Providers

Medical Policy Upcoming Updates

Notification Date: August 18, 2021

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
Genetic and Pharmacogenetic Testing	Re-Reviewed	08/25/2021 Enhanced Benefit	Covered for some indications; investigative and therefore not covered for all other indications	SCN1A single gene testing for hereditary epilepsies is no longer investigative and is therefore COVERED. Multi-gene panels for hereditary epilepsies, which are defined as assays that simultaneously test for multiple epilepsy genes, are investigative and therefore NOT COVERED based on MCG 25th Edition Ambulatory Care Guidelines (ACGs), Epilepsies (Hereditary) – Gene Panels.

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.