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Health Care Service Corporation (HCSC) Medical Policy Updates – December 2022
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December 2022 Health Care Service Corporation (HCSC) Medical Policy Updates:
- Abatacept
- Actigraphy
- Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses
- Adoptive Immunotherapy
- Aducanumab-avwa
- Allogeneic Processed Thymus Tissue-agdc (Rethymic)
- Ambulance and Transport Services
- Ambulatory or Video Electroencephalogram (EEG) Monitoring, Including Digital Analysis of Electroencephalogram
- Amniotic Membrane and Amniotic Fluid
- Artificial Intervertebral Disc
- Artificial Intervertebral Disc
- Autism Spectrum Disorders (ASD)
- Autologous Chondrocyte Implantation (ACI) for Focal Articular Cartilage Lesions
- Automated Point-of-Care Nerve Conduction Testing
- Automated Point-of-Care Nerve Conduction Testing
- Balloon Dilation of the Eustachian Tube
- Balloon Dilation of the Eustachian Tube
- Bariatric Surgery
- Bariatric Surgery
- Benralizumab
- Benralizumab
- Betibeglogene autotemcel
- Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
- Blepharoplasty, Blepharoptosis and Brow Repair
- Blepharoplasty, Blepharoptosis and Brow Repair
- Breast Implant, Removal and/or Insertion
- Breast Implant, Removal and/or Insertion
- Burosumab-twza
- Burosumab-twza
- Canakinumab
- Cardiac Applications of Positron Emission Tomography Scanning
- Cardiac Contractility Modulation (CCM) Device
- Cardiac Contractility Modulation (CCM) Device
- Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
- Casirivimab and Imdevimab Antibody Cocktail for COVID-19
- Casirivimab and Imdevimab Antibody Cocktail for COVID-19
- Certolizumab Pegol
- Certolizumab Pegol
- Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
- Computerized Wheeze Detection/Monitoring
- Crizanlizumab-tmca
- Crizanlizumab-tmca
- Cryosurgical Ablation of Primary or Metastatic Liver Tumors
- Deep Brain Stimulation (DBS)
- Deep Brain Stimulation (DBS)
- Diagnosis of Obstructive Sleep Apnea Syndrome
- Digital Health Technologies: Diagnostic Applications
- Digital Health Therapies for Substance Use Disorders
- Dynamic Spinal Visualization and Vertebral Motion Analysis
- Dynamic Spinal Visualization and Vertebral Motion Analysis
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Elivaldogene autotemcel
- Elivaldogene autotemcel
- Endoscopic Ultrasound-Guided Direct Hepatic Portosystemic Pressure Gradient Measurement
- Endoscopic, Arthroscopic, Laparoscopic, Bronchoscopic and Thoracoscopic Surgery
- Endoscopic, Arthroscopic, Laparoscopic, Bronchoscopic and Thoracoscopic Surgery
- Enhanced External Counterpulsation (EECP)
- Enhanced External Counterpulsation (EECP)
- Esophageal pH Monitoring
- Esophageal pH Monitoring
- Eteplirsen
- Eyelid Thermal Pulsation
- Eyelid Thermal Pulsation
- Fetal Surgery for Prenatally Diagnosed Malformations
- Gait Analysis
- Gastrointestinal (GI) Motility Measurement
- Gastrointestinal Panels
- Gastrointestinal Panels
- Genicular Artery Embolization
- Genicular Artery Embolization
- Glucose Monitoring and Insulin Delivery Devices for Managing Diabetes
- Glucose Monitoring and Insulin Delivery Devices for Managing Diabetes
- Golimumab
- Golimumab
- Heart Transplant
- Heart Transplant
- Heat and Cold Therapy Devices
- Heat and Cold Therapy Devices
- Hematopoietic Cell Transplantation for Acquired Immunodeficiency Syndrome (AIDS)
- Hematopoietic Cell Transplantation for Acquired Immunodeficiency Syndrome (AIDS)
- Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)
- Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias
- Hematopoietic Cell Transplantation for Solid Tumors of Childhood
- Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia
- Home Cardiorespiratory Monitoring
- Home-Based Monitoring of Visual Field
- Home-Based Monitoring of Visual Field
- Immunoglobulin (Ig) Therapy (Including Intravenous [IVIG] and Subcutaneous Ig [SCIG])
- Implantation of Intrastromal Corneal Ring Segments
- Implantation of Intrastromal Corneal Ring Segments
- Inebilizumab-cdon
- Inebilizumab-cdon
- Infliximab and Associated Biosimilars
- Interspinous Fixation (Fusion) Devices
- Interspinous Fixation (Fusion) Devices
- Intravitreal, Punctum, and Intracameral Implants
- Intravitreal, Punctum, and Intracameral Implants
- Jaw Motion Rehabilitation Systems
- Jaw Motion Rehabilitation Systems
- Kidney Transplant
- Laser Treatment of Congenital Port Wine Stain (PWS), Hemangiomas, and Other External Vascular Malformations
- Laser Treatment of Congenital Port Wine Stain (PWS), Hemangiomas, and Other External Vascular Malformations
- Leadless Cardiac Pacemaker
- Levodopa-Carbidopa Enteral Suspension (e.g., Duopa) for The Treatment of Parkinson Disease
- Lipid Apheresis
- Liver Transplant and Combined Liver-Kidney Transplant
- Long-Acting Injectable Antiretroviral Agents for HIV
- Lysis of Epidural Adhesions
- Lysis of Epidural Adhesions
- Mastopexy
- Mastopexy
- Measurement of Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
