Coronary Artery Calcium Scoring
|
Re-Reviewed
|
05/21/2018
|
Investigative and therefore not covered
|
No change in determination
|
Electromagnetic Navigation Bronchoscopy
|
Re-Reviewed
|
05/21/2018
|
Investigative and therefore not covered
|
No change in determination
|
Expanded Carrier Testing for Genetic Diseases
|
Re-Reviewed
|
05/21/2018
|
Covered for some indications; investigative and therefore not covered for all other indications
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- Added 5 additional conditions/diseases to the not investigative indications for limited genetic panels for individuals of Ashkenazi Jewish ancestry: familial hyperinsulinism, glycogen storage disease type I, Joubert syndrome, maple syrup urine disease, Usher syndrome.
- Expanded carrier testing panels remain investigative for all indications.
|
Health Research Institute/Pfeiffer Treatment Center Protocols
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Re-Reviewed
|
05/21/2018
|
Investigative and therefore not covered
|
No change in determination
|
Percutaneous Disc Decompression Procedures (Percutaneous Discectomies, Nucleoplasty)
|
Re-Reviewed
|
05/21/2018
|
Investigative and therefore not covered
|
No change in determination
|
PancraGEN™ Genotyping for Risk Assessment of Pancreatic Cancer
|
New
|
05/21/2018
|
Investigative and therefore not covered
|
- PancraGEN™ is a new molecular anatomic pathology test for pancreas cancer.
- This policy replaces Topographic Genotyping (PathFinder TG®) policy that has been retired.
|
Sacral Nerve Stimulation (SNS)
|
Re-Reviewed
|
05/21/2018
|
Covered for some indications; investigative and therefore not covered for all other indications
|
No change in determination
|
Topographic Genotyping (PathFinder TG®) for Diagnosis of Cancer
|
Re-Reviewed
|
05/21/2018
|
Inactivated
|
- Policy inactivated because the test has been retired from the market and is no longer commercially available.
|
Vision Therapy
|
Re-Reviewed
|
02/21/2018
|
Covered for some indications per the member plan document.
|
- Policy inactivated 02/21/18.
- Vision Therapy benefits are cited in the member plan document.
|