- Allergy Testing and Immunotherapy – Scheduled review. Deleted “In vitro testing for allergen specific IgG” from the list of testing considered medically necessary. Added additional testing considered experimental or investigational. Deleted coverage statement for sublingual immunotherapy (SLIT) using Oralair®, Grastek®, or Ragwitek®. Revised Reimbursement Information section. Updated references. Reformatted guideline.
- Aqueous Shunts and Stents for Glaucoma – Scheduled review. Revised description. Added clarification regarding micro-stent coverage. Revised index terms. Updated references.
- Autologous Chondrocyte Implantation (ACI) – Revision: updated description section. Deleted E/I coverage statement for matrix-induced autologous chondrocyte implantation (MACI). Updated references. Reformatted guideline.
- Autonomic Nervous System Testing – Annual review; position statements maintained and references updated; formatting changes.
- Bio-Engineered Skin and Soft Tissue Substitutes, Amniotic Membrane and Amniotic Fluid – Revision; Integra Omnigraft deleted from investigational product list and added to bullet for Integra® Dermal Regeneration Template.
- Bioimpedance Devices for Detection and Management of Lymphedema – Review; Investigational position maintained; description section and references updated.
- Brentuximab (Adcetris™) Injection – Review and revision to guideline; consisting of updating position statement, coding, and references.
- Bronchial Thermoplasty – Review; no change in position statement. Updated references.
- Extracorporeal Shock Wave Therapy in the Treatment of Peyronie’s Disease – Review; investigational position maintained, description section and references updated.
- Fecal Microbiota Transplantation – Scheduled review. Maintained Position Statement section. Updated reference. Reformatted guideline.
- Frenectomy or Frenotomy for Ankyloglossia – (Tongue-Tie) – Revision; coding section updated.
- Hepatitis C Drug Therapy – Review and revision to guideline consisting of updating position statement and references.
- Human EGFR Inhibitors (Cetuximab [Erbitux®], Panitumumab [Vectibix®]) – Revision to guideline consisting of updating position statement, coding, and references.
- Ibrutinib (Imbruvica™) – Review and revision to guideline consisting of updating the description section, position statement, dosing/administration section, and references.
- Immune Globulin Therapy – Review and revision to guideline; consisting of revising position statement, coding and references.
- Intravascular Brachytherapy for Prevention and Management of Restenosis after Percutaneous Transluminal Angioplasty (PTA) – Review; no change in position statement. Updated description and references.
- KRAS, NRAS, and BRAF Mutation Analysis in Metastatic Colorectal Cancer – Review; BRAF position statement and references updated.
- Left Atrial Appendage Closure – Revision. Added coverage statements for epicardial clipping of the left atrial appendage and left atrial appendectomy. Revised description section and index terms. Updated references.
- Non-Covered Services – Deleted code S3620.
- Nusinersen (Spinraza) – Revision to guideline consisting of description and position statement.
- Obeticholic Acid (Ocaliva®) Tablet – Review and revision to guideline consisting of updating the description section, position statement, and references.
- Obinutuzumab (Gazyva™) Injection – Review and revision to guideline consisting of updating the description, position statement, and references.
- PCSK9 Inhibitors – Revision to guideline consisting of updating the position statement and references in relation to ezetimibe treatment.
- Preventive Services – Revised service descriptor and description for obesity screening and counseling: children; added adolescents.
- Quantitative Sensory Testing – Review; investigational status maintained; description section and references updated.
- Ramucirumab (Cyramza™) Injection – Review and revision to guideline consisting of updating position statement and references.
- Reduction Mammoplasty – Review; no change in position statement. Updated references.
- Ultrasound for the Evaluation of Paranasal Sinuses – Review; no change in position statement. Updated references.
- Venetoclax (Venclexta®) Tablet – Review and revision to guideline consisting of updating the description section and references.
- Ventricular Assist Devices and Total Artificial Hearts – Revision: updated description section. Added additional coverage indications for percutaneous VAD. Added HCPCS codes Q0478, Q0479, Q0480, Q0481, Q0482, Q0483, Q0484, Q0485, Q0486, Q0487, Q0488, Q0489, Q0490, Q0491, Q0492, Q0493, Q0494, Q0495, Q0496, Q0497, Q0498, Q0499, Q0500, Q0501, Q0502, Q0503, Q0504, Q0506, Q0507, Q0508 and Q0509. Revised index terms. Updated references.
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.