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Medicaid Medical Policy Search



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



Name
Type
State
Effective
Ambulatory Blood Pressure Monitors Medical PolicyPA Medicaid09/16/2019
Bariatric Surgery Medical PolicyPA Medicaid 05/06/2019
BCR-ABL1 Genetic Testing in Leukemia Medical PolicyPA Medicaid03/18/2019
BRAF Medical PolicyPA Medicaid10/21/2019
BRCA1 & BRCA2 Genetic Testing Medical PolicyPA Medicaid 06/17/2019
Bronchial Thermoplasty Medical PolicyPA Medicaid03/18/2019
Capsule Endoscopy Medical PolicyPA Medicaid03/18/2019
Cardiac Rehabilitation Medical PolicyPA Medicaid07/15/2019
Carpal Tunnel Syndrome Medical PolicyPA Medicaid 06/17/2019
Chromosomal Microarray Analysis Medical PolicyPA Medicaid 05/06/2019
Cochlear Implants Medical PolicyPA Medicaid 05/06/2019
Colorectal Cancer Screening Medical PolicyPA Medicaid 05/06/2019
Continuous Glucose Monitoring Medical PolicyPA Medicaid 06/17/2019
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA) Medical PolicyPA Medicaid09/16/2019
Electrical Bone Growth Stimulators for the Spine Medical PolicyPA Medicaid 05/06/2019
Enteral Feeding In-line Cartridge Medical PolicyPA Medicaid07/15/2019
Fecal Microbiota Transplant Medical PolicyPA Medicaid10/21/2019
Fetal Aneuploidy Medical PolicyPA Medicaid08/12/2019
Gender Transition Services Medical PolicyPA Medicaid 05/06/2019
Genetic Testing for Colorectal Cancer Susceptibility Medical PolicyPA Medicaid11/18/2019
Genetic Testing for Cystic Fibrosis Medical PolicyPA Medicaid01/15/2019
Genetic Testing for Warfarin Medical PolicyPA Medicaid08/12/2019
Home Oxygen Therapy (HOT) Medical PolicyPA Medicaid10/21/2019
Hyperbaric Oxygen Therapy (HBOT) Medical PolicyPA Medicaid12/09/2019
Hypoglossal Nerve Stimulator Medical PolicyPA Medicaid03/18/2019
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 Medicaid10/21/2019
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) Medical PolicyPA Medicaid09/16/2019
Myoelectric Upper Extremity Orthoses Medical PolicyPA Medicaid02/18/2019
Negative Pressure Wound Therapy in the Outpatient Setting Medical PolicyPA Medicaid03/18/2019
Non-Oncologic Genetic Testing Panels Medical PolicyPA Medicaid11/18/2019
Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C Medical PolicyPA Medicaid12/09/2019
Noninvasive Electrical Bone Growth Stimulators Medical PolicyPA Medicaid01/15/2019
Noninvasive Positive Pressure Intermittent Ventilation (NPPV) Medical PolicyPA Medicaid12/15/2018
Oncologic Genetic Testing Panels Medical PolicyPA Medicaid12/15/2018
Oncotype DX Medical PolicyPA Medicaid12/09/2019
Panniculectomy Medical PolicyPA Medicaid03/18/2019
Passive Oscillatory Devices in the Outpatient Setting Medical PolicyPA Medicaid01/15/2019
Place of Service Medical PolicyPA Medicaid11/15/2018
Pulmonary Rehabilitation Medical PolicyPA Medicaid 06/17/2019
Reconstructive Breast Surgery Medical PolicyPA Medicaid 06/17/2019
Supervised Exercise Therapy (SET) Medical PolicyPA Medicaid03/18/2019
Single Use ECG Monitoring (ZIO Patch) Medical PolicyPA Medicaid01/15/2019
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting Medical PolicyPA Medicaid03/18/2019
Testing for Genetic Disease Medical PolicyPA Medicaid01/15/2019
Ultrasound Bone Growth Stimulator Medical PolicyPA Medicaid03/18/2019
Wearable Cardioverter-Defibrillators in the Home Setting Medical PolicyPA Medicaid11/18/2019
Whole Exome and Whole Genome Genetic Testing Medical PolicyPA Medicaid03/18/2019
Ambulance – Ground Medical PolicyPA Medicaid5/6/2019
Ambulance – Air Medical PolicyPA Medicaid5/6/2019
MRgFUS Medical PolicyPA Medicaid5/6/2019
Labiaplasty Medical Policy PA Medicaid 5/20/2019
Prostate Cancer Genetic Testing Medical Policy PA Medicaid 12/09/2019
Upper Gastrointestinal Endoscopy Medical PolicyPA Medicaid08/12/2019
Vitamin D Deficiency Testing Medical PolicyPA Medicaid06/17/2019
Scanning Computerized Ophthalmic Imaging Medical PolicyPA Medicaid07/15/2019
Artificial Pancreas Medical PolicyPA Medicaid08/12/2019
Percutaneous Left Atrial Appendage Closure (LAAC) Medical PolicyPA Medicaid08/12/2019
Deep Brain Stimulation Medical PolicyPA Medicaid08/12/2019
Treatment of Obstructive Sleep Apnea Medical PolicyPA Medicaid11/18/2019
Electrical Stimulation for Oropharyngeal Dysphagia Medical PolicyPA Medicaid11/18/2019
Repetitive Transcranial Magnetic Stimulation Medical PolicyPA Medicaid11/18/2019
Oncologic Genetic Testing Panels Medical PolicyPA Medicaid11/18/2019
Cosmetic Procedures Medical Policy PA Medicaid 12/09/2019
Gastric Electrical Stimulation (GES) Medical Policy PA Medicaid 12/09/2019
Bronchial Valves Medical PolicyPA Medicaid12/09/2019
Exhaled Nitric Oxide Measurement in the Management of Respiratory Disorders Medical PolicyPA Medicaid12/09/2019