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BCBS Horizon Medical Policy Updates – September 2018

BCBS Horizon Medical Policy Updates – September 2018
BCBS Horizon NJ Medical Policy Updates

Click here to view the Blue Cross Blue Shield Horizon Medical Policy Updates »

September 2018 Medical Policy Updates:

  • Ablation Procedures for Peripheral Neuromas
  • Actigraphy
  • Agalsidase Beta (Fabrazyme)
  • Alcohol Injections for Treatment of Peripheral Neuromas
  • Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
  • Arthroscopy for Treatment of Knee Derangement
  • Automated Point-of-Care Nerve Conduction Tests
  • Autonomic Nervous System Testing
  • Belimumab (Benlysta)
  • Bronchial Thermoplasty
  • Bronchial Valves
  • Chemonucleolysis
  • Colon Hydrotherapy
  • Cosmetic Procedures
  • Cupping Therapy
  • Drug Therapy for Hereditary Angioedema [Cinryze Berinert Haegarda (Human C1 Inhibitor) Kalbitor (Ecallantide) Firazyr (Icatibant) Ruconest (C1 Esterase Inhibitor [Recombinant])]
  • Eculizumab (Soliris)
  • Electromagnetic Navigation Bronchoscopy
  • Electronic Salivary Reflex Stimulator
  • Epidural Spinal Endoscopy
  • Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
  • Fluency Enhancing Devices for Stuttering
  • Gait Trainers and Standing Frames
  • Gaucher Disease Therapy
  • Gender Reassignment Surgery
  • Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
  • Heart Rate Variability Measurement
  • Hematopoietic Cell Transplantation for Acute Myeloid Leukemia
  • Home Traction Devices for the Treatment of Spinal Disorders and Pain
  • Hyperbaric Oxygen Therapy
  • Immune Globulin Subcutaneous (Vivaglobin Hizentra Gammagard Liquid Gamunex-C or Gammaked HyQvia and Cuvitru for Subcutaneous Administration)
  • In Vitro Chemosensitivity and Chemoresistance Assays
  • Interferential Current Stimulation
  • Intermittent Pneumatic or Mechanical Compression Devices for Peripheral Artery Disease
  • Intravenous Immunoglobulin (IVIG) Therapy
  • Laronidase (Aldurazyme) Galsulfase (Naglazyme) and Idursulfase (Elaprase) elosulfase alfa (Vimizim) and vestronidase alfa (Mepsevii)
  • Low-Level Laser Therapy
  • Magnetic Resonance-Guided Focused Ultrasound
  • Melphalan (Alkeran and Evomela)
  • Navigated Transcranial Magnetic Stimulation
  • Neurofeedback
  • Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
  • Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux (VUR)
  • Polysomnography for NonRespiratory Sleep Disorders
  • Pompe Disease Treatment with Myozyme (Alglucosidase alfa) and Lumizyme (Alglucosidase alfa)
  • Quantitative Sensory Testing
  • Removal of Benign Skin Lesions
  • Rhinoplasty
  • Salivary Hormone Testing for Menopause
  • Seat Lift Mechanisms
  • Site of Service for Administration for Infusion and Injectable Prescription Medications
  • Thoracic-Lumbo-Sacral Orthosis with Pneumatics
  • Treatment of Tinnitus

Added 9/18/2018;

  • Ablation Procedures for Peripheral Neuromas
  • Alcohol Injections for Treatment of Peripheral Neuromas
  • Angiogenic Inhibitors for the Treatment of Ophthalmic Macular Conditions
  • Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
  • Automated Point-of-Care Nerve Conduction Tests
  • Autonomic Nervous System Testing
  • BRAF Gene Mutation Testing To Select Melanoma or Glioma Patients for Targeted Therapy
  • Bronchial Thermoplasty
  • Bronchial Valves
  • Compression Stockings
  • Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid
  • Cranial Electrotherapy Stimulation and Auricular Electrostimulation
  • Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver Prostate or Dermatologic Tumors
  • Cytochrome P450 Genotype-Guided Treatment Strategy
  • Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
  • Electromagnetic Navigation Bronchoscopy
  • Electromyography and Nerve Conduction Studies
  • Electronic Brachytherapy for Nonmelanoma Skin Cancer
  • Electrotherapies in Pain Management
  • Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
  • Fecal Calprotectin Testing
  • Gender Reassignment Surgery
  • Gene Expression Profiling for Uveal Melanoma
  • Genetic Testing for Diagnosis and Management of Mental Health Conditions
  • Genetic Testing for Mitochondrial Disorders
  • Genotype-Guided Warfarin Dosing
  • Home Cardiorespiratory Monitoring
  • Interferential Current Stimulation
  • Interspinous and Interlaminar Stabilization or Distraction Devices (Spacers)
  • JAK2 MPL and CALR Testing for Myeloproliferative Neoplasms
  • Low-Level Laser Therapy
  • Lumbar Spinal Fusion
  • Lung Volume Reduction Surgery for Severe Emphysema
  • Molecular Markers in Fine Needle Aspirates of the Thyroid
  • Myoelectric Prosthetic and Orthotic Components for the Upper Limb
  • Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA
  • Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Disorders
  • Polysomnography for NonRespiratory Sleep Disorders
  • Prostatic Urethral Lift
  • Proton Beam Therapy
  • Quantitative Sensory Testing
  • Radioembolization for Primary and Metastatic Tumors of the Liver
  • Refractive Keratoplasty Procedures
  • Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases
  • Sodium Hyaluronate Injections
  • Transcatheter Arterial Chemoembolization To Treat Primary or Metastatic Liver Malignancies
  • Treatment of Varicose Veins or Venous Insufficiency
  • Tumor-Treatment Fields Therapy

 

Click here to view the Blue Cross Blue Shield Horizon Medical Policy Updates »

 

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