Medicare Medical Policy Archive Search

Name	Type	State	Effective
Automatic External Defibrillator	Medical Policy	KY Medicare	04/15/2018
Botox	Drug Policy	NC Medicare	08/01/17
Botox	Drug Policy	PA Medicare	08/01/17
Bronchial Thermoplasty	Medical Policy	KY Medicare	08/01/17
Bronchial Thermoplasty	Medical Policy	NC Medicare	08/01/17
Bronchial Thermoplasty	Medical Policy	OH Medicare	08/01/17
Bronchial Thermoplasty	Medical Policy	PA Medicare	08/01/17
Cardiac Pacemaker Evaluation Services	Medical Policy	PA Medicare	04/15/18
Carpal Tunnel	Medical Policy	KY Medicare	09/15/17
Carpal Tunnel	Medical Policy	NC Medicare	09/15/17
Carpal Tunnel	Medical Policy	OH Medicare	09/15/17
Carpal Tunnel	Medical Policy	PA Medicare	09/15/17
Cataract Extraction	Medical Policy	KY Medicare	01/01/17
Cataract Extraction	Medical Policy	NC Medicare	01/01/17
Cataract Extraction	Medical Policy	OH Medicare	01/01/17
Cataract Extraction	Medical Policy	PA Medicare	01/01/17
Chromosomal Microarray	Medical Policy	KY Medicare	12/01/17
Chromosomal Microarray	Medical Policy	OH Medicare	12/01/17
Chromosomal Microarray	Medical Policy	PA Medicare	12/01/17
Cochlear Implantation	Medical Policy	KY Medicare	04/15/18
Exondys 51	Drug Policy	KY Medicare	05/01/17
Exondys 51	Drug Policy	NC Medicare	05/01/17
Exondys 51	Drug Policy	PA Medicare	05/01/17
Exondys 51	Drug Policy	OH Medicare	05/01/17
Faslodex	Drug Policy	KY Medicare	05/01/17
Faslodex	Drug Policy	NC Medicare	05/01/17
Faslodex	Drug Policy	OH Medicare	05/01/17
Faslodex	Drug Policy	PA Medicare	05/01/17
G-CSF	Drug Policy	KY Medicare	05/01/2017
G-CSF	Drug Policy	NC Medicare	05/01/2017
G-CSF	Drug Policy	OH Medicare	05/01/17
G-CSF	Drug Policy	PA Medicare	05/01/2017
Herceptin	Drug Policy	PA Medicare	08/01/2017
Hyperbaric Oxygen Therapy	Medical Policy	NC Medicare	02/15/18
Hyperbaric Oxygen Therapy	Medical Policy	OH Medicare	02/15/18
Hyperbaric Oxygen Therapy	Medical Policy	PA Medicare	02/15/18
Interleukin-5 Inhibitors	Drug Policy	KY Medicare	05/01/17
Interleukin-5 Inhibitors	Drug Policy	NC Medicare	05/01/17
Interleukin-5 Inhibitors	Drug Policy	OH Medicare	05/01/17
Interleukin-5 Inhibitors	Drug Policy	PA Medicare	05/01/17
Keytruda	Drug Policy	PA Medicare	08/01/17
Kyprolis	Drug Policy	PA Medicare	08/01/17
Ocrevus	Drug Policy	KY Medicare	08/01/17
Ocrevus	Drug Policy	NC Medicare	08/01/17
Ocrevus	Drug Policy	OH Medicare	08/01/17
Ocrevus	Drug Policy	PA Medicare	08/01/17
Opdivo	Drug Policy	PA Medicare	07/15/18
Opdivo	Drug Policy	PA Medicare	05/01/17
Outpatient Sleep Studies	Medical Policy	PA Medicare	06/01/2018
Perjeta	Drug Policy	PA Medicare	08/01/17
Perjeta	Drug Policy	NC Medicare	05/01/17
Portrazza	Drug Policy	PA Medicare	07/19/17
Pulmonary Rehabilitation	Medical Policy	KY Medicare	12/01/17
Pulmonary Rehabilitation	Medical Policy	NC Medicare	12/01/17
Pulmonary Rehabilitation	Medical Policy	OH Medicare	12/01/17
Pulmonary Rehabilitation	Medical Policy	PA Medicare	12/01/17
Remicade	Drug Policy	PA Medicare	08/01/17
Rituxan	Drug Policy	PA Medicare	08/01/17
Soliris	Medical Policy	PA Medicare	11/15/18
Soliris	Drug Policy	PA Medicare	01/15/18
Soliris	Drug Policy	NC Medicare	07/19/17
