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Premera Blue Cross Medical Policy Updates – October 2018
Click here to view the Premera Blue Cross Medical Policy Updates »
October 2018 Medical Policy Updates:
- Anterior Cervical Spine Decompression and Fusion in Adults
- Artificial Pancreas Device Systems
- Breast Surgery/Management of Breast Implants
- Cellular Immunotherapy for Prostate Cancer
- Chromosomal Microarray Testing for the Evaluation of Pregnancy Loss
- Composite Tissue Allotransplantation of the Hand and Face
- Coronary Angiography for Known or Suspected Coronary
- Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
- CYP450 Genotyping to Determine Drug Metabolizer
- Drug Testing in Pain Management and Substance Abuse Treatment Settings
- Electronic Brachytherapy for Nonmelanoma Skin Cancer
- Gender Reassignment Surgery
- General Medical Necessity Criteria for Companion Diagnostics Related to Drug Approval
- Genetic Testing for Li-Fraumeni Syndrome
- Genetic Testing for Mitochondrial Disorders
- Genotype-Guided Warfarin Dosing
- Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood
- Home Enteral Nutrition
- IL-5 Inhibitors
- Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
- Islet Transplantation
- Knee Arthroscopy in Adults
- Medical Necessity Criteria for Pharmacy Ed
- Meniscal Allografts and Other Meniscal Implants
- Miscellaneous Genetic and Molecular Diagnostic Tests
- Moderate Penetrance Variants Associated With Breast Cancer in Individuals at High Breast Cancer Risk
- Opioid Analgesics
- Orthoptic Training for the Treatment of Vision or Learning Disabilities
- Pharmacogenetic Testing for Pain Management
- Pharmacologic Treatment of Neuropathy, Fibromyalgia, and Seizure Disorders
- Pharmacotherapy of Arthropathies
- Radioembolization for Primary and Metastatic Tumors of the Liver
- Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
- Repository Corticotropin Injection
- Sinus Surgery
- Transcatheter Arterial Chemoembolization as a Treatment for Primary or Metastatic Liver Malignancies
- Medical Policy Search | Provider | Premera Blue Cross
- Physical Medicine and Rehabilitation – Physical Therapy Medical Massage Therapy
Added 10/31/2018;
- Adoptive Immunotherapy
- Advanced Therapies for Pharmacological Treatment of Pulmonary Arterial Hypertension
- Anterior Cervical Spine Decompression and Fusion in Adults
- Antidepressants: Pharmacy Medical Necessity Criteria for Brands
- Applied Behavior Analysis (ABA)
- Cellular Immunotherapy for Prostate Cancer
- Epidermal Growth Factor Receptor (EGFR) Inhibitors
- Extracorporeal Photopheresis
- Gender Reassignment Surgery
- Genetic Testing for Alpha -Thalassemia
- Genetic Testing for Neurofibromatosis
- Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
- Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood
- IL-5 Inhibitors
- Immune Globulin Therapy
- Immune Prophylaxis for Respiratory Syncytial Virus
- Infusion Drugs and Biologic Agents
- Islet Transplantation
- Kalydeco® (ivacaftor), Orkambi® (lumacaftor / ivacaftor), and Symdeko™ (tezacaftor / ivacaftor)
- Keratoprosthesis
- Lipid Apheresis
- Medical Necessity Criteria for Pharmacy Ed
- Miscellaneous Oncology Drugs
- Multiple Receptor Tyrosine Kinase Inhibitors
- Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA
- Orthognathic Surgery
- Percutaneous Ventricular Assist Devices
- Pharmacologic Treatment of Neuropathy, Fibromyalgia, and Seizure Disorders
- Pharmacotherapy of Arthropathies
- Preimplantation Genetic Testing in Embryos
- Prostate Cancer Targeted Therapies
- Solid Organ Transplants
- Transcatheter Arterial Chemoembolization as a Treatment for Primary or Metastatic Liver Malignancies
- Treatment of Hyperhidrosis
- Treatment of Varicose Veins/Venous Insufficiency
- Use of Vascular Endothelial Growth Factor Receptor (VEGF) Inhibitors and Other Angiogenesis Inhibitors in Oncology Patients
- Xolair® (omalizumab)
- PDF: 12.04.114.pdf
- PDF: 12.04.59.pdf
Click here to view the Premera Blue Cross Medical Policy Updates »
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