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BCBS Excellus Medical Policy Updates – October 2018
Click here to view the Blue Cross Blue Shield Excellus Medical Policy Updates »
October 2018 Medical Policy updates:
- Allergen Immunotherapy: Injections. Sublingual Immunotherapy
- Ambulatory Event Monitor (AEM): Ambulatory Electrocardiographic (AECG) Devices, Cardiac Event Detection (CED), CardioNet, Mobile Cardiac Outpatient Telemetry (MCOT), Ziopatch
- Aquatic therapy, Biodex, Cybex, Gait analysis, Hippotherapy, Hydrotherapy, Isokinetic dynamometry, Isokinetic testing, Myowave, Physical therapy, PT, Vibromyography (VMG)
- Augmentative and Alternative Communication Systems: AAC, Dynavox, Introtalker, VoiceMate, Walker Talker, Say-It-All, Speech Generating Devices (SGD)
- Bone Densitometry/Bone Density Studies: DEXA Scan, Dual Photon Absorptiometry (DPA), Morphometric X-ray Absorptiometry, Single Photon Absorbtiometry (SPA), Ultrasound Measurement of the Heel
- Breast Reconstruction Surgery
- Cardiac Resynchronization Therapy (Biventricular Pacemakers) for the Treatment of Heart Failure (Bioimpedance, Dual Chamber Pacemaker)
- Computer Assisted Navigation for Knee and Hip Arthroplasty: Orthopilot® Navigation Platform
- Continuous Passive Motion Device (CPM) in the Home Setting
- Disability Determination for Extension of Benefits after Contract Termination
- Durable Medical Equipment (DME) – Standard and Non-Standard, Home Medical Equipment
- Enteral Formula/Nutrition, Enteral Therapy, Probiotics, Tube Feeding
- Erectile Dysfunction: Caverject, Edex, ErecAid, Intracavernosal Therapy, Intraurethral Therapy, MUSE (Medicated Urethral System for Erection), Penile Prosthesis, Penile Vein Ligation, Vacuum Erection Device, Vascular Revascularization
- External Prosthetic Devices: C-leg, Intelligent prosthesis, microprocessor-controlled lower limbs, Ossur Rheo, Vacuum-assisted-socket system (VASS)
- Fecal Bacteriotherapy, Fecal microbiota therapy (FMT), Fecal transfusion, Fecal transplant, Human probiotic infusion (HPI), Intestinal microbiotia Transplantation (IMT), Microbiome, Stool transplant
- Foot Care and Treatment of Mycotic Nails
- Foot Orthotics, Arch Supports, Shoe Inserts
- Genetic Testing for Hereditary Hemochromatosis
- High Resolution Anoscopy (Anal Colposcopy)
- Home Phototherapy for Hyperbilirubinemia (e.g., Biliblanket, Bili Lights)
- Hypnosis
- Immunizations/Vaccines (e.g., Hepatitis A, Hepatitis B, Human Papillomavirus [HPV, Cervarix, Gardasil], Meningococcal, Pneumococcal [Pneumovax 23, Prevnar], Rotavirus [Rotarix], Varicella [Varivax], Varicella Zoster [Zostavax])
- Implantable Cardiac Hemodynamic Monitoring for Heart Failure: CardioMEMS HF, Pulmonary artery pressure sensor, Wireless hemodynamic monitor
- Intensity Modulated Radiation Therapy (IMRT)
- Isolated Limb Perfusion and Infusion (Alkeran, L-PAM, Melphalan, Tumor Necrosis Factor)
- Light and Laser Therapies for Dermatologic Conditions (BCLear Lamp, CureLight Broadband, Excilite Lamp, Levulan®, Kerastick®, Metvix®, Narrow Band Ultraviolet B, Psoralens, PUVA, Ultraviolet Light, UVA, UVB, VTRAC Lamp, XeCL, XTRAC)
- Mammography: Computer Aided Detection (CAD): Image Checker System, MammoReader, R2 Checker, Second Look, RapidScreen
- Medical Response to Contamination from Terrorist Attacks: Biological (e.g., Anthrax, Germ Warfare, Plague, Smallpox), Chemical, Radiation
- Occupational Therapy (OT), Constraint Induced Movement Therapy (CIMT), Gait Analysis, Sensory Integration Therapy, SIT
- Peptide Receptor Radionuclide Therapy (PRRT, PRRNT): Receptor-Mediated Radiotherapy, Radiolabeled Nuclide Therapy, Somatostatin Analog, 90Y-DOTATOC, 177Lu-DOTA0, Tyr3, 90Y-DOTA0
- Percutaneous Intradiscal Electrothermal Annuloplasty (IDET, IDTA, PIRFT, Biacuplasty)
- Phototherapeutic Keratoplasty/Keratectomy, PTK
- Positive Airway Pressure Devices: CPAP, BiPAP, APAP, DPAP, C-FLex
- Prostate Cancer Screening, Detection and Monitoring (e.g., Digital Rectal Exam – DRE, PCA3Plus, Prostate Specific Antigen – PSA, Prostatic Acid Phosphatase – Male PAP Test)
- Psychological Testing
- Quantitative Sensory Testing (QST)
- Reduction Mammaplasty/ Breast Reduction
- Sacroiliac Joint Fusion, IFUSE® Implant System ,SI-FIX, SImmetry® Sacroiliac Joint Fusion System, Silex™ Sacroiliac Joint Fusion System, SI-LOK® Sacroiliac Joint Fixation System
- Serum Tumor Markers for Diagnosis and Management of Cancer (AFP, CA-125, CA-19-9, CA-15-3, CA 27, CA 29, CEA, HCG, Proteomic)
- Speech/Language Pathology and Therapy (e.g., Fast ForWord, Lee Silverman Voice Therapy [LSVT-LOUD™],Vocal Cord Dysfunction, Voice Therapy
- Surgical Stockings (e.g., Gradient Compression/GCS, Jobst, Sigvaris, TEDs) and Compression Garments (e.g., Arm Assist, Belisse Compressure Bra, Lymphedema, Mastectomy, Circaid, Juzo, Reid Sleeves)
- Total Parenteral Nutrition (TPN), Intradialytic Parenteral Nutrition (IDPN), Intraperitoneal Nutrition (IPN), or Hyperalimentation
- Transpupillary Thermotherapy (TTT)
- Vagus Nerve Stimulation
Click here to view the Blue Cross Blue Shield Excellus Medical Policy Updates »
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