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Medical Policy Upcoming Updates

Notification Date: July 19, 2017 

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

Utilization Management

Policy Title
Status
Effective Date
Determination
Summary of Change
Wheelchairs, Scooters and Accessories
Re-reviewed
07/19/2017 – Enhanced benefit
Medically necessary for a select population of patients
Prior authorization requirement for accessories,repairs and modifications will be required when the billed charge is $1,000 or more per item.
Previously, prior authorization had been required for a billed charge of $500 or more per item.

Coverage Policies

Policy Title
Status
Effective Date
Determination
Summary of Change
Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD)
Re-reviewed
07/19/2017 – Enhanced benefit
Not investigative
S-ICD is no longer investigative
Breast-Specific Gamma Imaging, Scintimammography, and Molecular Breast Imaging
Re-reviewed
09/18/2017
Investigative and therefore not covered
No change in determination
Endoscopic Procedures for Treatment of Gastroesophageal Reflux Disease (GERD)
Re-reviewed
09/18/2017
Investigative and therefore not covered
No change in determination

 




The updated clinical policies and guidelines above will be available as of their effective date, as noted. 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.


Date: 7/31/2021 10:36:27 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02