Providers

Medical Policy Upcoming Updates

Notification Date: July 20, 2022

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

Policy Title	Policy Type	Status	Effective Date	Determination	Summary of Changes
Negative Pressure Wound Therapy With Instillation	Coverage	New	09/19/2022	Investigative and therefore not covered	Negative pressure wound therapy with instillation and dwell therapy systems (e.g., V.A.C. VERAFLO™ Therapy device, and Cardinal Health Simultaneous Irrigation™ tubing sets) are investigative. Reliable evidence does not permit conclusions concerning their effectiveness.
Surgical and Minimally Invasive Treatments for Benign Prostatic Hypertrophy/Hyperplasia (BPH)	Coverage	Re-review	07/20/2022	Covered for some indications; investigative and therefore not covered for all other indications	The following procedures have been added to the policy as COVERED services: Fiber laser enucleation technologies, e.g., holmium laser ablation/enucleation/resection (HoLAP, HoLEP, HoLRP); thulium laser (ThuLEP).
Volara Oscillation and Lung Expansion System	Coverage	New	09/19/2022	Investigative and therefore not covered	Volara Oscillation and Lung Expansion System is investigative for all indications. Reliable evidence does not permit conclusion concerning its effectiveness.

Policy Title	Policy Type	Status	Effective Date	Determination	Summary of Changes
Genetic Testing Policies	Utilization Management and Coverage	Re-reviewed and New	Rolling implementation dates to begin on or after 08/01/2022	Covered and medically necessary for some indications; investigative and therefore not covered for all other indications	Medica has contracted with Concert Genetics, an industry-leader in genetic testing technology assessment and policy development. Medica will adopt Concert Genetics clinical criteria for the management of genetic testing services.

Policy Title

Policy Type

Status

Effective Date

Determination

Summary of Changes

Genetic Testing Policies

Utilization
Management and Coverage

Re-reviewed and New

Rolling implementation dates to begin on or after 08/01/2022

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

Medica has contracted with Concert Genetics, an industry-leader in genetic testing technology assessment and policy development.

Medica will adopt Concert Genetics clinical criteria for the management of genetic testing services.