular Risk Panels
• Certified Nurse Midwives
• Certified Nurse Practitioners
• Chromoendoscopy as an Adjunct to Colonoscopy
• Circulating Tumor Cells in the Management of Patients with Cancer, Detection of
• Clinical Nurse Specialist
• Cold Therapy
• Computed Tomography (CT) Scanning for Lung Cancer Screening
• Computed Tomography, Cardiac and Coronary Artery
• Electric Breast Pump (Hospital Grade)
• Electrical Stimulation, Deep Brain (e.g. Parkinsonism, Dystonia, Multiple Sclerosis, Post-Traumatic Dyskinesia)
• Electronic Brachytherapy for Nonmelanoma Skin Cancer
• Extracorporeal Shock Wave Therapy for Plantar Fasciitis and Other Musculoskeletal Conditions
• Fecal Microbiota Transplantation for the Treatment of Clostridium Difficile
• Gastroesophageal Reflux Disease (GERD), Magnetic Esophageal Ring
• Gene Therapy for Inherited Retinal Dystrophy-Voretigene (Luxturna)
• Genetic Test: Analysis of MGMT Promoter Methylation in Malignant Gliomas
• Genetic Test: BRCA1 or BRCA2 Mutations
• Genetic Test: Breast Ca; Risk Recurrence to Determine Need for Adjuvant Therapy (Oncotype DX)
• Genetic Test: Carbamazepine HLA-B*1502
• Genetic Test: Cardiac Ion Channelopathies (Long QT Syndrome, Brugada Syndrome, CPVT, Short QT Syndrome)
• Genetic Test: Colon Cancer, KRAS, NRAS and BRAF Mutation Analysis to Determine Tumor Sensitivity to Chemotherapy
• Genetic Test: Fecal DNA to Detect Colorectal Cancer, Screening
• Genetic Test: FMR 1 Mutations Including Fragile X Syndrome
• 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: Hypertrophic Cardiomyopathy, Predisposition
• Genetic Test: Molecular Testing of Tumors for Genomic Profiling as a Therapeutic Guide
• Genetic Test: Neurofibromatosis
• Genetic Test: Testing for the Diagnosis and Management of Mental Health Conditions
• Genetic Test: Universal Gene Test (Counsyl)
• Genetic Test: Uveal Melanoma, Gene Expression Profile To Predict Risk Of Metastasis
• Genetic Test: X-Linked Opitz G/BBB Syndrome, MID1 Mutation Testing
• Golimumab (Simponi®)
• Hemodynamic Monitoring of Heart Failure, Management in the Outpatient Setting
• HIV Tropism, Testing
• Hyperbaric Oxygen Pressurization (HBO)
• Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
• Intrastromal Corneal Ring Segments, Implantation
• Iron Therapy, Parenteral
• Leadless Cardiac Pacemakers
• Left Atrial Appendage, Closure Device, Percutaneous
• Lyme Disease Intravenous Antibiotic Therapy and Associated Diagnostic Testing
• Magnetic Resonance Imaging (MRI), Breast
• Measurement of Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in the Assessment of Cardiovascular Risk
• Mepolizumab (Nucala)
• Metabolite Testing, Monitor Antimetabolite Therapy for Inflammatory Bowel & Collagen Vascular Disease, Acute Lymphoblastic Leukemia
• Multispectral Digital Skin Lesion Analysis (MelaFind®) (MSDSLA)
• Noninvasive Imaging Technologies to Detect Liver Fibrosis or Cirrhosis (Elastography)
• Novel Lipid Risk Factors in Risk Assessment and Management of Cardiovascular Disease (apolipoprotein B) (apolipoprotein A-1) (HDL subclass) (LDL subclass) (apolipoprotein E) (Lipoprotein A)
• Nusinersen (Spinraza) for the Treatment of Spinal Muscular Atrophy
• Oscillatory Devices for Chest Physical Therapy
• Percutaneous Angioplasty, Stenting & Atherectomy of the Lower Extremity, Abdominal Aortic & Visceral Arteries
• Percutaneous Transluminal Endovascular Graft for Abdominal Aortic Aneurysm
• Peripheral Subcutaneous Field Stimulation
• PET Scans (Positron Emission Tomography)
• Physician Assistants
• Pilot Policy: Telemedicine for Applied Behavioral Analysis in the Treatment of Autism Spectrum Disorder
• Pilot Policy: Total Hip Arthroplasty (THA)
• Preimplantation Genetic Diagnosis, Testing or Treatment
• Preventive Services for Non-Gradfathered (PPACA) Plans: Lung Cancer Screening
• Preventive Services for Non-Grandfathered (PPACA) Plans: Abdominal Aortic Aneurysm Screening
• 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: Breast Cancer Preventive Medication
