| 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 |
| 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 |
| Oncotype DX | Medical Policy | PA Medicaid | 07/25/2018 |
| Fetal Aneuploidy | Medical Policy | PA Medicaid | 09/15/2018 |
| Macular Degeneration | Medical Policy | PA Medicaid | 09/15/2018 |
| Genetic Testing for Warfarin | Medical Policy | PA Medicaid | 09/15/2018 |
| Upper Gastrointestinal Endoscopy | Medical Policy | PA Medicaid | 05/20/2019 |
| Implantable Cardioverter-Defibrillator/ Subcutaneous Implantable Cardioverter-Defibrillator | Medical Policy | PA Medicaid | 03/18/2019 |
| Custom-Made Oral Appliances in the Treatment of Obstructive Sleep Apnea (OSA) | Medical Policy | PA Medicaid | 03/18/2019 |
| Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) | Medical Policy | PA Medicaid | 09/15/2018 |
| Ambulatory Blood Pressure Monitors | Medical Policy | PA Medicaid | 07/15/2018 |
| BRAF | Medical Policy | PA Medicaid | 10/01/2018 |
| Molecular Markers for Fine Needle Aspirates of Thyroid Nodules | Medical Policy | PA Medicaid | 10/01/2018 |
| Fecal Microbiota Transplant | Medical Policy | PA Medicaid | 11/15/2018 |
| Home Oxygen Therapy (HOT) | Medical Policy | PA Medicaid | 12/15/2018 |
| Genetic Testing for Colorectal Cancer Susceptibility | Medical Policy | PA Medicaid | 11/15/2018 |
| Non-Oncologic Genetic Testing Panels | Medical Policy | PA Medicaid | 11/15/2018 |
| Oncologic Genetic Testing Panels | Medical Policy | PA Medicaid | 12/15/2018 |
| Wearable Cardioverter-Defibrillators in the Home Setting | Medical Policy | PA Medicaid | 12/15/2018 |
| Oncotype DX | Medical Policy | PA Medicaid | 12/15/2018 |
| Hyperbaric Oxygen Therapy (HBOT) | Medical Policy | PA Medicaid | 12/15/2018 |
| Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C | Medical Policy | PA Medicaid | 01/15/2019 |
| Prostate Cancer Genetic Testing |
Medical Policy |
PA Medicaid |
5/20/2019 |
| Noninvasive Positive Pressure Intermittent Ventilation (NPPV) | Medical Policy | PA Medicaid | 01/20/2020 |
| Genetic Testing for Cystic Fibrosis | Medical Policy | PA Medicaid | 01/20/2020 |
| Testing for Genetic Disease | Medical Policy | PA Medicaid | 01/20/2020 |
| Place of Service | Medical Policy | PA Medicaid | 01/20/2020 |
| Passive Oscillatory Devices in the Outpatient Setting | Medical Policy | PA Medicaid | 01/20/2020 |
| Single Use ECG Monitoring (ZIO Patch) | Medical Policy | PA Medicaid | 01/20/2020 |
| Noninvasive Electrical Bone Growth Stimulators | Medical Policy | PA Medicaid | 01/20/2020 |
| Myoelectric Upper Extremity Orthoses | Medical Policy | PA Medicaid | 02/17/2020 |
| Supervised Exercise Therapy (SET) | Medical Policy | PA Medicaid | 02/17/2020 |