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Dean Health Plan Medical Policy Updates – December 2022
Click here to view the Dean Health Plan Medical Policy Updates »
December 2022 Dean Health Plan Medical Policy Updates:
- 2023 Revision Summary Crosswalk MSK
- 2023 Revision Summary Crosswalk Radiology
- Advantage Gender Reassignment
- Advantage Phototherapy UVB Home Treatment
- Advantage Plastic and Reconstructive Surgery
- AMVUTTRA ® (vutrisiran)
- Antihemophilia Factors and Clotting Factors
- Antihemophilic Factor Ix Products
- BEOVU (brolucizumab-dbll)
- Bone Anchored Hearing Aid
- Bone Cartilage Ligament Graft Substitutes
- Botulinum Toxin
- Breast Implant Removal
- Cell Therapy Cardiac Disease
- Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis Diagnosis and Treatment
- Clinical Trials
- Cognitive Rehabilitation Remediation
- Corneal Cross Linking CXL
- Dental Services and Treatment Required for Direct Treatment of a Medical Condition
- ELAPRASE® (idursulfase) (Intravenous)
- Elastography
- Electric Tumor Treatment Fields
- ELELYSO® (taliglucerase alfa) (Intravenous)
- ENJAYMO ® (sutimlimab-jome)
- Eustachian Tube Balloon Dilation Acclarent
- Evenity (Romosozumab-Aqqg)
- EVENITY (romosozumab-aqqg)
- Exhaled Breath Tests for Asthma and Other Inflammatory Pulmonary Conditions: Exhaled Nitric Oxide Breath Test and Exhaled Breath Condensate pH Measurement
- Eye Move Densen
- Facet Joint Injections and Radiofrequency Ablation
- Female Breast Reduction
- Functional Electrical Stimulation (FES) Therapy, Functional Neuromuscular Electrical Stimulation (NMES) Rehabilitation Therapy, and Lower Limb Activity-Based Locomotor Exercise (ABLE) Training
- Gender Reassignment
- Genetic Test Payment
- Genetic Testing
- Genetic Testing Epilepsy Neurodegenerative, and Neuromuscular Disorders
- Genetic Testing Pharmacogenetics
- Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
- Genetic Testing: Prenatal and Preconception Carrier Screening
- Genetic Testing: Prenatal Diagnosis and Pregnancy Loss
- Hemlibra (emicizumab)
- High Frequency Chest Compression (Vest System)
- Hospice Services
- Immune Globulin, subcutaneous (SCIG)
- Infliximab Infusions – Renflexis (Infliximab-Abda) Inflectra (Infliximab-Dyyb) Ixifi (Infliximab-Gbtx) Avsola (Infliximab-Axxq) Remicade (Infliximab)
- Injectable Medicines
- Insulin Pump Policy
- Intensive Outpatient – Behavioral Health
- Intravenous Lidocaine and Ketamine for Chronic Pain
- Kanuma® IV (sebelipase alfa)
- KYMRIAH (tisagenlecleucel)
- Lab Testing
- Laser Treatment for Psoriasis
- Laser Treatments for Choroidal Neovascularization Associated with Macular Degeneration
- LEQVIO ® (inclisiran)
- Levothyroxine Intravenous
- Light Treatment and Laser Therapies for Benign Dermatologic Conditions
- LINX Reflux Management System
- Liver and Other Neoplasm – Chemoembolization (CE) and IntraHepatic Microspheres (TheraSphere)
- Liver and Other Neoplasm – Chemoembolization (CE) and Radioembolization for Hepatic Tumors (TheraSphere or SIR-Spheres)
- LUMIZYME (alglucosidase alfa) (Intravenous), Nexviazyme® (avalglucosidase alfa)
- LUMIZYME (alglucosidase alfa) (Intravenous), Nexviazyme® (avalglucosidase alfa)
- LUTATHERA (lutetium Lu 177 dotatate)
- Male Gynecomastia
- Multichannel Intraluminal Esophageal Impedance with pH Monitoring
- NAGLAZYME® (galsulfase) (Intravenous)
- Neurofeedback or Biofeedback for Behavioral and Substance Use Disorders
- Neuropsychological Testing
- Non covered Medical Procedures and Services
- Non invasive Prenatal Screen
- Obstructive Sleep Apnea
- Obstructive Sleep Apnea
- Outpatient and Inpatient Electroconvulsive Therapy (ECT)
- Oxlumo® (Lumasiran)
- Parenteral Iron Products
- Pegfilgrastim And Biosimilars Fulphila (Pegfilgrastim-Jmdb) Ziextenzo (Pegfilgrastim-Bmez) Udenyca (Pegfilgrastim-Cbqv) Nyvepria (Pegfilgrastim-Apgf) Neulasta (Pegfilgrastim
- Pelvic Vein Embolization
- Percutaneous Left Ventricular Assist Device (pVAD)
- Percutaneous Tibial Nerve Stimulation
- Pertuzumab Products
- Phototherapy for Skin Conditions, including Home Ultraviolet Light (UVB)
- Phototherapy for Skin Conditions, including Home Ultraviolet Light (UVB)
- Plastic Reconstructive Surgery
- Preimplantation Genetic Testing
- Prostate Treatment
- Pulmonary Hypertension – Intravenous EPOPROSTENOL, FLOLAN/VELETRI (epoprostenol sodium), REMODULIN (treprostinil)
- RETHYMIC ® (Allogenic processed thymus tissue-agdc)
- RITUXIMAB-Containing Products
- SIGNIFOR LAR (PASIREORTIDE)
- SKYRIZI IV (risankizumab)
- Sleep Studies
- Somatuline (lanreotide) depot
- TECARTUS (brexucabtagene autoleucel)
- TEZSPIRE ® (tezepelumab)
- TIVDAK (tisotumab vedotin-tftv)
- Total Ankle Arthroplasty (TAA)
- Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA) Ambulatory Level of Care
- Transcranial Magnetic Stimulation (TMS)
- Treatment Obstructive Sleep Apnea
- Vertos Minimally Invasive Lumbar Decompression
- VYVGART ® (efgartigmoid)
- Vyzulta (Latanoprostene Bunod) Rhopressa (Netarsudil)
- YESCARTA (axicabtagene ciloleucel)
Click here to view the Dean Health Plan Medical Policy Updates »
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