• Preventive Services for Non-Grandfathered (PPACA) Plans: Breast Cancer Screening (Mammography)
• Preventive Services for Non-Grandfathered (PPACA) Plans: Colorectal Cancer Screening
• Preventive Services For Non-Grandfathered (Ppaca) Plans: Depression Screening, Adults
• Preventive Services for Non-Grandfathered (PPACA) Plans: Human Papillomavirus (HPV), Screening for Sexually Active Women
• Preventive Services for Non-Grandfathered (PPACA) Plans: Overview
• Preventive Services for Non-Grandfathered (PPACA) Plans: Prevention of Falls in Community-Dwelling Older Adults
• Preventive Services for Non-Grandfathered (PPACA) Plans: Tobacco use, Screening, Counseling and Interventions
• Prostate Cancer Predicting Risk of Recurrence, Systems Pathology
• Proteomics, Screening and Detection of Cancer (e.g., OvaCheck)
• Radiation Therapy, Proton Beam for Treatment of Prostate Cancer
• Radiation Therapy, Proton Beam or Helium Ion Irradiation, Other than Prostate
• Radioactive Seed Localization of Nonpalpable Breast Lesions
• Radiofrequency Ablation and Other Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids
• Radiofrequency Treatment of Fecal Incontinence
• Radioimmunoscintigraphy Imaging – Indium-111 Capromab Pendetide (ProstaScint)
• Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
• Renal Artery, Angioplasty/Stenting, Percutaneous
• Sacral Nerve Stimulation for the Treatment of Fecal Incontinence
• Sacral Nerve Stimulation for the Treatment of Urge Urinary Incontinence
• Sensory Integration Therapy and Auditory Integration Therapy
• Serum Antibodies for Diagnosis of Inflammatory Bowel Disease
• Sipuleucel-T (Provenge) for the Treatment of Prostate Cancer
• Site of Care or Site of Service Review
• Skin and Soft Tissue Substitutes, Bio-Engineered Products
• Sleep Apnea and Other Pulmonary Diseases, Ventilation Support and Respiratory Assist Devices
• Sleep Apnea, Minimally Invasive Surgical Treatment
• Spinal Decompression Therapy (Internal Disc Decompression Therapy, Spinal Distraction Therapy) Using Motorized and/or Computerized Traction
• Stem Cell Growth Factors, Erythropoiesis-Stimulating Agents (ESAs), Darbepoetin, Epoetin, Peginesatide
• Surgery for Morbid Obesity
• Temporomandibular Joint Dysfunction
• Testing for Drugs of Abuse or Drugs at Risk of Abuse including Controlled Substances
• Tocolysis, Acute and Maintenance Therapy
• Transanal Endoscopic Microsurgery (TEMS/TAMIS)
• Transcatheter Pulmonary Valve Implantation
• Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
• Transplant, Heart
• Treatment of Varicose Veins/Venous Insufficiency
• Tumor Antigen, Prostate Specific Antigen (PSA)
• Vedolizumab (Entyvio) for Inflammatory Bowel Disease
• Vertebroplasty, Percutaneous
• Viscosupplementation for the Treatment of Osteoarthritis of the Hip, Knee, and All Other Joints
• Ziv-aflibercept (Zaltrap)

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

Policy Alerts monitors Commercial and Medicare medical policies for changes. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. When reviews occur out of cycle they often go unnoticed. Policy Alerts keeps you updated when Payers make coverage changes to medical policies affecting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on medical Insurance decisions in real-time. When changes occur, instant email alerts are delivered to your inbox. Clients have access to detailed coverage reports and medical policies through the interactive Policy Alerts Dashboard portal. Save time each month and keep focused on important Payer medical policy reviews and coverage decisions affecting your business!

Policy Alerts takes a client-focused hands-on approach and is constantly working to provide our customers with helpful insights and actionable analytics. We understand what our clients need and are dedicated to providing timely, accurate, and always up-to-date reports.

Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.