| Chemoembolization for Hepatic Tumors |
Re-Reviewed |
07/15/2019 |
Covered for some indications; investigative and therefore not covered for all other indications |
No change in determination |
| Endoscopic Radiofrequency Ablation for Barrett’s Esophagus |
Re-Reviewed |
07/15/2019 |
Covered for some indications; investigative and therefore not covered for all other indications |
No change in determination |
| Genetic Testing for Alzheimer Disease |
Re-Reviewed |
07/15/2019 |
Investigative |
No change in determination |
| Interferential Current Stimulation |
Re-Reviewed |
07/15/2019 |
Investigative |
No change in determination |
| Intraoperative Neurophysiologic Monitoring (IONM) |
New |
07/15/2019 |
Covered for some indications; investigative and therefore not covered for all other indications |
The use of IONM is not investigative when the following criteria are met:
- One or more of the following IONM are used:
1. Somatosensory evoked potentials (SSEPs) motor evoked potentials (MEPs)
2. Brainstem auditory, BAEPs)
3. Electromyography (EMG)
4. Electroencephalogram (EEG)
5. Electrocorticography (ECoG).
- IONM is provided by a physician (other than the surgical team) that is trained in clinical neurophysiology.
- The individual has an abnormal anatomy that pose a potential risk of significant damage to a cranial nerve, spinal cord, or to an essential central nervous system structure compromising neurologic function.
Note: See IONM coverage policy for a list of complete indications.
The use of IONM is investigative and therefore not covered for all other indications, including but not limited to:
- Individuals with normal anatomy undergoing routine surgical procedures
1. Routine spinal fusion, decompression, discectomy, or laminectomy
2. Routine thyroid and parathyroid gland lobectomy or dissection.
- Cardiac surgery
- Esophageal surgeries.
|
| Powered Robotic Exoskeleton Devices |
Re-Reviewed |
07/15/2019 |
Investigative |
No change in determination |
| Sleep Studies for Initial Diagnosis of Obstructive Sleep Apnea |
Re-Reviewed |
07/15/2019 |
Covered for some indications; investigative and therefore not covered for all other indications |
No change in determination
New Device: Home (unattended/unsupervised) sleep studies with a portable device using peripheral arterial tonometry (PAT) (e.g., WatchPAT) was added to the policy: Covered for a subset of adults at least 18 years of age; investigative and not covered for children and adolescents.
|
| Transvaginal and Transurethral Radiofrequency (RF) Treatments of Stress Urinary Incontinence in Women |
Re-Reviewed |
07/15/2019 |
Investigative |
No change in determination |