Providers

Medical Policy Upcoming Updates

Notification Date: July 18, 2018

Below are the policies that are new or have been reviewed, along with the determination and summary of any changes.

Coverage Policies

Policy Title	Status	Effective Date	Determination	Summary of Change
Digital Breast Tomosynthesis	Re-reviewed	07/18/2018	Coverage for screening and diagnosis of breast cancer	Coverage Policy inactivated
Durable Medical Equipment	Re-reviewed	07/16/2018	Covered according to the terms of the member's plan document	New non-covered indication: DME purchases from online retailers are not covered
Endoscopic Balloon Sinuplasty Ostial Dilation and Steroid-Eluting Sinus Stents for Treatment of Chronic Sinusitis Former Title: Endoscopic Balloon Sinuplasty for Treatment of Chronic Sinusitis	New and Re-reviewed	09/17/2018	Balloon Sinuplasty: Covered for some indications; investigative and therefore not covered for all other indications. Steroid-Eluting Sinus Stents: Investigative and therefore not covered	Ballon Sinuplasty: No change in determination Steroid-Eluting Sinus Stents: New determination
KRAS Mutation Analysis for Predicting Response to Drug Therapy	Re-reviewed	07/18/2018	Covered for some indications; investigative and therefore not covered for all other indications	New indication: KRAS mutation analysis for predicting response to anti-epidermal growth factor receptor (EGFR) monoclonal antibodies is not investigative for patients with non-small cell lung cancer (NSCLC)
Scar Revision	Re-reviewed	07/16/2018	Covered for some indications. Cosmetic procedures are excluded from coverage.	No change in determination

The updated clinical policies and guidelines above will be available as of their effective date, as noted. View policies and guidelines.

To request paper copies of a policy, please leave a message at the Medica Provider Literature Request Line: 1-800-458-5512, option 1, then option 8, then ext. 2-2355.

Where information conflicts with applicable state and/or federal law, Medica follows such applicable federal and/or state law.