Highmark BCBS Medical Policy Updates – July 2018

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

July 2018 Medical Policy Updates:

• Acute Myeloid Leukemia Genetic Testing
• Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
• Angelman Syndrome Testing
• Arterial Puncture Hemostasis (e.g., Angio-Seal)
• Ataxia-Telangiectasia
• Biomarkers in Risk Assessment and Management of Cardiovascular
• bortezomib (Velcade)
• BRCA Ashkenazi Jewish Founder Mutation Testing
• Breast Ductal Lavage and Fiberoptic Ductoscopy
• Buprenorphine (Probuphine®) Implant for Treatment of Opioid Dependence
• Charcot-Marie-Tooth Neuropathy Testing Panel
• Cryosurgical Ablation and Radiofrequency Ablation of Renal Tumors
• CYP2D6 Variant Analysis for Drug Response
• Duchenne & Becker Muscular Dystrophy Testing
• EGFR Testing for Non-Small Cell Lung Cancer TKI Response
• Ehlers Danlos Syndrome Testing
• Enteral Nutrition
• Experimental/Investigational Services
• Extracorporeal Membrane Oxygenation (ECMO) for Adult Conditions
• Factor II/Prothrombin Testing for Thrombophilia
• Fragile X Syndrome Testing
• Gene Expression Profiling Tests for Prostate Cancer
• Genetic Testing for Epilepsy
• Genetic Testing for Nonsyndromic Hearing Loss and Deafness
• Genitourinary Conditions Molecular Testing
• Hereditary Connective Tissue Disorder Testing
• High Resolution Anoscopy (HRA)
• Hydroxyprogesterone Caproate Injection as a Technique to Reduce Preterm Birth in High-Risk Pregnancies
• iac Disease Testing
• Immunizations
• Inotuzumab Ozogamicin (Besponsa)
• Intracellular Micronutrient Testing Panel
• Investigational and Experimental Molecular/Genomic Testing
• Ipilimumab (Yervoy)
• Liquid Biopsy Testing – Solid Tumors
• Lynch Syndrome Tumor Screening – First -Tier
• Mitochondrial Genetic Testing
• Molecular Gastrointestinal Pathogen Panel (GIPP) Testing
• OncotypeDX Breast DCIS
• PALB2 Genetic Testing for Breast Cancer Risk
• PancraGEN
• Pharmacogenomic Testing for Drug Toxicity and Response
• Pharmacogenomic Testing Panels for Major Depressive Disorder
• Pneumatic Compression Devices
• Polymerase Gamma (POLG) Related Disorders Genetic Testing
• Prader-Willi Syndrome Testing
• Radiation Treatment with Lutathera
• Recombinant and Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non‒Orthopedic Conditions
• Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
• ScoliScore for Adolescent Idiopathic Scoliosis Prognosis
• SensiGene Fetal RHD Genotyping
• Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Testing
• Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Testing
• ThyGenX and ThyraMIR miRNA Gene Expression Classifier
• ThyroSeq
• Transcatheter Pulmonary Valve Implantation
• Tumor Marker Testing-Solid Tumors
• Voretigene Neparvovec-rzyl (Luxturna)

Added 7/23/2018;

• Actinic Keratosis
• BRCA Analysis
• Bronchial Thermoplasty
• Diabetic Services and Supplies
• Donor Leukocyte Infusion for Hematologic Malignancies that Relapse after Allogeneic Stem Cell Transplant
• Gastric Electrical Stimulation, Gastric Pacing
• Ibalizumab-uiyk (Trogarzo)
• Ilizarov Bone Lengthening
• Mandatory Second Surgical Opinion
• Mohs Micrographic Surgery (MMS)
• Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
• Portable External Infusion Pump
• Seat Lift Mechanisms
• Solitary Pancreas Transplantation
• Total Ankle Replacement
• Treatment of Hyperhidrosis

Added 7/31/2018;

• Azacitidine (Vidaza®)
• Cxbladder
• Hematopoietic Stem-Cell Transplantation (HSCT) for Autoimmune
• Image-Guided Radiation Therapy (IGRT)
• Liquid Biopsy Testing – Solid Tumors
• Ocular Photodynamic Therapy (PDT)
• Proton Beam Therapy
• Radiation Therapy for Bone Metastases
• Radiation Therapy for Brain Metastases
• Radiation Therapy for Breast Cancer
• Radiation Therapy for Head and Neck Cancer
• Radiation Therapy for Non-malignant Disease
• Radiation Therapy for Oligometastases
• Radiation Therapy for Prostate Cancer
• Radiation Therapy for Skin Cancer
• Radium Ra 223 Dichloride for Treatment of Prostate Cancer
• Rituximab (Rituxan) and Rituximab and Hyaluronidase Human
• Selective Internal Radiation Therapy (SIRT)/Radioembolization
• Total Hip and Total Knee Arthroplasty
• Treatment of Acne

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

Policy Alerts monitors Commercial and Medicare medical policies for changes. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. When reviews occur out of cycle they often go unnoticed. Policy Alerts keeps you updated when Payers make coverage changes to medical policies affecting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on medical Insurance decisions in real-time. When changes occur, instant email alerts are delivered to your inbox. Clients have access to detailed coverage reports and medical policies through the interactive Policy Alerts Dashboard portal. Save time each month and keep focused on important Payer medical policy reviews and coverage decisions affecting your business!

Policy Alerts takes a client-focused hands-on approach and is constantly working to provide our customers with helpful insights and actionable analytics. We understand what our clients need and are dedicated to providing timely, accurate, and always up-to-date reports.

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. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.