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Health Alliance Plan of Michigan (HAP) November 2017 Medical Policy Updates

Click here to view the Health Alliance Plan of Michigan (HAP) November 2017 Medical Policy Updates »

 

Recent Changes November 2017;

  • Acoustic Pharyngometry
  • Agalsidase Beta (Fabrazyme®)
  • Anti-Cancer Drugs
  • Aralast NP, Zeimara, Glassia, Prolastin, Prolastin-C (human alpha1-proteinase inhibitor)
  • Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma, PRP)
  • Avastin® (Bevacizumab) for Oncology
  • Breast Prosthesis (External) and Related Supplies Following Mastectomy or Lumpectomy
  • Breath Test for the Detection of Heart Transplant Rejection
  • Cervical Cancer Screening Visualization Technologies (Cervicography, Speculoscopy, and Spectroscopy)
  • Complementary, Alternative, Holistic or Natural Medicine
  • Compounded Medications
  • Computer Assisted Corneal Topography
  • Computer-Aided Detection of Chest Radiographs for Lung Cancer Screening
  • Corneal Graft with Amniotic Membrane Transplant or Limbal Stem Cell Transplantation
  • Denosumab (Prolia®)
  • Denosumab (Xgeva®)
  • Diapers, Incontinence Liners, Pants, Youth Pull On Briefs, and Underpads
  • Drug Therapy for Smoking Cessation – OTC Smoking Cessation Products
  • Eculizumab (Soliris®)
  • Edaravone (Radicava™)
  • Hair (Eyebrow) Transplant
  • Heart, Lung and Heart-Lung Transplantation
  • Hepatic Lesions, Tumors or Metastases; Treatment Approaches (Combining two existing policies: Liver and Other Neoplasms – Treatment Approaches and Ablation of Hepatic Lesions)
  • Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
  • Immune Globulin (Human)
  • Kidney Transplantation, Pancreas-Kidney Transplantation, and Pancreas Transplantation Alone
  • Pediatric Intensive Feeding Programs
  • Photocoagulation Laser Treatment of Macular Drusen
  • RSV Prevention Vaccine, Palivizumab (Synagis®)
  • Sacral Nerve Stimulation for Urinary Voiding Dysfunction and Fecal Incontinence
  • Signal-Average Electrocardiography (SAECG) (renamed from: Computerized Electrocardiography (ECG) Analysis)
  • Stem-Cell Transplant for Autoimmune Diseases
  • Stem-Cell Transplant for Sickle Cell Disease and Thalassemia Major
  • Treatments for Hereditary Angioedema (HAE): Human C1 Esterase Inhibitor (Cinryze®), Human C1 Esterase Inhibitor (Berinert®), Human C1 Esterase Inhibitor (Haegarda®), Ecallantide (Kalbitor®), Icatibant (Firazyr®)
  • Tumor Ablation, Malignant or Benign (including Cryoablation, Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound)
  • Tumor Markers for Cancer
  • Yag Laser (1064 nm neodymium-doped yttrim aluminum garnet [Nd:YAG] laser) for Hidradenitis Suppurativa (acne inversa)
  • ZZ – Retired Policy – CRYOABLATION OF BREAST LESIONS
  • ZZ – Retired Policy – CRYOABLATION OF RENAL TUMORS
  • ZZ – Retired Policy – CRYOSURGERY/CRYOABLATION OF THE PROSTATE
  • ZZ – Retired Policy – Hammer Toe Surgery
  • ZZ – Retired Policy – HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)
  • ZZ – Retired Policy – MICROWAVE THERMOTHERAPY FOR BREAST CANCER
  • ZZ – Retired Policy – PRODUCTION GLOVE
  • ZZ – Retired Policy – RADIOFREQUENCY ABLATION (RFA) OF PULMONARY TUMORS
  • ZZ – Retired Policy – Radiofrequency Ablation of Breast Cancer
  • ZZ – Retired Policy – RADIOFREQUENCY TUMOR ABLATION
  • ZZ – Retired Policy – UTERINE ARTERY EMBOLIZATION FOR THE TREATMENT OF UTERINE FIBROIDS

 

Click here to view the Health Alliance Plan of Michigan (HAP) November 2017 Medical Policy Updates »

 

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