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Medicaid Medical Policy Archive Search



Name
Type
State
Effective
Bariatric Surgery Medical PolicyPA Medicaid08/01/2018
Bariatric Surgery Medical PolicyPA Medicaid07/05/2016
Bariatric Surgery Medical PolicyPA Medicaid04/15/2018
BCR-ABL1 Genetic Testing in Leukemia Medical PolicyPA Medicaid10/01/2016
BCR-ABL1 Genetic Testing in Leukemia Medical PolicyPA Medicaid04/15/2018
BRAF Medical PolicyPA Medicaid12/01/2017
BRCA1 & BRCA2 Genetic Testing Medical PolicyPA Medicaid08/01/2016
BRCA1 & BRCA2 Genetic Testing Medical PolicyPA Medicaid04/15/2018
Bronchial Thermoplasty Medical PolicyPA Medicaid07/19/2017
Bronchial Thermoplasty Medical PolicyPA Medicaid04/15/2018
Capsule Endoscopy Medical PolicyPA Medicaid05/01/2017
Capsule Endoscopy Medical PolicyPA Medicaid03/01/2017
Capsule Endoscopy Medical PolicyPA Medicaid04/15/2018
Cardiac Rehabilitation Medical PolicyPA Medicaid09/15/2017
Carpal Tunnel Syndrome Medical PolicyPA Medicaid07/19/2017
Chromosomal Microarray Analysis Medical PolicyPA Medicaid10/01/2016
Colorectal Cancer Screening Medical PolicyPA Medicaid04/15/2018
Colorectal Cancer Screening Medical PolicyPA Medicaid08/01/2017
Continuous Glucose Monitoring Medical PolicyPA Medicaid09/15/2017
Continuous Glucose Monitoring Medical PolicyPA Medicaid05/01/2017
Continuous Glucose Monitoring Medical PolicyPA Medicaid05/01/2018
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea(OSA) Medical PolicyPA Medicaid05/01/2017
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA) Medical PolicyPA Medicaid04/15/2018
Enteral Feeding In-line Cartridge Medical PolicyPA Medicaid07/19/2017
Esophagogastroduodenoscopy (EGD) Medical PolicyPA Medicaid08/01/2018
Fecal Microbiota Transplant Medical PolicyPA Medicaid02/15/2018
Fetal Aneuploidy Medical PolicyPA Medicaid08/15/2017
Fetal Aneuploidy Medical PolicyPA Medicaid07/16/2016
G-CSF DrugPolicyPA Medicaid09/15/2017
Gender Transition Services Medical PolicyPA Medicaid12/01/2016
Genetic Testing for Cystic Fibrosis Medical PolicyPA Medicaid04/14/2016
Genetic Testing for Warfarin Medical PolicyPA Medicaid12/01/2017
Home Oxygen Therapy (HOT) Medical PolicyPA Medicaid12/01/2017
Hyperbaric Oxygen Therapy (HBOT) Medical PolicyPA Medicaid02/15/2018
Hyperbaric Oxygen Therapy (HBOT) Medical PolicyPA Medicaid07/05/2016
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator Medical PolicyPA Medicaid04/15/2018
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator Medical PolicyPA Medicaid07/19/2017
Interleukin-5 Inhibitors DrugPolicyPA Medicaid12/01/2017
Interleukin-5 Inhibitors DrugPolicyPA Medicaid12/01/2016
Macular Degeneration Medical PolicyPA Medicaid10/01/2017
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules Medical PolicyPA Medicaid12/01/2017
Molecular Tumor Markers NSCLC Medical PolicyPA Medicaid12/01/2017
Negative Pressure Wound Therapy in the Outpatient Setting Medical PolicyPA Medicaid12/01/2016
Negative Pressure Wound Therapy in the Outpatient Setting Medical PolicyPA Medicaid04/15/2018
Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C Medical PolicyPA Medicaid04/15/2018
Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C Medical PolicyPA Medicaid06/02/2016
Noninvasive Positive Pressure Intermittent Ventilation (NPPV) Medical PolicyPA Medicaid04/15/2018
