Medicaid Medical Policy Archive Search

Name	Type	State	Effective
Ambulatory Blood Pressure Monitors	Medical Policy	PA Medicaid	09/16/2019
Bariatric Surgery	Medical Policy	PA Medicaid	05/06/2019
BCR-ABL1 Genetic Testing in Leukemia	Medical Policy	PA Medicaid	03/16/2020
BRAF	Medical Policy	PA Medicaid	10/21/2019
BRCA1 & BRCA2 Genetic Testing	Medical Policy	PA Medicaid	06/17/2019
Bronchial Thermoplasty	Medical Policy	PA Medicaid	03/16/2020
Capsule Endoscopy	Medical Policy	PA Medicaid	03/16/2020
Carpal Tunnel Syndrome	Medical Policy	PA Medicaid	06/17/2019
Chromosomal Microarray Analysis	Medical Policy	PA Medicaid	03/16/2020
Cochlear Implants	Medical Policy	PA Medicaid	05/06/2019
Colorectal Cancer Screening	Medical Policy	PA Medicaid	04/13/2020
Continuous Glucose Monitoring	Medical Policy	PA Medicaid	06/17/2019
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicaid	09/16/2019
Electrical Bone Growth Stimulators for the Spine	Medical Policy	PA Medicaid	05/06/2019
Enteral Feeding In-line Cartridge	Medical Policy	PA Medicaid	07/15/2019
Fecal Microbiota Transplant	Medical Policy	PA Medicaid	10/21/2019
Fetal Aneuploidy	Medical Policy	PA Medicaid	08/12/2019
Gender Transition Services	Medical Policy	PA Medicaid	05/06/2019
Genetic Testing for Colorectal Cancer Susceptibility	Medical Policy	PA Medicaid	11/18/2019
Genetic Testing for Cystic Fibrosis	Medical Policy	PA Medicaid	01/20/2020
Genetic Testing for Warfarin	Medical Policy	PA Medicaid	08/12/2019
Home Oxygen Therapy (HOT)	Medical Policy	PA Medicaid	10/21/2019
Hyperbaric Oxygen Therapy (HBOT)	Medical Policy	PA Medicaid	12/09/2019
Hypoglossal Nerve Stimulator	Medical Policy	PA Medicaid	03/16/2020
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator	Medical Policy	PA Medicaid	08/12/2019
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules	Medical Policy	PA Medicaid	10/21/2019
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC)	Medical Policy	PA Medicaid	09/16/2019
Myoelectric Upper Extremity Orthoses	Medical Policy	PA Medicaid	02/17/2020
Negative Pressure Wound Therapy in the Outpatient Setting	Medical Policy	PA Medicaid	03/16/2020
Non-Oncologic Genetic Testing Panels	Medical Policy	PA Medicaid	11/18/2019
Noninvasive Electrical Bone Growth Stimulators	Medical Policy	PA Medicaid	01/20/2020
Noninvasive Positive Pressure Intermittent Ventilation (NPPV)	Medical Policy	PA Medicaid	01/20/2020
Oncotype DX	Medical Policy	PA Medicaid	12/09/2019
Panniculectomy	Medical Policy	PA Medicaid	03/16/2020
Passive Oscillatory Devices in the Outpatient Setting	Medical Policy	PA Medicaid	01/20/2020
Place of Service	Medical Policy	PA Medicaid	01/20/2020
Pulmonary Rehabilitation	Medical Policy	PA Medicaid	04/13/2020
Reconstructive Breast Surgery	Medical Policy	PA Medicaid	06/17/2019
Supervised Exercise Therapy (SET)	Medical Policy	PA Medicaid	02/17/2020
Single Use ECG Monitoring (ZIO Patch)	Medical Policy	PA Medicaid	01/20/2020
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting	Medical Policy	PA Medicaid	03/16/2020
Testing for Genetic Disease	Medical Policy	PA Medicaid	01/20/2020
Ultrasound Bone Growth Stimulator	Medical Policy	PA Medicaid	03/16/2020
Wearable Cardioverter-Defibrillators in the Home Setting	Medical Policy	PA Medicaid	11/18/2019
Whole Exome and Whole Genome Genetic Testing	Medical Policy	PA Medicaid	03/16/2020
Ambulance – Ground	Medical Policy	PA Medicaid	04/13/2020
Ambulance – Air	Medical Policy	PA Medicaid	04/13/2020
MRgFUS	Medical Policy	PA Medicaid	5/6/2019
Prostate Cancer Genetic Testing	Medical Policy	PA Medicaid	12/09/2019
Upper Gastrointestinal Endoscopy	Medical Policy	PA Medicaid	08/12/2019
Vitamin D Deficiency Testing	Medical Policy	PA Medicaid	06/17/2019
Treatment of Obstructive Sleep Apnea	Medical Policy	PA Medicaid	11/18/2019
Electrical Stimulation for Oropharyngeal Dysphagia	Medical Policy	PA Medicaid	11/18/2019
Repetitive Transcranial Magnetic Stimulation	Medical Policy	PA Medicaid	11/18/2019
Oncologic Genetic Testing Panels	Medical Policy	PA Medicaid	11/18/2019
Cosmetic Procedures	Medical Policy	PA Medicaid	12/09/2019
Gastric Electrical Stimulation (GES)	Medical Policy	PA Medicaid	12/09/2019
Bronchial Valves	Medical Policy	PA Medicaid	12/09/2019
Exhaled Nitric Oxide Measurement in the Management of Respiratory Disorders	Medical Policy	PA Medicaid	12/09/2019
Breast Scintimammography	Medical Policy	PA Medicaid	01/20/2020
DXA for Vertebral Fracture Assessment	Medical Policy	PA Medicaid	01/20/2020
Minimally Invasive Lumbar Decompression	Medical Policy	PA Medicaid	3/16/2020
Prostatic Urethral Lift	Medical Policy	PA Medicaid	3/16/2020
Multimarker Serum Testing for Ovarian Cancer	Medical Policy	PA Medicaid	3/16/2020
Speech Generating Devices	Medical Policy	PA Medicaid	3/16/2020
Gender Transition Services	Medical Policy	PA Medicaid	04/13/2020
Bariatric Surgery	Medical Policy	PA Medicaid	05/18/2020
Electrical Bone Growth Stimulators for the Spine	Medical Policy	PA Medicaid	05/18/2020
Reconstructive Breast Surgery	Medical Policy	PA Medicaid	06/17/2019
Cardiac Rehabilitation	Medical Policy	PA Medicaid	07/15/2019
Artificial Pancreas	Medical Policy	PA Medicaid	08/12/2019
Percutaneous Left Atrial Appendage Closure (LAAC)	Medical Policy	PA Medicaid	08/12/2019
Deep Brain Stimulation	Medical Policy	PA Medicaid	08/12/2019
Scanning Computerized Ophthalmic Imaging	Medical Policy	PA Medicaid	07/15/2019
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicaid	09/16/2019
Fecal Microbiota Transplant	Medical Policy	PA Medicaid	10/21/2019
Home Oxygen Therapy (HOT)	Medical Policy	PA Medicaid	10/21/2019
Ambulance Services – Ground	Medical Policy	PA Medicaid	4/13/2020
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC)	Medical Policy	PA Medicaid	09/16/2019
Vitamin D Deficiency Testing	Medical Policy	PA Medicaid	06/17/2019
Upper Gastrointestinal Endoscopy	Medical Policy	PA Medicaid	08/12/2019