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Medical Policy Upcoming Updates

Notification Date: August 19, 2020

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
Genetic Testing for Colorectal Cancer

Former coverage policies being inactivated & incorporated into this new policy:
  • Gene Expression Profiling Assays for Predicting Colon Cancer Recurrence Risk
  • Molecular Profiling in Colorectal Cancer to Guide Treatment
New 10/19/2020 Covered for some indications; investigative and therefore not covered for all other indications Change in Determination:
Investigative and therefore not covered: Large multigene panels, including those to guide targeted pharmacogenetics, unless required by the FDA.

No change to all other tests addressed in this policy.
Sacroiliac Joint Fusion Re-Review 08/19/2020

Enhanced benefit
Covered for some indications; investigative and therefore not covered for all other indications Change in Determination:
Minimally invasive sacroiliac joint fusion (SIJF) is now covered for:
  • SIJF using iFuse Implant System for moderate-to-severe SI joint pain that:
    • Limits activites of daily living or demonstrates functional disability
    • Is refractory to intensive conservative therapy.
  • Investigative and therefore not covered: Using other device systems and for all other indications.
Open SIJF: No change from current 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 10:39:19 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01