Medicaid Medical Policy Archive Search

Name	Type	State	Effective
Bariatric Surgery	Medical Policy	PA Medicaid	08/01/2018
Bariatric Surgery	Medical Policy	PA Medicaid	07/05/2016
Bariatric Surgery	Medical Policy	PA Medicaid	04/15/2018
BCR-ABL1 Genetic Testing in Leukemia	Medical Policy	PA Medicaid	10/01/2016
BCR-ABL1 Genetic Testing in Leukemia	Medical Policy	PA Medicaid	04/15/2018
BRAF	Medical Policy	PA Medicaid	12/01/2017
BRCA1 & BRCA2 Genetic Testing	Medical Policy	PA Medicaid	08/01/2016
BRCA1 & BRCA2 Genetic Testing	Medical Policy	PA Medicaid	04/15/2018
Bronchial Thermoplasty	Medical Policy	PA Medicaid	07/19/2017
Bronchial Thermoplasty	Medical Policy	PA Medicaid	04/15/2018
Capsule Endoscopy	Medical Policy	PA Medicaid	05/01/2017
Capsule Endoscopy	Medical Policy	PA Medicaid	03/01/2017
Capsule Endoscopy	Medical Policy	PA Medicaid	04/15/2018
Cardiac Rehabilitation	Medical Policy	PA Medicaid	09/15/2017
Carpal Tunnel Syndrome	Medical Policy	PA Medicaid	07/19/2017
Chromosomal Microarray Analysis	Medical Policy	PA Medicaid	10/01/2016
Colorectal Cancer Screening	Medical Policy	PA Medicaid	04/15/2018
Colorectal Cancer Screening	Medical Policy	PA Medicaid	08/01/2017
Continuous Glucose Monitoring	Medical Policy	PA Medicaid	09/15/2017
Continuous Glucose Monitoring	Medical Policy	PA Medicaid	05/01/2017
Continuous Glucose Monitoring	Medical Policy	PA Medicaid	05/01/2018
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea(OSA)	Medical Policy	PA Medicaid	05/01/2017
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicaid	04/15/2018
Enteral Feeding In-line Cartridge	Medical Policy	PA Medicaid	07/19/2017
Esophagogastroduodenoscopy (EGD)	Medical Policy	PA Medicaid	08/01/2018
Fecal Microbiota Transplant	Medical Policy	PA Medicaid	02/15/2018
Fetal Aneuploidy	Medical Policy	PA Medicaid	08/15/2017
Fetal Aneuploidy	Medical Policy	PA Medicaid	07/16/2016
G-CSF	DrugPolicy	PA Medicaid	09/15/2017
Gender Transition Services	Medical Policy	PA Medicaid	12/01/2016
Genetic Testing for Cystic Fibrosis	Medical Policy	PA Medicaid	04/14/2016
Genetic Testing for Warfarin	Medical Policy	PA Medicaid	12/01/2017
Home Oxygen Therapy (HOT)	Medical Policy	PA Medicaid	12/01/2017
Hyperbaric Oxygen Therapy (HBOT)	Medical Policy	PA Medicaid	02/15/2018
Hyperbaric Oxygen Therapy (HBOT)	Medical Policy	PA Medicaid	07/05/2016
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator	Medical Policy	PA Medicaid	04/15/2018
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator	Medical Policy	PA Medicaid	07/19/2017
Interleukin-5 Inhibitors	DrugPolicy	PA Medicaid	12/01/2017
Interleukin-5 Inhibitors	DrugPolicy	PA Medicaid	12/01/2016
Macular Degeneration	Medical Policy	PA Medicaid	10/01/2017
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules	Medical Policy	PA Medicaid	12/01/2017
Molecular Tumor Markers NSCLC	Medical Policy	PA Medicaid	12/01/2017
Negative Pressure Wound Therapy in the Outpatient Setting	Medical Policy	PA Medicaid	12/01/2016
Negative Pressure Wound Therapy in the Outpatient Setting	Medical Policy	PA Medicaid	04/15/2018
Non-oncologic genetic testing panels	Medical Policy	PA Medicaid	11/15/2018
Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C	Medical Policy	PA Medicaid	04/15/2018
Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C	Medical Policy	PA Medicaid	06/02/2016
Noninvasive Positive Pressure Intermittent Ventilation (NPPV)	Medical Policy	PA Medicaid	04/15/2018
Noninvasive Positive Pressure Intermittent Ventilation (NPPV)	Medical Policy	PA Medicaid	07/05/2016
Ocrevus	DrugPolicy	PA Medicaid	08/01/2017
Oncotype DX	Medical Policy	PA Medicaid	04/15/2018
Oncotype DX	Medical Policy	PA Medicaid	07/05/2016
Panniculectomy	Medical Policy	PA Medicaid	05/01/2017
Panniculectomy	Medical Policy	PA Medicaid	04/15/2018
Passive Oscillatory Devices in the Outpatient Setting	Medical Policy	PA Medicaid	12/01/2016
Place of Service	Medical Policy	PA Medicaid	10/01/2017
Place of Service	Medical Policy	PA Medicaid	06/15/2016
Pulmonary Rehabilitation	Medical Policy	PA Medicaid	09/15/2017
Reconstructive Breast Surgery	Medical Policy	PA Medicaid	07/19/2017
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting	Medical Policy	PA Medicaid	05/01/2017
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting	Medical Policy	PA Medicaid	04/15/2018
Soliris	DrugPolicy	PA Medicaid	07/01/2016
Wearable Cardioverter-Defibrillator in Home Setting	Medical Policy	PA Medicaid	02/15/2018
Wearable Cardioverter-Defibrillator in Home Setting	Medical Policy	PA Medicaid	04/20/2016
Whole Exome and Whole Genome Genetic Testing	Medical Policy	PA Medicaid	06/01/2016
Whole Exome and Whole Genome Genetic Testing	Medical Policy	PA Medicaid	04/15/2018
Bariatric Surgery	Medical Policy	PA Medicaid	08/01/2018
Cochlear Implants	Medical Policy	PA Medicaid	06/01/2018
Colorectal Cancer Screening	Medical Policy	PA Medicaid	08/01/2018
Gender Transition Services	Medical Policy	PA Medicaid	09/01/2018
Electrical Bone Growth Stimulators for the Spine	Medical Policy	PA Medicaid	04/15/2018
Chromosomal Microarray Analysis	Medical Policy	PA Medicaid	04/15/2018
Reconstructive Breast Surgery	Medical Policy	PA Medicaid	09/01/2018
Carpal Tunnel Syndrome	Medical Policy	PA Medicaid	09/01/2018
Pulmonary Rehabilitation	Medical Policy	PA Medicaid	07/15/2018
BRCA1 & BRCA2 Genetic Testing	Medical Policy	PA Medicaid	03/18/2019
Continuous Glucose Monitoring	Medical Policy	PA Medicaid	03/18/2019
Enteral Feeding In-line Cartridge	Medical Policy	PA Medicaid	09/01/2018
Cardiac Rehabilitation	Medical Policy	PA Medicaid	09/01/2018