Providers

Medical Policy Upcoming Updates

Notification Date: August 21, 2019

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
Computerized Dynamic Posturography	Re-Reviewed	10/21/2019	Investigative and therefore not covered	No change in determination
Inhaled Nitric Oxide (iNO) Therapy	Re-Reviewed	10/21/2019	Covered for some indications; investigative and therefore not covered for all other indications	No change in determination
Laser Surgery for Corneal Pathology	Re-Reviewed	10/21/2019	Covered when associated with disease or injury.	Coverage Policy inactivated 10/21/2019. Please note that refractive eye surgery is generally excluded from coverage. Please refer to the specific member plan document.
Pelvic Vein Embolization	Re-Reviewed	10/21/2019	Investigative and therefore not covered	No change in determination
Single Nucleotide Polymorphism (SNP) Genetic Testing for Assessment of Cancer Risk	Re-Reviewed	10/21/2019	Investigative and therefore not covered	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.