Providers

Medical Policy Upcoming Updates

Notification Date: July 15, 2020

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
Elastography for Evaluation of Hepatic Fibrosis	New	09/14/2020	Covered for some indications; investigative and therefore not covered for all other indications	Ultrasound transient elastography (e.g. FibroScan) for diagnosing and monitoring liver fibrosis or cirrhosis in individuals with chronic liver disease is covered. Ultrasound transient elastography (e.g., FibroScan) is investigative and not covered for all other liver disease indications. Magnetic resonance elastography is covered for diagnosing and monitoring: a. Liver fibrosis or cirrhosis in individuals with chronic liver disease, when ultrasound transient elastography is unavailable, contraindicated, or results are indeterminate b. Nonalcoholic fatty liver disease, known or suspected. Magnetic resonance elastography is investigative and not covered for all other liver disease indications. Other modalities of elastography (e.g., acoustic radiation force impulse imaging (ARFI), two-dimensional shear wave (SWE)) are investigative and not covered for all indications.
Myocardial Strain Imaging (e.g., Cardiac Magnetic Resonance, Speckle Tracking Echocardiography, Tissue Doppler Echocardiography)	New	09/14/2020	Investigative and therefore not covered.

Policy Title

Status

Effective Date

Determination

Summary of Change

Elastography for Evaluation of Hepatic Fibrosis

New

09/14/2020

Covered for some indications; investigative and therefore not covered for all other indications

Ultrasound transient elastography (e.g. FibroScan) for diagnosing and monitoring liver fibrosis or cirrhosis in individuals with chronic liver disease is covered.

Ultrasound transient elastography (e.g., FibroScan) is investigative and not covered for all other liver disease indications.

Magnetic resonance elastography is covered for diagnosing and monitoring:
a. Liver fibrosis or cirrhosis in individuals with chronic liver disease, when ultrasound transient elastography is unavailable, contraindicated, or results are indeterminate
b. Nonalcoholic fatty liver disease, known or suspected.

Magnetic resonance elastography is investigative and not covered for all other liver disease indications.

Other modalities of elastography (e.g., acoustic radiation force impulse imaging (ARFI), two-dimensional shear wave (SWE)) are investigative and not covered for all indications.

Myocardial Strain Imaging (e.g., Cardiac Magnetic Resonance, Speckle Tracking Echocardiography, Tissue Doppler Echocardiography)

New

09/14/2020

Investigative and therefore not covered.

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.