Soliris	Drug Policy	PA Medicare	07/19/17
Spinraza	Drug Policy	KY Medicare	07/19/17
Spinraza	Drug Policy	NC Medicare	07/19/17
Spinraza	Drug Policy	OH Medicare
Spinraza	Drug Policy	PA Medicare	07/19/17
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	KY Medicare	09/15/17
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	NC Medicare	09/15/17
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	OH Medicare	09/15/17
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	09/15/17
Supervised Exercise Therapy for PAD	Medical Policy	NC Medicare	12/15/2018
Supervised Exercise Therapy for PAD	Medical Policy	OH Medicare	12/15/2018
Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs)	Medical Policy	PA Medicare	04/15/18
Testing of Genetic Disease	Medical Policy	PA Medicare	12/01/17
Tysabri	Drug Policy	KY Medicare	05/01/17
Tysabri	Drug Policy	NC Medicare	05/01/17
Tysabri	Drug Policy	OH Medicare	05/01/17
Tysabri	Drug Policy	PA Medicare	05/01/17
Velcade	Drug Policy	KY Medicare	07/19/17
Velcade	Drug Policy	OH Medicare	07/19/17
Velcade	Drug Policy	PA Medicare	07/19/17
Vimizim	Drug Policy	KY Medicare	05/01/17
Vimizim	Drug Policy	NC Medicare	05/01/17
Vimizim	Drug Policy	OH Medicare	05/01/17
Vimizim	Drug Policy	PA Medicare	05/01/17
Xolair	Drug Policy	KY Medicare	05/01/17
Xolair	Drug Policy	NC Medicare	05/01/17
Xolair	Drug Policy	OH Medicare	05/01/17
Xolair	Drug Policy	PA Medicare	05/01/17
Yervoy	Drug Policy	KY Medicare	05/01/17
Yervoy	Drug Policy	OH Medicare	05/01/17
Yervoy	Drug Policy	PA Medicare	05/01/17
Self-contained Cardiac Pacemakers	Medical Policy	PA Medicare	04/15/2018
Automatic External Defibrillators	Medical Policy	PA Medicare	04/15/2018
Electrocardiographic Services	Medical Policy	PA Medicare	06/01/2018
Electrical Nerve Stimulator	Medical Policy	PA Medicare	04/15/2018
Spinal Cord Stimulation (Dorsal Column Stimulation)	Medical Policy	PA Medicare	06/01/2018
Self-contained Cardiac Pacemakers	Medical Policy	OH Medicare	04/15/2018
Transtelephonic Monitoring	Medical Policy	OH Medicare	04/15/2018
Automatic External Defibrillators	Medical Policy	OH Medicare	04/15/2018
Electrocardiographic Services	Medical Policy	OH Medicare	06/01/2018
Electrical Nerve Stimulator	Medical Policy	OH Medicare	04/15/2018
Self-contained Cardiac Pacemakers	Medical Policy	NC Medicare	04/15/2018
Transtelephonic Monitoring	Medical Policy	NC Medicare	04/15/2018
Automatic External Defibrillators	Medical Policy	NC Medicare	04/15/2018
Electrocardiographic Services	Medical Policy	NC Medicare	06/01/2018
Electrical Nerve Stimulator	Medical Policy	NC Medicare	04/15/2018
Cochlear Implantation	Medical Policy	NC Medicare	04/15/2018
Cochlear Implantation	Medical Policy	OH Medicare	04/15/2018
Cochlear Implantation	Medical Policy	PA Medicare	04/15/2018
Plethysmography	Medical Policy	NC Medicare	04/15/2018
Plethysmography	Medical Policy	OH Medicare	04/15/2018
Plethysmography	Medical Policy	PA Medicare	04/15/2018
TMS	Medical Policy	NC Medicare	04/15/2018
TMS	Medical Policy	OH Medicare	04/15/2018
TMS	Medical Policy	PA Medicare	04/15/2018
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	NC Medicare	04/15/2018
