BCBS Louisiana Medical Policy Updates – June 2021

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

June 2021 BCBS Louisiana Medical Policy Updates:

• Angiotensin Converting Enzyme-Inhibitors and Angiotensin
• Auto-injectable/Pre-filled Syringe Methotrexate (Otrexup , Reditrex )
• belimumab (Benlysta)
• bezlotoxumab (Zinplava )
• Chelation Therapy
• Chronic Intermittent Intravenous Insulin Therapy (CIIIT)
• Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
• Corneal Collagen Cross-linking
• Cryosurgery Ablation of Miscellaneous Solid Tumors other than Liver or Prostate Tumors or Breast Fibroadenomas
• denosumab (Prolia )
• Dermatologic Applications of Photodynamic Therapy
• dichlorphenamide (Keveyis )
• Electrostimulation and Electromagnetic Therapy for Treating Wounds
• Enhanced External Counterpulsation (EECP)
• Extended Release Amantadine Products
• Gastric Electrical Stimulation
• Gene Expression-Based Assays for Cancers of Unknown Primary
• Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
• Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers
• Genetic Testing for Epilepsy
• Genetic Testing for PTEN Hamartoma Tumor Syndrome
• Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults
• In Vitro Chemoresistance and Chemosensitivity Assays
• Intracellular Micronutrient Analysis
• Keratoprosthesis
• L Glutamine Endari CC 00604 20180516
• Levothyroxine Oral Solution Products
• Nasal Allergy Medications
• naxitamab (Danyelza )
• Nerve Graft With Radical Prostatectomy
• ocrelizumab (Ocrevus )
• Orthopedic Applications of Stem Cell Therapy
• penicillamine (Cuprimine )/trientine (Syprine ), generics
• Powered Exoskeleton for Ambulation in Patients With Lower Limb CC 00673 20190515
• Quantitative Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers
• Radioembolization for Primaryand Metastatic Tumors of the Liver
• sebelipase alfa (Kanuma )
• Sex Reassignment Surgery CC 00643 20181219
• Surgical Ventricular Restoration
• telotristat (Xermelo™)
• Transcatheter Aortic Valve Implantation for Aortic Stenosis
• Trimpex trimethoprim oral solution CC 00616 20180516
• uridine triacetate (Xuriden )
• Vagus Nerve Stimulation
• vestronidase alfa vjbk Mepsevii CC 00618 20180516
• voclosporin (Lupkynis )

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

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