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BCBS Kansas City Medical Policy Updates – May 2019

BCBS Kansas City Medical Policy Updates – May 2019
BCBS Kansas City Medical Policy Updates

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

May 2019 BCBS Kansas City Medical Policy Updates:

Ampyra (dalfampridine) rev 052019

Ilumya (tildrakizumab-asmn)

Calquence (acalabrutinib)

Dupixent (dupilumab)

Egrifta (tesamorelin)

Erleada (apalutamide)

Fasenra (benralizumab)

Firazyr (icatibant)

Firdapse (amifampridine)

Hemlibra (emicizumab-kxwh)

Intravenous Anesthetics for the Treatment of Chronic Pain

Korlym (mifepristone)

Lobrena (lorlatinib)

Mepsevii (vestronidase-aslfa-vjbk)

Nononcologic Uses of Rituxan (rituximab)

Ocrevus (ocrelizumab)

Otezla (apremilast)

Oxervate (cenegermin-bkbj)

Rebinyn (factor IX (recombinant[glycopegylated]))

Revcovi (elapegademase-lvlr)

Solosec (secnidazole)

Symdeko (tezacaftor-ivacaftor)

Abilify Mycite

Benlysta (belimumab)

Cosentyx (secukinumab)

Custom Compounded Hormone Replacement Therapy

Daurismo (glasdegib)

Emflaza (deflazacort)

Entyvio (vedolizumab)

Immune Globulin Therapy

Kuvan (sapropterin)

Promacta (eltrombopag)

Samsca (tolvaptan)

Triptans Step Therapy Policy

Ultomiris (ravulizumab-cwvz)

Vitrakvi (larotrectinib)

Xospata (gilteritinib)

Electric or Power Wheelchairs and Scooters2

Home Cardiorespiratory Monitoring

and Management of Lymphedema

Bone Turnover Markers for the Diagnosis and Management of Osteoporosis High Bone Turnover

Circulating Tumor Cells for Cancer

Gene Expression Based Assays for Cancers of Unknown Primary

Genetic Testing for the Developmental Delay Intellectual Disability Austism Spectrum Disorder

Identification of Microorganisms Using Nucleic Acid Probes

Ingestible pH and Pressure Capsule

KRAS NRAS and BRAF Variant Analysis in Metastatic Colorectal Cancer

Laser Treatment of Onychomycosis

Therapy for Psoriasis and Eczema

Measurement of Lipoprotein Associated Phospholipase A2 Lp-PLA2 in the Assessment of Cardiovascular Risk

Multianalyte Assays with Algorithmic Analyses for Predicting Risk of Type 2 Diabetes

Non Pharmacologic Treatment of Rosacea

Orthopedic Applications of Platelet Rich Plasma

Serum Biomarker Human Epididymis Protein 4

Prophylactic Oophorectomy

Artificial Intervertebral Disc of the Cervical Spine

Bone Morphogenetic Protein

Cryosurgical Ablation of Primary or Metastatic Liver Tumors

Dynamic Stabilization Systems

Facet Joint Denervation

Image-Guided Minimally Invasive Decompression for Spinal Stenosis

Intraoperative Neurophysiologic Monitoring

Occipital Nerve Stimulation

Percutaneous Tibial Nerve Stimulation

Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux

Radiofrequency Ablation Renal Sympathetic Nerves for Resistant Hypertension

Subtalar Arthroereisis

Transmyocardial Revascularization

of the Breast and Lung

Intensity Modulated Radiotherapy of the Prostate

Corneal Collagen Cross Linking

Eyelid Thermal Pulsation

Gamifant (emapalumab-lzsg)

Testosterone Replacement Therapies rev05-2019

Lemtrada (alemtuzumab)

Step Therapy Policy rev05-19

Abdomen Imaging

Behavioral Health Medical Necessity Critera

Breast Imaging

Cardiac Imaging

Cardiac Rhythm Implantable Device CRID Imaging

Chest Imaging

Head Imaging

Lumbar Spine Fusion

Musculoskeletal MSK Imaging

Neck Imaging

OB Ultrasound Imaging

Oncology Imaging

Pediatric Abdomen Imaging

Pediatric Cardiac Imaging

Pediatric Chest Imaging

Pediatric Musculoskeletal MSK Imaging

Pediatric Neck Imaging

Pediatric Oncology Imaging

Pediatric Peripheral Nerve Disorders PND Imaging

Pediatric Peripheral Vascular Disease PVD Imaging

Pediatric Spine Imaging

Peripheral Nerve Disorder PND Imaging

Peripheral Vascular Disease PVD Imaging

Rebinyn (factor IX (recombinant[glycopegylated])

Repetitive Transcranial Magnetic Stimulation rTMS for Treatment of Major Depression

Spine Imaging

 

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

 

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