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	OH Medicare	04/15/2018
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	PA Medicare	04/15/2018
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	NC Medicare	06/01/2018
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicare	06/01/2018
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	OH Medicare	06/01/2018
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	NC Medicare	06/01/2018
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	OH Medicare	06/01/2018
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicare	06/01/2018
Polysomnography and Other Sleep Studies	Medical Policy	NC Medicare	06/01/2018
Polysomnography and Other Sleep Studies	Medical Policy	OH Medicare	06/01/2018
Noninvasive Peripheral Venous Studies	Medical Policy	PA Medicare	06/01/2018
Polysomnography and Other Sleep Studies	Medical Policy	PA Medicare	06/01/2018
Cataract Extraction	Medical Policy	PA Medicare	07/15/2019
Cataract Extraction	Medical Policy	NC Medicare	07/15/2019
Cataract Extraction	Medical Policy	OH Medicare	07/15/2019
Brineura	Drug Policy	OH Medicare	07/15/2019
Brineura	Drug Policy	PA Medicare	07/15/2019
Bronchial Thermoplasty	Medical Policy	NC Medicare	07/15/2019
Pulmonary Rehabilitation	Medical Policy	NC Medicare	07/15/2019
Pulmonary Rehabilitation	Medical Policy	OH Medicare	07/15/2019
Pulmonary Rehabilitation	Medical Policy	PA Medicare	07/15/2019
CV Nuclear Medicine	Medical Policy	OH Medicare	07/15/2019
CV Nuclear Medicine	Medical Policy	PA Medicare	07/15/2019
Cardiac Radionuclide Imaging	Medical Policy	NC Medicare	07/15/2019
Percutaneous Transluminal Angioplasty (PTA)	Medical Policy	NC Medicare	07/15/2019
Percutaneous Transluminal Angioplasty (PTA)	Medical Policy	OH Medicare	07/15/2019
Percutaneous Transluminal Angioplasty (PTA)	Medical Policy	PA Medicare	07/15/2019
Ambulatory Blood Pressure Monitors	Medical Policy	NC Medicare	07/15/2019
Ambulatory Blood Pressure Monitors	Medical Policy	OH Medicare	07/15/2019
Ambulatory Blood Pressure Monitors	Medical Policy	PA Medicare	07/15/2019
Cataract Removal Reimbursement Policy	Medical Policy	PA Medicare	07/15/2018
Cataract Removal Questionnaire	Medical Policy	PA Medicare	07/15/2018
Glucose Monitoring	Medical Policy	NC Medicare	09/01/2018
Glucose Monitoring	Medical Policy	OH Medicare	09/01/2018
Glucose Monitoring	Medical Policy	PA Medicare	09/01/2018
Noninvasive Assessment of Liver Fibrosis	Medical Policy	NC Medicare	09/15/2017
Noninvasive Assessment of Liver Fibrosis	Medical Policy	OH Medicare	09/15/2017
Noninvasive Assessment of Liver Fibrosis	Medical Policy	PA Medicare	09/15/2017
Chromosomal Microarray	Medical Policy	PA Medicare	09/01/2018
Chromosomal Microarray	Medical Policy	NC Medicare	12/01/2017
Chromosomal Microarray	Medical Policy	OH Medicare	09/01/2018
Carpal Tunnel	Medical Policy	NC Medicare	09/15/2018
Carpal Tunnel	Medical Policy	OH Medicare	09/15/2018
Carpal Tunnel	Medical Policy	PA Medicare	09/15/2018
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	NC Medicare	09/15/2018
