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BCBS Horizon Medical Policy Updates – December 2018
Click here to view the Blue Cross Blue Shield Horizon Medical Policy Updates »
December 2018 Medical Policy Updates:
- Abdominoplasty
- Adult Abdomen Imaging Policy
- Adult Spine Imaging Policy
- Agalsidase Beta (Fabrazyme)
- Allergen Immunotherapy
- Allogeneic Pancreas Transplant
- Applied Behavior Analysis in the Treatment of Autism Spectrum Disorders (ASD)
- Autonomic Nervous System Testing
- Axicabtagene Ciloleucel (Yescarta)
- Belimumab (Benlysta)
- Bendamustine hydrochloride (Treanda Bendeka)
- Beta Amyloid Imaging with Positron Emission Tomography (PET) for Alzheimers Disease
- Bioengineered Skin and Soft Tissue Substitutes
- Biofeedback
- Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry
- Bortezomib (Velcade)
- Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
- Carfilzomib (Kyprolis)
- Chiropractic Review Policy
- Chromosomal Microarray Analysis for the Evaluation of Pregnancy Loss
- Circulating Tumor DNA for Management of Non-Small-Cell-Lung Cancer (Liquid Biopsy)
- Colorectal Cancer Screening
- Computed Tomography (CT) Perfusion Imaging of the Brain
- Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid
- Definition of Investigational or Experimental Procedure
- Donor Lymphocyte Infusion for Malignancies Treated with an Allogeneic Hematopoietic Stem-Cell Transplant
- Drug Therapy for Hereditary Angioedema [Cinryze Berinert Haegarda (Human C1 Inhibitor) Kalbitor (Ecallantide) Firazyr (Icatibant) Ruconest (C1 Esterase Inhibitor [Recombinant])]
- Dupilumab (Dupixent)
- Eculizumab (Soliris)
- Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer
- Erythropoietin Therapy Epoetin Alfa Darbepoetin Alfa Pegylated (PEG)-epoetin Beta and Epoetin Alfa-epbx
- Esophageal pH Monitoring
- Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies
- Fecal Microbiota Transplantation
- Focal Treatments for Prostate Cancer
- Foot Care Services
- Fulvestrant (Faslodex)
- Gaucher Disease Therapy
- Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
- Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
- Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
- Golimumab (Simponi Aria)
- Heart Transplant
- Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias Including Multiple Myeloma and POEMS Syndrome
- Ibalizumab-uiyk (Trogarzo)
- Immune Globulin Subcutaneous (Vivaglobin Hizentra Gammagard Liquid Gamunex-C or Gammaked HyQvia and Cuvitru for Subcutaneous Administration)
- Injectable Bulking Agents for the Treatment of Urinary Incontinence
- Intravenous Immunoglobulin (IVIG) Therapy
- Invasive Prenatal (Fetal) Diagnostic Testing
- Islet Transplantation
- Lemtrada (Alemtuzumab)
- Liver Transplant and Combined Liver-Kidney Transplant
- Meniscal Allografts and Other Meniscal Implants
- Microwave Tumor Ablation
- Molecular Analysis for Targeted Therapy for Non-Small-Cell Lung Cancer
- Molecular Markers in Fine Needle Aspirates of the Thyroid
- Molecular Testing for the Management of Pancreatic Cysts or Barrett Esophagus
- Multigene Expression Assay for Predicting Recurrence in Colon Cancer
- Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure
- Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA
- Ovarian and Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome
- Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
- Percutaneous Tibial Nerve Stimulation
- Pertuzumab (Perjeta)
- Photodynamic Therapy for Choroidal Neovascularization
- Preimplantation Genetic Testing
- Radiation Therapy for Prostate Cancer
- Radiation Treatment with Lutathera (Lutetium Lu 177 dotatate)
- Radioactive Seed Localization of Nonpalpable Breast Lesions
- Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
- Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension
- Sacral Nerve Neuromodulation or Stimulation
- Sacroiliac Joint Arthrography
- Sandostatin Sandostatin LAR depot (Octreotide) Somatuline Depo (lanreotide) Signifor LAR (pasireotide)
- Septoplasty
- Site of Service for Administration for Infusion and Injectable Prescription Medications
- Sodium Hyaluronate Injections
- Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
- Testosterone [Implantable Testosterone Pellets (Testopel Pellets) Testosterone Undecanoate (Aveed)] Testosterone Cypionate (Depo-Testosterone) or Testosterone Enanthate (Delatestryl)]
- Thermography
- Threshold Electrical Stimulation as a Treatment of Motor Disorders
- Total Artificial Hearts and Implantable Ventricular Assist Devices
- Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
- Ultrasound Accelerated Fracture Healing Device
- Unna Boot
- Ustekinumab (Stelara)
- Vedolizumab (Entyvio)
- Vitrectomy Chair or Vitrectomy Support System or Face-Down Positioning Device for Post-Vitrectomy Positioning
- Whole Body Dual X-Ray Absorptiometry (DEXA) to Determine Body Composition
Click here to view the Blue Cross Blue Shield Horizon Medical Policy Updates »
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