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February 2018 Medical Policy updates:
- Automated Percutaneous and Endoscopic Discectomy: Stryker DeKompressor, Nucleotome, SpineJet Hydrodiscectomy (PDF) Policy 7.01.16 (posted 2/20/18)
- Lumbar Fusion for Adults, Degenerative Disc Disease, Disc herniation, Lumbar arthrodesis, Scoliosis, Spinal stenosis, spondylodesis, spondylosyndesis, spondylolisthesis (PDF) Policy 7.01.90 (posted 2/20/18)
- Osteochondral Grafting (Allograft, Autograft): Chondrofix®, Mosaicplasty, OATS (PDF) Policy 7.01.59 (posted 2/20/18)
- Total Hip Resurfacing, Metal-on-Metal (PDF) Policy 7.01.74 (posted 2/20/18)
- Treatment of Tinnitus: Habituation Therapy, Jastreboff Method, Masking, Retraining Therapy (PDF) Policy 8.01.07 (posted 2/20/18)
- Genetic Testing for Hereditary BRCA Mutations: BART test, BRCA1, BRCA2, CHEK2 (PDF) Policy 2.02.06 (posted 2/20/18)
- Genetic Testing for Inherited Susceptibility to Colorectal Cancer: Familial Adenomatous Polyposis (FAP), Hereditary Nonpolyposis Colorectal Cancer (HNPCC), COLARIS®, Microsatellite instability (MSI), MYH-associated polyposis(MAP) (PDF) Policy 2.02.11 (posted 2/20/18)
- Genetic Testing for Susceptibility to Hereditary Cancers (PTEN, Cowden Syndrome, TP53, Li Fraumeni Syndrome, BreastNext, CancerNext, OvaNext, MyRisk Hereditary Cancer, Melaris, Prolaris, Panexia) (PDF) Policy 2.02.44 (posted 2/20/18)
- Genotyping Cytochrome P450 (CYP450) for Drug Metabolism: Amplichip (PDF) Policy 2.02.30 (posted 2/20/18)
- Genotyping or Phenotyping for Thiopurine Methyltransferase (TPMT) for Patients Treated with Azathioprine (6-MP), Inflammatory Bowel Disease (PDF) Policy 2.02.37 (posted 2/20/18)
- MAZE Procedures for Atrial Fibrillation and Flutter (e.g., Convergent procedure, COX III, Epicardial Maze, Hybrid, Mini Maze, Pulmonary Vein Isolation, Thoroscopic off-pump surgical ablation [TOPS]) (PDF) Policy 7.01.27 (posted 2/20/18)
- Signal Averaged Electrocardiogram (SAECG) (PDF) Policy 2.01.02 (posted 2/20/18)
- Pathfinder TG® Molecular Testing: Redpath, Topographic Genotyping (PDF) Policy 2.02.39 (posted 2/20/18)
- Bronchial Thermoplasty (e.g., Alair® System) (PDF) Policy 7.01.88 (posted 2/20/18)
- Electromagnetic Navigation Bronchoscopy (ENB) (PDF) Policy 6.01.40 (posted 2/20/18)
- Measurement of Exhaled Markers of Airway Inflammation in Patients with Asthma: Exhaled Breath Condensate, Exhaled Nitric Oxide, Nioxx (PDF) Policy 2.01.41 (posted 2/20/18)
- Evoked Potentials: Auditory, Brainstem Auditory, Somatosensory, Visual and Intraoperative Monitoring of Evoked Potentials (PDF) Policy 2.01.27 (posted 2/20/18)
- Peptide Receptor Radionuclide Therapy (PRRT, PRRNT): Receptor-Mediated Radiotherapy, Radiolabeled Nuclide Therapy, Somatostatin Analog, 90Y-DOTATOC, 177Lu-DOTA0, Tyr3, 90Y-DOTA0 (PDF) Policy 7.01.78 (posted 2/20/18)
- Low-Dose Computed Tomography (LDCT) for Lung Cancer Screening: Electron Beam Computed Tomography (EBCT), Helical CT, Low-Dose CT, Spiral CT (PDF) Policy 6.01.19 (posted 2/20/18)
- Liver/Hepatic Transplantation (PDF) Policy 7.02.07 (posted 2/20/18)
- Pancreas Transplant (Pancreas Transplant Alone, Pancreas After Kidney Transplant, Simultaneous Pancreas Kidney Transplant) (PDF) Policy 7.02.01 (posted 2/20/18)
- Sacral Nerve Stimulation for Pelvic Floor Dysfunction (Incontinence, Neuromodulation, Urinary Retention) (PDF) Policy 7.01.10 (posted 2/20/18)
Policies currently in the review process
Comments regarding the following draft medical policies must be received by March 16, 2018.
- Sialendoscopy (new policy)
- Bioengineered Tissue Products for Wound Treatment and Surgical Interventions (updated policy)
Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!
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Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.