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Medical Policy Upcoming Updates

Notification Date: December 19, 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
Cytochrome P450 (CYP450) Variant Genotyping (e.g., CYP2D6, CYP2C9, CYP2C19, CYP1A2, CYP3A4)
Re-Reviewed
02/18/2019
Investigative and therefore not covered
No change in determination
Exhaled Breath Tests for Asthma and Other Inflammatory Pulmonary Conditions: Exhaled Nitric Oxide Breath Test and Exhaled Breath Condensate pH Measurement Re-Reviewed 02/18/2019 Covered for some indications; investigative and therefore not covered for all other indications No change in determination
Lipoprotein-associated Phospholipase A2 (Lp-PLA2) Immunoassay for Prediction of Risk for Coronary Heart Disease or Ischemic Stroke (PLAC® Test) Re-Reviewed 02/18/2019 Investigative and therefore not covered No change in determination
Lipoprotein Subclass Testing for Screening, Evaluation, and Monitoring of Cardiovascular Disease Re-Reviewed 02/18/2019 Investigative and therefore not covered No change in determination
Multichannel Intraluminal Esophageal Impedance with pH Monitoring Re-Reviewed 12/19/2018
Enhanced benefit
Covered for some indications; investigative and therefore not covered for all other indications Change in determination:
  • Not investigative for the evaluation of gastroesophageal reflux disease (GERD) in individuals non-responsive to treatment or with atypical symptoms.
  • Investigative for all other indications.
Quantitative Electroencephalogram (qEEG) and Referenced Electroencephalogram (rEEG) Re-Reviewed 02/18/2019 Covered for some indications; investigative and therefore not covered for all other indications No change in determination
Transcatheter Heart Valve Replacement and Repair Procedures Re-Reviewed 02/18/2019 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 9:33:41 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01