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Health Care Service Corporation (HCSC) Medical Policy Updates – January 2023
Click here to view the Health Care Service Corporation (HCSC) Medical Policy Updates »
January 2023 Health Care Service Corporation (HCSC) Medical Policy Updates:
- Ablation of Peripheral Nerves to Treat Pain
- Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses
- Adoptive Immunotherapy
- Aducanumab-avwa
- Airway Clearance Devices
- Ambulatory or Video Electroencephalogram (EEG) Monitoring, Including Digital Analysis of Electroencephalogram
- Applied Behavior Analysis (ABA) for Autism Spectrum Disorder (ASD) Diagnosis
- Autism Spectrum Disorders (ASD)
- Autologous Chondrocyte Implantation (ACI) for Focal Articular Cartilage Lesions
- Bamlanivimab and Etesevimab Antibody Therapy
- Bariatric Surgery
- Biofeedback as a Treatment of Chronic Pain
- Botulinum Toxin
- Brain Tissue Transplantation and Neurotransplantation
- Bronchial Thermoplasty
- Canakinumab
- Cardiac Applications of Positron Emission Tomography Scanning
- Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
- Cervical Spinal Fusion
- Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
- Computed Tomography to Detect Coronary Artery Calcification
- Computerized Wheeze Detection/Monitoring
- Cosmetic and Reconstructive Procedures
- Cryosurgical Ablation of Primary or Metastatic Liver Tumors
- Digital Health Technologies: Diagnostic Applications
- Digital Health Therapies for Substance Use Disorders
- Elastography and Associated Imaging Techniques
- Electrical Bone Growth Stimulation of the Appendicular Skeleton
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Electromagnetic Navigation Bronchoscopy (ENB)
- Electroretinography (ERG), Multi-Focal Electroretinography (mfERG) And Pattern Electroretinography (PERG)
- Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
- Endoscopic Ultrasound-Guided Direct Hepatic Portosystemic Pressure Gradient Measurement
- Esketamine Nasal Spray
- Eteplirsen
- Etranacogene dezaparvovec-drlb
- Etranacogene dezaparvovec-drlb
- Experimental, Investigational and/or Unproven Procedures/Services
- Extracranial Carotid Angioplasty or Stenting
- Facet Joint Injections
- FDA-Approved Drugs and Biologicals
- Gait Analysis
- Gastrointestinal (GI) Motility Measurement
- Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
- Genetic Testing for Mitochondrial Disorders
- Givosiran
- Glucose Monitoring and Insulin Delivery Devices for Managing Diabetes
- Hematopoietic Cell Transplantation (HCT) or Additional Infusion Following Preparative Regimens (General Donor and Recipient Information)
- Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias
- Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia
- Home Cardiorespiratory Monitoring
- Human Growth Hormone (GH)
- Inhaled Nitric Oxide
- Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)
- Intraoperative Neurophysiologic Monitoring (IONM)
- In-Vivo Analysis of Colorectal Polyps
- Kidney Transplant
- Laser Treatment of Vulvovaginal Atrophy (VVA)
- Levodopa-Carbidopa Enteral Suspension (e.g., Duopa) for The Treatment of Parkinson Disease
- Liver Transplant and Combined Liver-Kidney Transplant
- Long-Term Ambulatory Cardiac Monitoring (Outpatient Cardiac Telemetry, Implantable Cardiac Rhythm Event Monitors, and Intracardiac Ischemia Detection Systems)
- Low-Level and High-Power Laser Therapy
- Measurement of Long Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor
- Measurement of Thromboxane Metabolites in Urine
- Microwave Tumor Ablation
- Molecular Testing For Chronic Heart Failure and Heart Transplant
- Myocardial Sympathetic Innervation Imaging in Patients With Heart Failure
- Nerve Graft With Radical Prostatectomy
- Nutritional Support
- Omalizumab
- Oncology Medications
- Orthognathic Surgery
- Pancreas and Related Organ Tissue Transplantation
- Pegloticase
- Percutaneous Arteriovenous Fistula
- Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation
- Percutaneous Image-Guided Nerve Cryoablation for Phantom Limb Pain (PLP)
- Photodynamic Therapy (PDT) for Choroidal Neovascularization (CNV)
- Plethysmography
- Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers
- Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia
- Progesterone Therapy as a Technique to Reduce Preterm Delivery in High-Risk Pregnancies
- Radioembolization for Primary and Metastatic Tumors of the Liver
- Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant or Uncontrolled Hypertension
- Reconstructive Breast Surgery
- Refractive and Therapeutic Keratoplasty
- Reslizumab
- Risk Stratification Tests for Determining Arrhythmias (Signal-Averaged Electrocardiography [SAECG] and Microvolt T-Wave Alternans [MTWA])
- Sacroiliac Joint Fixation/Fusion
- 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
- Services for Infertility and Recurrent Fetal Loss
- Shoulder Resurfacing
- Sleep Related Breathing Disorders: Surgical Management
- Specialty Medication Administration Site of Care
- Speech-Language Therapy (SLT)
- Staphylococcal Vaccines
- Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy
- Subtalar Arthroereisis (STA)
- Temporary Prostatic Stent
- Teplizumab-mzmv
- Teplizumab-mzmv
- Three-dimensional (3D), Four-dimensional (4D), and Five-dimensional (5D) Obstetrical Ultrasound
- Tocilizumab
- Total Ankle Replacement (TAR)
- Transcatheter Arterial Chemoembolization (TACE) of the Liver
- Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee
- Ustekinumab
- Varicose Vein Management
- Viscocanalostomy and Canaloplasty
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