BCBS Michigan Medical Policy Updates – November 2022

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

November 2022 BCBS Michigan Medical Policy Updates:

• Air Ambulance Services
• Allografts for Nerve Repair
• Ambulatory Blood Pressure Monitoring For Screening and Diagnosis of Hypertension
• Annular Closure Devices (E.G., Barricaid®, Xclose®, Inclose™)
• Auditory Brain Stem Implant
• Autism Spectrum Disorder Services
• Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
• Autologous Serum Eye Drops
• Balloon Ostial Dilation for Treatment of Chronic and Recurrent Rhinosinusitis
• Bioimpedance Devices for Detection and Management of Lymphedema
• BMT – Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
• BMT – Hematopoietic Cell Transplantation for Germ-Cell Tumors
• BMT – Hematopoietic Cell Transplantation for Hodgkin Lymphoma
• BMT – Hematopoietic Cell Transplantation for NonHodgkin Lymphomas
• BMT – Hematopoietic Cell Transplantation for Solid Tumors of Childhood
• BMT- Hematopoietic Cell Transplantation (HCT) for CNS Tumors, Embryonal Tumors, and Ependymoma
• Bone Growth Stimulation:  Electrical Bone Growth Stimulation of the Appendicular Skeleton
• Bone Growth Stimulation: Electrical Bone Growth Stimulation of the Appendicular Skeleton
• Bone Marrow – Hematopoietic Cell Transplant for Waldenström’s Macroglobulinemia
• Bone Marrow Transplant – Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer
• Bone Marrow Transplant Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms, Allogeneic
• Bone Marrow Transplantation for Malignant Astrocytomas and Gliomas, Autologous
• Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
• Breast Reduction for Breast-Related Symptoms
• Bronchial Valves
• Cardiac Rehabilitation, Outpatient
• Cochlear Implant
• CPT Category III Codes-Noncovered Services
• Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation
• Donor Lymphocyte Infusion For Malignancies Treated With An Allogeneic Hematopoietic Cell Transplant
• Electronic Brachytherapy
• Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
• Enhanced External Counterpulsation (EECP)
• Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
• Fetal Magnetocardiography
• Gastric Bypass Surgery for Gastroparesis
• Gastric Electrical Stimulation
• Genetic Testing – Chromosomal Microarray (CMA) Analysis and Next-Generation Sequencing Panels, for the Evaluation of Children with Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and/or Congenital Anomalies
• Genetic Testing for Alpha1-Antitrypsin Deficiency
• Genetic Testing for Hereditary Hemochromatosis
• Genetic Testing for Marfan Syndrome, Ehlers-Danlos, Thoracic Aortic Aneurysms and Dissections, and Connective Tissue Related Disorders
• Genetic Testing of Cadasil Syndrome
• Genetic Testing-Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
• Implantable Bone-Conduction and Bone-Anchored Hearing Devices
• Ingestible Capsule for Assessment of Gastrointestinal (Motility) Disorders
• Inhaled Nitric Oxide (iNO)
• Intraocular Radiation Therapy for Age-Related Macular Degeneration
• Laboratory Testing for HIV Tropism
• Liver Transplant
• Lung and Lobar Lung Transplant
• Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (GERD)
• Molecular Testing in the Management of Pulmonary Nodules
• Noninvasive Measurement of Central Blood Pressure (e.g., SphygmoCor® System, Vicorder® Pulse Wave Velocity, PhysioWave)
• Occipital Nerve Stimulation
• Oncoprotein Des-gamma-carboxy Prothrombin (DCP) Immunoassay
• Orthopedic Applications of Platelet-Rich Plasma
• Orthotic Devices
• Phrenic Nerve Stimulation and Diaphragm Pacing
• Phrenic Nerve Stimulation for Central Sleep Apnea
• Pneumatic Compression Pumps and Appliances (e.g., Flexitouch™ System) for Lymphedema
• Polymetabolite Urine Testing for Adenomatous Polyps
• Procalcitonin Testing (PCT)
• Proprietary Laboratory Analyses (PLA) Codes
• Prosthetic Devices
• Radiofrequency Ablation of Peripheral Nerves to Treat Pain including Coolief Cooled RF
• Retinal Polarization Scan (Retinal Birefringence Scanning)
• Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
• Skin and Tissue Substitutes
• Sphenopalatine Ganglion Block for Headache
• Spinal Surgery: Automated Percutaneous and Endoscopic Discectomy
• Steroid-Eluting Sinus Implants
• Telemedicine Services
• Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
• Ultrasonographic Measurement of Carotid Intima-Media Thickness as an Assessment of Subclinical Atherosclerosis
• Vertical Expandable Prosthetic Titanium Rib

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

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