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BCBS Massachusetts Medical Policy Updates – September 2024
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Click here to view the Blue Cross Blue Shield BCBS Massachusetts Medical Policy Updates »
September 2024 BCBS Massachusetts Medical Policy Updates:
- Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
- Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias
- Allogeneic Hematopoietic Cell transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
- Ambulatory Electrocardiograph (AECG) Monitoring
- Ampyra ™ (dalfampridine)
- Anti-Parkinsonism Drugs
- Asthma and Chronic Obstructive Pulmonary Disease Medication Management
- Balloon Sinuplasty for Treatment of Chronic Sinusitis
- Biofeedback as a Treatment of Chronic Pain
- Biofeedback as a Treatment of Fecal Incontinence or Constipation
- Biofeedback as a Treatment of Headache
- Biofeedback as a Treatment of Urinary Incontinence in Adults
- Biofeedback for Miscellaneous Indications
- Bioimpedance Devices for the Detection of Lymphedema
- Blepharoplasty, Blepharoptosis Repair and Brow Ptosis Repair
- Blue Cross Blue Shield of Massachusetts Clinical Pharmacy Department
- Bone Mineral Density Studies
- CA-125
- Cardiac Catheterization and Coronary Angiography
- Carelon (formerly AIM) Advanced Imaging/Radiology and Sleep Disorder Management
- Catheter Ablation as Treatment for Atrial Fibrillation
- Chemical Peels
- Complementary Medicine
- Compounded Medications
- Compounded Medications
- Confocal Laser Endomicroscopy
- Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone
- Cryosurgical Ablation of Primary or Metastatic Liver Tumors
- Dermatologic Applications of Photodynamic Therapy
- Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis
- Digital Health Technologies for Attention Deficit /Hyperactivity Disorder
- Digital Health Technologies: Diagnostic Applications
- Digital Health Technologies: Therapeutic Applications
- Drug Management & Retail Pharmacy Prior Authorization Policy
- Drugs for Cystic Fibrosis
- Dynamic Posturography
- Electrical Stimulation Devices for Psychiatric and Neurological Conditions
- Elzonris (tagraxofusp-erzs) for the Treatment of Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) Prior Authorization Request Form
- Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
- Entyvio (vedolizumab) Policy
- Erythropoietin, Recombinant Human
- Esketamine Nasal Spray (SpravatoTM) and Intravenous Ketamine for Mental Health Conditions
- Esophageal pH Monitoring
- Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
- Fecal Microbiota Transplantation
- Fentanyl, oral-transmucosal
- Gastric Electrical Stimulation
- Gene Therapy for Inherited Retinal Dystrophy
- Hematopoietic Cell Transplantation for Acute Myeloid Leukemia
- Hematopoietic Cell Transplantation for CNS Embryonal Tumors and Ependymoma
- Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer
- Hematopoietic Cell Transplantation for Hodgkin Lymphoma
- Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults
- Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas
- Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia
- Hetlioz ™ (tasimelteon)
- Hyperthermic Intraperitoneal Chemotherapy for Select IntraAbdominal and Pelvic Malignancies
- Immune Cell Function Assay
- Immunomodulators for Skin Conditions
- In Vivo Analysis of Colorectal Polyps
- Influenza Drugs
- Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence
- Islet Transplantation
- Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroids Myolysis
- Laser Treatment of Onychomycosis
- Magnetic Resonance‒Guided Focused Ultrasound
- Medical and Surgical Management of Obesity including Anorexiants
- Medical Benefit Prior Authorization Medication List
- Medical Utilization Management (MED UM) & Pharmacy Prior Authorization Policy
- Melanoma Vaccines
- Multimarker Serum Testing Related to Ovarian Cancer
- Nerve Fiber Density Measurement
- Neuropsychological and Psychological Testing
- Noninvasive Techniques for the Evaluation and Monitoring of Patients with Chronic Liver Disease
- Nutrient/Nutritional Panel Testing
- Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus
- Oncology Drugs (Oral and Subcutaneous)
- Ophthalmic Prostaglandins
- Opioid and Opioid Combination Medication Management
- Orthopedic Applications of Stem Cell Therapy (Including Allograft and Bone Substitute Products Used with Autologous Bone Marrow)
- Percutaneous Coronary Intervention
- Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
- Photocoagulation of Macular Drusen
- Plugs for Anal Fistula Repair
- Pregabalin (Lyrica ® and Lyrica ® CR)
- Proteomic Testing for Systemic Therapy in Non-Small-Cell Lung Cancer
- Radioembolization for Primary and Metastatic Tumors of the Liver
- Radiofrequency Ablation of Primary or Metastatic Liver Tumors
- Radiofrequency Coblation Tenotomy for Musculoskeletal Conditions
- Reduction Mammaplasty for Breast-Related Symptoms
- Saturation Biopsy for Diagnosis, Staging and Management of Prostate Cancer
- Scenesse (afamelanotide) for Treatment of Erythropoietic Protoporphyria (EPP)
- Serum Biomarker Human Epididymis Protein 4
- Serum Tumor Markers for Breast and Gastrointestinal Malignancies
- Sexual Dysfunction Diagnosis and Therapy
- Shoulder Resurfacing
- Signal-Averaged Electrocardiography (SAECG)
- Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
- Stem Cell Therapy for Peripheral Arterial Disease
- Step Therapy Policy for Mupirocin
- Suprachoroidal Delivery of Pharmacologic Agents
- Surgical and Debulking Treatments for Lymphedema
- Surgery for Groin Pain in Athletes
- Surgical and Non-CPAP Treatment of Snoring and Obstructive Sleep Apnea Syndrome
- Surgical and Transesophageal Endoscopic Procedures to Treat Gastroesophageal Reflux Disease
- Surgical Deactivation of Headache Trigger Sites
- Surgical Ventricular Restoration
- Temporomandibular Joint Disorder
- Thermography
- Threshold Electrical Stimulation as a Treatment of Motor Disorders
- Transanal Endoscopic Microsurgery
- Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
- Transesophageal Echocardiography (TEE)
- Transmyocardial Revascularization
- Transpupillary Thermotherapy for Treatment of Choroidal Neovascularization
- Transthoracic Echocardiography (TTE)
- Ultrasonographic Evaluation of Skin Lesions
- Ultrasound for the Evaluation of Paranasal Sinuses
- Whole Body Dual X-Ray Absorptiometry to Determine Body Composition
- Whole Gland Cryoablation of the Prostate
- Wireless Pressure Sensors in Endovascular Aneurysm Repair
- Zolgensma (onasemnogene abeparvovec-xioi) for Spinal Muscular Atrophy (SMA)
- ZulressoTM (Brexanolone) for the Treatment of Post-Partum Depression
Click here to view the Blue Cross Blue Shield BCBS Massachusetts Medical Policy Updates »
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