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	OH Medicare	09/15/2018
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	09/15/2018
Brineura	Drug Policy	NC Medicare	02/18/2019
Brineura	Drug Policy	OH Medicare	02/18/2019
Brineura	Drug Policy	PA Medicare	02/18/2019
Ambulance (Ground)	Medical Policy	OH Medicare	09/15/2018
Ambulance Services (Air)	Medical Policy	OH Medicare	09/15/2018
Ambulance Services (Ground)	Medical Policy	NC Medicare	09/15/2018
Ambulance Services (Ground)	Medical Policy	PA Medicare	09/15/2018
Ambulance Services(Air)	Medical Policy	PA Medicare	09/15/2018
Implantable Automatic Defibrillators	Medical Policy	NC Medicare	04/15/2018
Implantable Automatic Defibrillators	Medical Policy	OH Medicare	04/15/2018
Implantable Automatic Defibrillators	Medical Policy	PA Medicare	04/15/2018
Noninvasive Technique for the Evaluation of Liver Fibrosis	Medical Policy	OH Medicare	09/01/2018
Noninvasive Technique for the Evaluation of Liver Fibrosis	Medical Policy	KY Medicare	09/01/2018
Noninvasive Technique for the Evaluation of Liver Fibrosis	Medical Policy	NC Medicare	09/01/2018
Noninvasive Technique for the Evaluation of Liver Fibrosis	Medical Policy	PA Medicare	09/01/2018
Spinraza	Drug Policy	NC Medicare	07/15/2018
Spinraza	Drug Policy	OH Medicare	07/15/2018
Botox	Drug Policy	PA Medicare	07/15/2018
Opdivo	Drug Policy	PA Medicare	10/01/2018
Testing of Genetic Disease	Medical Policy	PA Medicare	11/15/2018
Exondys 51	Drug Policy	NC Medicare	07/15/2018
Exondys 51	Drug Policy	OH Medicare	07/15/2018
Exondys 51	Drug Policy	PA Medicare	07/15/2018
Ocrevus	Drug Policy	PA Medicare	07/15/2018
Xolair	Drug Policy	NC Medicare	07/15/2018
Xolair	Drug Policy	OH Medicare	07/15/2018
Xolair	Drug Policy	PA Medicare	07/15/2018
Vimizim	Drug Policy	NC Medicare	07/15/2018
Vimizim	Drug Policy	OH Medicare	07/15/2018
Vimizim	Drug Policy	PA Medicare	07/15/2018
Tysabri	Drug Policy	NC Medicare	07/15/2018
Tysabri	Drug Policy	OH Medicare	07/15/2018
Tysabri	Drug Policy	PA Medicare	07/15/2018
Ocrevus	Drug Policy	KY Medicare	07/15/2018
Ocrevus	Drug Policy	NC Medicare	07/15/2018
Ocrevus	Drug Policy	OH Medicare	07/15/2018
Botox	Drug Policy	NC Medicare	07/15/2018
Adcetris	Drug Policy	PA Medicare	07/15/2018
Portrazza	Drug Policy	PA Medicare	07/15/2018
Alimta	Drug Policy	PA Medicare	07/15/2018
Herceptin	Drug Policy	PA Medicare	07/15/2018
Keytruda	Drug Policy	PA Medicare	07/15/2018
Kyprolis	Drug Policy	PA Medicare	07/15/2018
Rituxan	Drug Policy	PA Medicare	07/15/2018
Pharmacogenomic Testing for Warfarin Response	Medical Policy	PA Medicare	11/15/2018
Faslodex	Drug Policy	PA Medicare	07/15/2018
Perjeta	Drug Policy	PA Medicare	07/15/2018
Yervoy	Drug Policy	PA Medicare	07/15/2018
Hyperbaric Oxygen Therapy	Medical Policy	PA Medicare	12/15/2018
Biomarkers Overview	Medical Policy	PA Medicare	12/15/2018
Supervised Exercise Therapy for PAD	Medical Policy	PA Medicare	12/15/2018
Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	10/21/2019
G-CSF	Drug Policy	PA Medicare	01/20/2020
Interleukin-5 Inhibitors	Drug Policy	PA Medicare	01/20/2020
Velcade	Drug Policy	PA Medicare	01/20/2020
Home Oxygen Therapy	Medical Policy	PA Medicare	01/20/2020