- Measurement of Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
- Measurement of Long Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor
- Measurement of Thromboxane Metabolites in Urine
- Medical Management of Sleep Related Breathing Disorders
- Mepolizumab
- Mepolizumab
- Microwave Tumor Ablation
- Nerve Graft With Radical Prostatectomy
- Noncontact Normothermic Wound Therapy
- Noncontact Normothermic Wound Therapy
- Nutritional Support
- Ocriplasmin for Symptomatic Vitreomacular Adhesion
- Ocriplasmin for Symptomatic Vitreomacular Adhesion
- Off-Label Use of Drugs Without a Medical Policy
- Off-Label Use of Drugs Without a Medical Policy
- Ophthalmologic Techniques For Evaluating Glaucoma
- Optilume (Drug Coated Balloon) for the Treatment of Urethral Stricture Conditions
- Optilume (Drug Coated Balloon) for the Treatment of Urethral Stricture Conditions
- Organ and Tissue Transplantation (General Donor and Recipient Information)
- Organ and Tissue Transplantation (General Donor and Recipient Information)
- Orthoptics (Vergence/Accommodative Therapy), Visual Exercises or Training
- Pancreas and Related Organ Tissue Transplantation
- Pasireotide
- Pasireotide
- Patisiran (Onpattro)
- Pegloticase
- Percutaneous Arteriovenous Fistula
- Percutaneous Arteriovenous Fistula
- Percutaneous Image-Guided Nerve Cryoablation for Phantom Limb Pain (PLP)
- Photodynamic Therapy (PDT) for Choroidal Neovascularization (CNV)
- Phototherapeutic Keratectomy
- Phototherapeutic Keratectomy
- Plethysmography
- Pneumatic Traction and Spinal Unloading Devices
- Pneumatic Traction and Spinal Unloading Devices
- Polysomnography for Non-Respiratory Sleep Disorders
- Psychological and Neuropsychological Testing
- Radioembolization for Primary and Metastatic Tumors of the Liver
- Radiofrequency Ablation (RFA) of Primary or Metastatic Liver Tumors
- Radiofrequency Ablation (RFA) of Primary or Metastatic Liver Tumors
- Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)
- Remote Electrical Neuromodulation for Migraines
- Risankizumab-rzaa
- Risk-Reducing (Prophylactic) Mastectomy
- Salivary Hormone Testing
- Salivary Hormone Testing
- Saturation Biopsy for Diagnosis, Staging and Management of Prostate Cancer, Including Comprehensive 3D Mapping with Biopsy
- Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
- Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases
- Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases
- Shoulder Resurfacing
- Skin Contact Monochromatic Infrared Energy (MIRE)
- Skin Contact Monochromatic Infrared Energy (MIRE)
- Speech-Language Therapy (SLT)
- Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy
- Subtalar Arthroereisis (STA)
- Surface Electrical Stimulation
- Surface Electrical Stimulation
- Surgical Interruption of Pelvic Nerve Pathways
- Surgical Interruption of Pelvic Nerve Pathways
- Surgical Treatment of Pectus Excavatum and Pectus Carinatum
- Surgical Treatment of Pectus Excavatum and Pectus Carinatum
- Sympathetic Therapy
- Sympathetic Therapy
- Temporary Prostatic Stent
- Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions
- Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions
- Therapeutic Lenses, Scleral Shell
- Therapeutic Lenses, Scleral Shell
- Thermal Capsulorrhaphy as a Treatment of Joint Instability
- Thermal Capsulorrhaphy as a Treatment of Joint Instability
- Three-dimensional (3D), Four-dimensional (4D), and Five-dimensional (5D) Obstetrical Ultrasound
- Tildrakizumab-asmn
- Tildrakizumab-asmn
- Topographic Brain Mapping (Quantitative Electroencephalography)
- Topographic Brain Mapping (Quantitative Electroencephalography)
- Total Ankle Replacement (TAR)
- Transanal Endoscopic Microsurgery
- Transanal Endoscopic Microsurgery
- Transanal Radiofrequency (RF) Treatment of Fecal Incontinence
- Transanal Radiofrequency (RF) Treatment of Fecal Incontinence
- Transcutaneous Electrical Stimulation (TENS) and Transcutaneous Electrical Modulation Pain Reprocessing (TEMPR)
- Ultrafiltration in Decompensated Heart Failure
- Ultrafiltration in Decompensated Heart Failure
- Ultrasonographic Measurement of Carotid Intima-Medial Thickness (CIMT) as an Assessment of Subclinical Atherosclerosis
- Ultrasonographic Measurement of Carotid Intima-Medial Thickness (CIMT) as an Assessment of Subclinical Atherosclerosis
- Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee
- Use of i-Factor Peptide Enhanced Bone Graft During Spinal Surgery
- Use of i-Factor Peptide Enhanced Bone Graft During Spinal Surgery
- Vedolizumab
- Veklury
- Ventricular Assist Devices and Total Artificial Hearts
- Ventricular Assist Devices and Total Artificial Hearts
- Vutrisiran
- Wheelchairs and Accessories
- Whole Body Composition Analysis using Dual X-Ray Absorptiometry (DXA) or Bioelectrical Impedance Analysis (BIA)
- Whole Body Composition Analysis using Dual X-Ray Absorptiometry (DXA) or Bioelectrical Impedance Analysis (BIA)
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Health Care Service Corporation
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