Noninvasive Positive Pressure Intermittent Ventilation (NPPV) Medical PolicyPA Medicaid07/05/2016
Ocrevus DrugPolicyPA Medicaid08/01/2017
Oncotype DX Medical PolicyPA Medicaid04/15/2018
Oncotype DX Medical PolicyPA Medicaid07/05/2016
Panniculectomy Medical PolicyPA Medicaid05/01/2017
Panniculectomy Medical PolicyPA Medicaid04/15/2018
Passive Oscillatory Devices in the Outpatient Setting Medical PolicyPA Medicaid12/01/2016
Place of Service Medical PolicyPA Medicaid10/01/2017
Place of Service Medical PolicyPA Medicaid06/15/2016
Pulmonary Rehabilitation Medical PolicyPA Medicaid09/15/2017
Reconstructive Breast Surgery Medical PolicyPA Medicaid07/19/2017
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting Medical PolicyPA Medicaid05/01/2017
Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting Medical PolicyPA Medicaid04/15/2018
Soliris DrugPolicyPA Medicaid07/01/2016
Wearable Cardioverter-Defibrillator in Home Setting Medical PolicyPA Medicaid02/15/2018
Wearable Cardioverter-Defibrillator in Home Setting Medical PolicyPA Medicaid04/20/2016
Whole Exome and Whole Genome Genetic Testing Medical PolicyPA Medicaid06/01/2016
Whole Exome and Whole Genome Genetic Testing Medical PolicyPA Medicaid04/15/2018
Bariatric Surgery Medical PolicyPA Medicaid08/01/2018
Cochlear Implants Medical PolicyPA Medicaid06/01/2018
Colorectal Cancer Screening Medical PolicyPA Medicaid08/01/2018
Gender Transition Services Medical PolicyPA Medicaid09/01/2018
Electrical Bone Growth Stimulators for the Spine Medical PolicyPA Medicaid04/15/2018
Chromosomal Microarray Analysis Medical PolicyPA Medicaid04/15/2018
Reconstructive Breast Surgery Medical PolicyPA Medicaid09/01/2018
Carpal Tunnel Syndrome Medical PolicyPA Medicaid09/01/2018
Pulmonary Rehabilitation Medical PolicyPA Medicaid07/15/2018
BRCA1 & BRCA2 Genetic Testing Medical PolicyPA Medicaid03/18/2019
Continuous Glucose Monitoring Medical PolicyPA Medicaid03/18/2019
Enteral Feeding In-line Cartridge Medical PolicyPA Medicaid09/01/2018
Cardiac Rehabilitation Medical PolicyPA Medicaid09/01/2018
Oncotype DX Medical PolicyPA Medicaid07/25/2018
Fetal Aneuploidy Medical PolicyPA Medicaid09/15/2018
Macular Degeneration Medical PolicyPA Medicaid09/15/2018
Genetic Testing for Warfarin Medical PolicyPA Medicaid09/15/2018
Upper Gastrointestinal Endoscopy Medical PolicyPA Medicaid05/20/2019
Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator Medical PolicyPA Medicaid03/18/2019
Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA) Medical PolicyPA Medicaid03/18/2019
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) Medical PolicyPA Medicaid09/15/2018
Ambulatory Blood Pressure Monitors Medical PolicyPA Medicaid07/15/2018
BRAF Medical PolicyPA Medicaid10/01/2018
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules Medical PolicyPA Medicaid10/01/2018
Fecal Microbiota Transplant Medical PolicyPA Medicaid11/15/2018
Home Oxygen Therapy (HOT) Medical PolicyPA Medicaid12/15/2018
Genetic Testing for Colorectal Cancer Susceptibility Medical PolicyPA Medicaid11/15/2018
Non-Oncologic Genetic Testing Panels Medical PolicyPA Medicaid11/15/2018
Oncologic Genetic Testing Panels Medical PolicyPA Medicaid12/15/2018
Wearable Cardioverter-Defibrillators in the Home Setting Medical PolicyPA Medicaid12/15/2018