Providers

Medical Policy Upcoming Updates

Notification Date: May 17, 2017

Below are the policies that are new or have been reviewed, along with the determination and summary of any changes.

Coverage Policies

Policy Title	Status	Effective Date	Determination	Summary of Change
Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease	Re-reviewed	5/17/2017	Now covered for some indications; investigative and therefore not covered for all other indications.	Change in determination Not investigative for the treatment of gatroesophageal reflux disease (GERD) that is refractive to medical treatment. Investigative for all other indications, including but not limited to, Barrett's Esophagus Provider Alert sent 5/17/17.
Biventricular Pacing (Cardiac Resynchronization Therapy) for Heart Failure	Re-reviewed	7/17/2017	Covered for some indications; investigative and therefore not covered for all other indications.	No change in determination
Sensory and Auditory Integration Therapies	Re-reviewed	7/17/2017	Investigative and therefore not covered	No change in determination
Molecular Profiling in Colorectal Cancer to Guide Treatment	New/Re-reviewed	7/17/2017	Covered for some indications; investigative and therefore not covered for all other indications.	Title change: Formerly titled Gene Expression Profiling Assays for Predicting Colon Cancer Recurrence Risk Expanded scope of policy: Added four genes/tests recommended by professional organizations and found all not-investigative Multigene panels that include any of the above genes/tests are not investigative No change in determination for multigene expression profiling assays for predicting recurrence risk in CRC (e.g. OncotypeDx Colon)
Non-Invasive Measurement of Left Ventricular End Diastolic Pressure	Re-reviewed	7/17/2017	Investigative and therefore not covered	No change in determination

The updated clinical policies and guidelines above are available as of July 17, 2017. View policies and guidelines.

To request paper copies of a policy, please leave a message at the Medica Provider Literature Request Line: 1-800-458-5512, option 1, then option 5, then ext. 2-2355.

Where information conflicts with applicable state and/or federal law, Medica follows such applicable federal and/or state law.