BCBS HealthNow NY December 2017 Medical Policy Updates

Click here to view the BCBS HealthNow NY Medical Policy Updates »

Protocol Revisions effective January 1, 2018

• Cochlear Implant
• Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
• Diagnosis and Treatment of Sacroiliac Joint Pain
• DNA-Based Testing for Adolescent Idiopathic Scoliosis
• Gene Expression Testing to Predict Coronary Artery Disease
• Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
• Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing
• Genetic Testing for Alpha1-Antitrypsin Deficiency
• Genetic Testing for Breast Cancer Gene Expression Prognosis Assay
• Genetic Testing for Cystic Fibrosis
• Genetic Testing for Developmental Delay and Autism Spectrum Disorder
• Genetic Testing for Hereditary Breast and Ovarian Cancer Syndrome
• Genetic Testing for Hereditary Hearing Loss
• Genetic Testing for Leukemia and Lymphoma
• Genetic Testing for Noninvasive Prenatal Testing
• Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
• In Vitro Chemoresistance and Chemosensitivity Assays
• Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer
• Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus
• Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
• Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions
• Ultrasound Accelerated Fracture Healing Device
• Use of Common Genetic Variants (Single Nucleotide Polymorphisms) to Predict Risk of Nonfamilial Breast Cancer
• Wearable Cardioverter Defibrillators

New Protocols effective January 1, 2018

• Magnetic Resonance Imaging‒Targeted Biopsy of the Prostate

Protocols Reviewed Without Change

• Ambulance (Emergency)
• Biofeedback as a Treatment of Urinary Incontinence in Adults
• Catheter Ablation as Treatment for Atrial Fibrillation
• Chelation Therapy for Off-Label Uses
• Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy)
• Computer-Assisted Navigation for Orthopedic Procedure (Formerly Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure)
• Continuous Passive Motion in the Home Setting
• Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
• Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)
• Diagnosis and Management of Idiopathic Environmental Intolerance and Intracellular Micronutrient Analysis
• Dopamine Transporter Imaging With Single-Photon Emission Computed Tomography (Formerly
• Dopamine Transporter Single-Photon Emission Computed Tomography)
• Endometrial Ablation
• Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
• Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
• Endovascular Stent Grafts for Abdominal Aortic Aneurysms
• Enhanced External Counterpulsation
• Extracorporeal Photopheresis
• Facet Arthroplasty
• General Approach to Evaluating the Utility of Genetic Panels
• General Approach to Genetic Testing
• Genetic Testing for Epilepsy
• Genetic Testing for FAP and Lynch Syndrome
• Genetic Testing for Statin-Induced Myopathy
• Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (Formerly Hematopoietic Stem Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome)
• Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia (Formerly Hematopoietic Stem
• Cell Transplantation for Waldenström Macroglobulinemia)
• Implantable Bone-Conduction and Bone-Anchored Hearing Aids
• Intradialytic Parenteral Nutrition
• KIF6 Genotyping for Predicting Cardiovascular Risk and/or Effectiveness of Statin Therapy
• Lung Volume Reduction Surgery for Severe Emphysema
• Meniscal Allografts and Other Meniscal Implants
• Myoelectric Prosthetic Components for the Upper Limb
• Occlusion of Uterine Arteries Using Transcatheter Embolization
• Orthopedic Applications of Platelet-Rich Plasma
• Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty (Formerly Percutaneous Intradiscal Electrothermal Annuloplasty and Percutaneous Intradiscal Radiofrequency Annuloplasty)
• Pharmacogenomic and Metabolite Markers for Patients Treated With Thiopurines
• Plasma Exchange
• Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
• Preimplantation Genetic Testing
• Prolotherapy
• Radiofrequency Ablation of Primary or Metastatic Liver Tumors
• Reconstructive Breast Surgery/Management of Breast Implants
• Sacral Nerve Neuromodulation/Stimulation
• Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
• Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
• Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
• Transcutaneous Electrical Nerve Stimulation
• Transmyocardial Revascularization
• Treatment of Hyperhidrosis
• Tumor Treatment Fields Therapy for Glioblastoma
• Urinary Tumor Markers for Bladder Cancer
• Vagus Nerve Stimulation
• Vectra® DA Blood Test for Rheumatoid Arthritis
• Wireless Capsule Endoscopy to Diagnose Disorders of the Small Bowel, Esophagus, and Colon (Formerly
• Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon)

Click here to view the BCBS HealthNow NY Medical Policy Updates »

Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!

Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.

Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.