Medicaid Medical Policy Search

All drug policies are housed on the Medication Policy webpage. View all drug policies/criteria here.

Automated Ambulatory Blood Pressure Monitoring (ABPM) Medical PolicyPA Medicaid09/07/2020
Bariatric Surgery Medical PolicyPA Medicaid 05/18/2020
BCR-ABL1 Testing in Chronic Muelogenous Leukemia and Acute Lymphoblastic Leukemia Medical PolicyPA Medicaid03/15/2021
BRAF Mutation Analysis Medical PolicyPA Medicaid10/19/2020
BRCA1 & BRCA2 Genetic Testing Medical PolicyPA Medicaid 06/22/2020
Bronchial Thermoplasty Medical PolicyPA Medicaid03/16/2020
Capsule Endoscopy Medical PolicyPA Medicaid03/16/2020
Cardiac Rehabilitation Medical PolicyPA Medicaid06/22/2020
Carpal Tunnel Syndrome Medical PolicyPA Medicaid 05/18/2020
Chromosomal Microarray Analysis Medical PolicyPA Medicaid 03/16/2020
Cochlear Implants Medical PolicyPA Medicaid 10/19/2020
Colorectal Cancer Screening Medical PolicyPA Medicaid 04/13/2020
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA) Medical PolicyPA Medicaid09/07/2020
Electrical Bone Growth Stimulators for the Spine Medical PolicyPA Medicaid 05/18/2020
Enteral Feeding In-line Cartridge Medical PolicyPA Medicaid06/22/2020
Fecal Microbiota Transplant Medical PolicyPA Medicaid09/07/2020
Fetal Testing Using Noninvasive Cell-Free Fetal DNA Aneuploidy Medical PolicyPA Medicaid08/17/2020
Gender Transition Services Medical PolicyPA Medicaid 04/13/2020
Genetic Testing for Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Attenuated FAP and MYH-associated Polyposis Medical PolicyPA Medicaid11/16/2020
Genetic Testing for Cystic Fibrosis Medical PolicyPA Medicaid12/21/2020
Genetic Testing for Warfarin and Clopidogrel Therapy Medical PolicyPA Medicaid08/17/2020
Home Oxygen Therapy (HOT) Medical PolicyPA Medicaid09/07/2020
Hyperbaric Oxygen Therapy (HBOT) Medical PolicyPA Medicaid11/16/2020
Hypoglossal Nerve Stimulation Implantation i n the Treatment of Obstructive Sleep Apnea Medical PolicyPA Medicaid03/15/2021
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator Medical PolicyPA Medicaid08/12/2019
Macular Degeneration Medical PolicyPA Medicaid08/12/2019
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules Medical PolicyPA Medicaid10/19/2020
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) Medical PolicyPA Medicaid 10/19/2020
Myoelectric Upper Extremity Orthoses Medical PolicyPA Medicaid01/18/2021
Negative Pressure Wound Therapy in the Outpatient Setting Medical PolicyPA Medicaid03/15/2021
Non-Oncologic Genetic Testing Panels Medical PolicyPA Medicaid11/16/2020
Noninvasive Electrical Bone Growth Stimulators (Osteogenesis Stimulators) Medical PolicyPA Medicaid01/18/2021
Noninvasive Positive Pressure Intermittent Ventilation in the Home Setting Medical PolicyPA Medicaid01/18/2021
Gene Expression Testing for Breast Cancer Treatment Medical PolicyPA Medicaid12/21/2020
Panniculectomy/Abdominoplasty/Lipectomy Medical PolicyPA Medicaid03/15/2021
Passive Oscillatory Devices in the Outpatient Setting Medical PolicyPA Medicaid01/18/2021
Place of Service Medical PolicyPA Medicaid10/19/2020
Pulmonary Rehabilitation Medical PolicyPA Medicaid 04/13/2020
Breast Reconstructive Surgery Medical PolicyPA Medicaid 06/22/2020
Supervised Exercise Therapy (SET) Medical PolicyPA Medicaid12/21/2020
Single Use ECG Monitoring (ZIO Patch) Medical PolicyPA Medicaid12/21/2020
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting Medical PolicyPA Medicaid 03/15/2021
Testing for Genetic Disease Medical PolicyPA Medicaid02/15/2021
Ultrasound Bone Growth Stimulator Medical PolicyPA Medicaid03/15/2021
Wearable Cardioverter-Defibrillators in the Home Setting Medical PolicyPA Medicaid01/18/2021
Whole Exome and Whole Genome Genetic Testing Medical PolicyPA Medicaid03/15/2021
Ambulance Services – Ground Medical PolicyPA Medicaid09/07/2020
MRgFUS Medical PolicyPA Medicaid5/18/2020
Prostate Cancer Genetic Testing Medical Policy PA Medicaid 12/21/2020
Upper Gastrointestinal Endoscopy (EGD-esophagogastroduodenoscopy) Medical PolicyPA Medicaid10/19/2020
Vitamin D Deficiency Testing Medical PolicyPA Medicaid 10/19/2020
Scanning Computerized Ophthalmic Imaging Medical PolicyPA Medicaid07/27/2020
Artificial Pancreas Medical PolicyPA Medicaid07/27/2020
Percutaneous Left Atrial Appendage Closure (LAAC) Medical PolicyPA Medicaid07/27/2020
Deep Brain Stimulation Medical PolicyPA Medicaid07/27/2020
Treatment of Obstructive Sleep Apnea Medical PolicyPA Medicaid11/16/2020
Electrical Stimulation for Oropharyngeal Dysphagia Medical PolicyPA Medicaid01/18/2021
Repetitive Transcranial Magnetic Stimulation Medical PolicyPA Medicaid11/18/2019
Oncologic Genetic Testing Panels Medical PolicyPA Medicaid11/16/2020
Cosmetic Procedures Medical Policy PA Medicaid 11/16/2020
Gastric Electrical Stimulation (GES) Medical Policy PA Medicaid 12/21/2020
Bronchial Valves Medical PolicyPA Medicaid12/21/2020
Exhaled Nitric Oxide Measurement in the Management of Respiratory Disorders Medical PolicyPA Medicaid12/21/2020
Breast Scintimammography Medical PolicyPA Medicaid12/21/2020
DXA for Vertebral Fracture Assessment Medical PolicyPA Medicaid12/21/2020
Minimally Invasive Lumbar Decompression Medical PolicyPA Medicaid03/15/2021
Prostatic Urethral Lift Medical PolicyPA Medicaid03/15/2021
Multimarker Serum Testing for Ovarian Cancer Medical PolicyPA Medicaid03/15/2021
Speech Generating Devices Medical PolicyPA Medicaid3/16/2020
Labiaplasty Medical Policy PA Medicaid 4/13/2020
Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) Medical Policy PA Medicaid 10/19/2020
Prescription Digital Therapeutics (e.g., reSET and reSET-O) Medical Policy PA Medicaid 12/21/2020

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