United Healthcare October 2017 Medical Policy Updates

Click here to view the United Healthcare October 2017 Medical Policy Updates »

United Healthcare posts October 2017 Medical Policy Updates:

Medical Policy Updates

NEW

• Carrier Testing for Genetic Diseases – Effective Nov. 1, 2017
• Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions – Effective Nov. 1, 2017
• Pharmacogenetic Testing – Effective Nov. 1, 2017
• Whole Exome and Whole Genome Sequencing – Effective Nov. 1, 2017

 

UPDATED

• Autologous Chondrocyte Transplantation in the Knee – Effective Oct. 1, 2017
• Attended Polysomnography for Evaluation of Sleep Disorders – Effective Nov. 1, 2017
• Bariatric Surgery – Effective Nov. 1, 2017
• Minimally Invasive Procedures for Gastroesophageal Reflux Disease (GERD) – Effective Nov. 1, 2017
• Percutaneous Vertebroplasty and Kyphoplasty – Effective Oct. 1, 2017
• Preterm Labor Management – Effective Nov. 1, 2017
• Sensory Integration Therapy and Auditory Integration Training – Effective Oct. 1, 2017
• Virtual Upper Gastrointestinal Endoscopy – Effective Oct. 1, 2017
• Visual Information Processing Evaluation and Orthoptic and Vision Therapy – Effective Oct. 1, 2017
• Warming Therapy and Ultrasound Therapy for Wounds – Effective Oct. 1, 2017

 

REVISED

• Abnormal Uterine Bleeding and Uterine Fibroids – Effective Nov. 1, 2017
• Gene Expression Tests for Cardiac Indications – Effective Nov. 1, 2017
• Genetic Testing for Hereditary Cancer – Effective Nov. 1, 2017
• Neurophysiologic Testing and Monitoring – Effective Nov. 1, 2017
• Omnibus Codes – Effective Nov. 1, 2017
• Temporomandibular Joint Disorders – Effective Oct. 1, 2017
• Transcatheter Heart Valve Procedures – Effective Nov. 1, 2017

 

RETIRED/REPLACED

• Genetic Testing – Effective Nov. 1, 2017
• Helicobacter Pylori Serology Testing – Effective Oct. 1, 2017
• Magnetoencephalography and Magnetic Source Imaging for Specific Neurological Applications – Effective Oct. 1, 2017
• Molecular Profiling to Guide Cancer Treatment – Effective Nov. 1, 2017
• Wearable Cardioverter-Defibrillators – Effective Oct. 1, 2017

 

Medical Benefit Drug Policy Updates

NEW

• Ilaris® (Canakinumab) – Effective Jan. 1, 2018
• Review at Launch for New to Market Medications – Effective Jan. 1, 2018

 

UPDATED

• Infliximab (Remicade®, Inflectra™, Renflexis™) – Effective Oct. 1, 2017

 

REVISED

• Exondys 51™ (Eteplirsen) – Effective Dec. 1, 2017
• Gonadotropin Releasing Hormone Analogs – Effective Nov. 1, 2017
• Hereditary Angioedema (HAE), Treatment and Prophylaxis – Effective Nov. 1, 2017
• Maximum Dosage – Effective Nov. 1, 2017
• Ocrevus™ (Ocrelizumab) – Effective Nov. 1, 2017
• Oncology Medication Clinical Coverage – Effective Nov. 1, 2017
• Orencia® (Abatacept) Injection for Intravenous Infusion – Effective Nov. 1, 2017
• Respiratory Interleukins (Cinqair® and Nucala®) – Effective Dec. 1, 2017
• Xolair® (Omalizumab) – Effective Dec. 1, 2017

 

Coverage Determination Guideline (CDG) Updates

UPDATED

• Infertility Services – Effective Oct. 1, 2017

 

REVISED

• Blepharoplasty, Blepharoptosis and Brow Ptosis Repair – Effective Dec. 1, 2017
• Panniculectomy and Body Contouring Procedures – Effective Nov. 1, 2017
• Preventive Care Services – Effective Oct. 1, 2017

 

Utilization Review Guideline (URG) Updates

REVISED

• Immune Globulin Site of Care Review Guidelines for Medical Necessity of Hospital Outpatient Facility Infusion – Effective Nov. 1, 2017

 

Quality of Care Guideline (QOCG) Updates

UPDATED

• Hospital Readmissions – Effective Oct. 1, 2017

 

Click here to view the United Healthcare October 2017 Medical Policy Updates »

 

Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!

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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. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.