Remicade	Drug Policy	PA Medicare	02/17/2020
Fecal Transplant	Medical Policy	PA Medicare	02/17/2020
Facility Emergency Department Policy	Medical Payment Policy	PA Medicare	12/31/2019
Soliris	Medical Policy	PA Medicare	03/16/2020
Cardiac Rhythm Device Evaluation	Medical Policy	PA Medicare	03/16/2020
Single and Dual Cardiac Pacemakers	Medical Policy	PA Medicare	03/16/2020
Cataract Extraction	Medical Policy	PA Medicare	04/13/2020
Automatic External Defibrillators	Medical Policy	PA Medicare	04/13/2020
Spinal Cord Stimulation (Dorsal Column Stimulation)	Medical Policy	PA Medicare	04/13/2020
Electrocardiographic Services	Medical Policy	PA Medicare	04/13/2020
Cochlear Implantation	Medical Policy	PA Medicare	05/18/2020
Vitamin D Deficiency	Medical Policy	PA Medicare	08/12/2019
Pulmonary Rehabilitation	Medical Policy	PA Medicare	07/27/2019
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicare	06/17/2019
Percutaneous Transluminal Angioplasty (PTA)	Medical Policy	PA Medicare	07/15/2019
Noninvasive Venous Studies	Medical Policy	PA Medicare	06/17/2019
Scanning Computerized Ophthalmic Screening	Medical Policy	PA Medicare	07/15/2019
Xolair	Drug Policy	PA Medicare	07/15/2018
Panniculectomy, Abdominoplasty/ Lipectomy	Medical Policy	PA Medicare	08/12/2019
Carpal Tunnel	Medical Policy	PA Medicare	09/16/2019
Home Oxygen Therapy	Medical Policy	PA Medicare	01/20/2020
Ambulatory Blood Pressure Monitors	Medical Policy	PA Medicare	07/15/2019
Ambulance Services(Air)	Medical Policy	PA Medicare	09/16/2019
Negative Pressure Wound Therapy	Medical Policy	PA Medicare	10/21/2019
Observation Care (Hospital Outpatient)	Medical Policy	PA Medicare	10/01/2019
Testing of Genetic Disease	Medical Policy	PA Medicare	10/21/2019
Pharmacogenomic Testing for Warfarin Response	Medical Policy	PA Medicare	11/18/2019
Biomarkers Overview	Medical Policy	PA Medicare	12/09/2019
Hyperbaric Oxygen Therapy	Medical Policy	NC Medicare	12/15/2018
Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	12/09/2019
Supervised Exercise Therapy for PAD	Medical Policy	NC Medicare	12/15/2018
Cochlear Implantation	Medical Policy	PA Medicare	05/18/2020
Acupuncture for Chronic Low Back Pain (NCD 30.3.3)	Medical Policy	PA Medicare	08/17/2020
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	PA Medicare	05/20/2019
Fecal Transplant	Medical Policy	PA Medicare	02/17/2020
Speech Generating Devices	Medical Policy	PA Medicare	02/17/2020
Oral Appliances for Obstructive Sleep Apnea	Medical Policy	PA Medicare	06/19/2019
Leadless Pacemaker	Medical Policy	OH Medicare	03/18/2019
Cardiac Event Detection Monitoring	Medical Policy	PA Medicare	03/16/2020
Esophagogastroduodenoscopy (EGD)	Medical Policy	PA Medicare	03/16/2020
4Kscore	Medical Policy	PA Medicare	03/16/2020
Micro-Invasive Glaucoma Surgery (MIGS)	Medical Policy	PA Medicare	03/16/2020
Peripheral Nerve Stimulation	Medical Policy	PA Medicare	03/16/2020
Cardiac Rhythm Device Evaluation	Medical Policy	PA Medicare	03/16/2020
Single and Dual Cardiac Pacemakers	Medical Policy	PA Medicare	03/16/2020
Glucose Monitoring	Medical Policy	PA Medicare	08/17/2020