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BCBS HealthNow NY March 2018 Medical Policy Updates

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

Protocol Revisions:

  • Artificial Pancreas Device Systems
  • Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
  • Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
  • Genetic Testing for Cardiac Ion Channelopathies
  • Genetic Testing of CADASIL Syndrome
  • Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma
  • Implantable Cardioverter Defibrillators
  • Invasive Prenatal (Fetal) Diagnostic Testing
  • Lipid Apheresis
  • Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer
  • Molecular Markers in Fine Needle Aspirates of the Thyroid
  • Multimarker Serum Testing Related to Ovarian Cancer
  • Prostatic Urethral Lift
  • Spinal Cord Stimulation
  • Surgical Ventricular Restoration
  • Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
  • Viscocanalostomy and Canaloplasty

 

New Protocols:

  • Circulating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy)

 

Protocols Reviewed Without Change:

  • Actigraphy
  • Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias (Formerly
  • Allogeneic Hematopoietic Stem Cell Transplantation for Genetic Diseases and Acquired Anemias)
  • Aqueous Shunts and Stents for Glaucoma
  • Artificial Intervertebral Disc: Cervical Spine
  • Artificial Intervertebral Disc: Lumbar Spine
  • Autonomic Nervous System Testing
  • Axial Lumbosacral Interbody Fusion
  • Balloon Ostial Dilation for Treatment of Chronic Rhinosinusitis (Formerly Balloon Ostial Dilation for
  • Treatment of Chronic Sinusitis)
  • Biofeedback for Miscellaneous Indications
  • Cardiovascular Risk Panels
  • Chromosomal Microarray Testing for the Evaluation of Pregnancy Loss (Formerly Chromosomal
  • Microarray Analysis for the Evaluation of Pregnancy Loss)
  • Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
  • Cryosurgical Ablation of Primary or Metastatic Liver Tumors
  • Dynamic Posturography
  • Electrical Bone Growth Stimulation of the Appendicular Skeleton
  • Electrical Stimulation for the Treatment of Arthritis
  • Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
  • Electromagnetic Navigation Bronchoscopy
  • Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer
  • Endothelial Keratoplasty
  • Facet Joint Denervation
  • Gastric Electrical Stimulation
  • Genetic Testing for Familial Cutaneous Malignant Melanoma
  • Genetic Testing for Human Leukocyte Genes (HLA)
  • Genetic Testing for Mental Health Conditions
  • Heart Transplant
  • Heart/Lung Transplant
  • Hematopoietic Cell Transplantation for Autoimmune Diseases (Formerly Hematopoietic Stem Cell
  • Transplantation for Autoimmune Diseases)
  • Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
  • (Formerly Hematopoietic Stem Cell Transplantation for Central Nervous System Embryonal Tumors and
  • Ependymoma)
  • Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (Formerly Hematopoietic Stem Cell
  • Transplantation for Epithelial Ovarian Cancer)
  • Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (Formerly Hematopoietic
  • Stem Cell Transplantation for Miscellaneous Solid Tumors in Adults)
  • Hip Resurfacing
  • Immune Cell Function Assay
  • Implantable Sinus Stents for Postoperative Use Following Endoscopic Sinus Surgery and for Recurrent
  • Sinus Disease
  • Implantation of Intrastromal Corneal Ring Segments
  • Interspinous Fixation (Fusion) Devices
  • Intra-Articular Hyaluronan Injections for Osteoarthritis
  • Low-Level Laser Therapy
  • Lysis of Epidural Adhesions
  • Magnetoencephalography/Magnetic Source Imaging
  • Microwave Tumor Ablation
  • Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis
  • Occipital Nerve Stimulation
  • Orthoptic/Vision Therapy
  • Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
  • Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers
  • Quantitative Sensory Testing
  • Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
  • Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for
  • Prostate Cancer
  • Reduction Mammaplasty for Breast-Related Symptoms
  • Scintimammography and Gamma Imaging of the Breast and Axilla
  • Sensory Integration Therapy and Auditory Integration Therapy
  • Subtalar Arthroereisis
  • Surgical Treatment of Bilateral Gynecomastia
  • Transcatheter Aortic Valve Implantation for Aortic Stenosis
  • Transcatheter Mitral Valve Repair
  • Transcatheter Pulmonary Valve Implantation

 

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

 

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