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Medical Policy Upcoming Updates

Notification Date: October 17, 2018 

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
Allogeneic Pancreatic Islet Cell Transplantation
Re-Reviewed
12/17/2018
Investigative and therefore not covered
No change in determination
Genetic and Pharmacogenetic Testing Re-Reviewed 12/17/2018 Covered for some indications No change in determination
Laboratory Tests Re-Reviewed 12/17/2018 Covered for some indications; investigative and therefore not covered for all other indications No change in determination
Minimally Invasive Spine Surgeries Re-Reviewed 12/17/2018 Covered for some indications; investigative and therefore not covered for all other indications No change in determination
Prostate Health Index (PHI) Lab Test New 12/17/2018 Covered for some indications; investigative and therefore not covered for all other indications

Not Investigative Determination:

  • Screening and detection of prostate cancer, in men age 50 years and older, with prostate-specific antigen (PSA) results in the range of 4 to 10 ng/mL, and who have a negative digital rectal examination (FDA approved indications).

Investigative Determination:

  • Screening and detection of prostate cancer for all other indications.

 

Stem Cell Therapy for Orthopedic Applications Re-Reviewed 12/17/2018 Investigative and therefore not covered

No change in determination

Further defined that this investigative indication includes:

  • Concentrated, engineered or expanded stem cells
  • Allograft bone products containing stem cells.
Transmyocardial Revascularization Re-Reviewed 12/17/2018 Covered for some indications; investigative and therefore not covered for all other indications 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 8, 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 9:36:28 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02