Medicare Retired Medical Policy Search

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Name	Type	State	Effective
Fetal Aneuploidy	Medical Policy	KY Medicare	07/15/18
Fetal Aneuploidy	Medical Policy	OH Medicare	07/15/18
Fetal Aneuploidy	Medical Policy	KY Medicare	08/01/17
Fetal Aneuploidy	Medical Policy	OH Medicare	08/01/17
Fetal Aneuploidy	Medical Policy	PA Medicare	07/15/18
Fetal Aneuploidy	Medical Policy	NC Medicare	08/01/17
Fetal Aneuploidy	Medical Policy	PA Medicare	08/01/17
Genetic Testing for Colorectal Cancer Susceptibility	Medical Policy	KY Medicare	10/01/17
Genetic Testing for Colorectal Cancer Susceptibility	Medical Policy	NC Medicare	10/01/17
Genetic Testing for Colorectal Cancer Susceptibility	Medical Policy	OH Medicare	10/01/17
Genetic Testing for Colorectal Cancer Susceptibility	Medical Policy	PA Medicare	10/01/17
Perjeta	Medical Policy	KY Medicare	09/15/18
Perjeta	Medical Policy	OH Medicare	09/15/18
Perjeta	Drug Policy	KY Medicare	05/01/17
Perjeta	Drug Policy	OH Medicare	05/01/17
Testing for Genetic Disease	Medical Policy	KY Medicare	11/15/18
Testing for Genetic Disease	Medical Policy	NC Medicare	11/15/18
Testing for Genetic Disease	Medical Policy	OH Medicare	11/15/18
Testing of Genetic Disease	Medical Policy	KY Medicare	12/01/17
Testing of Genetic Disease	Medical Policy	NC Medicare	12/01/17
Testing of Genetic Disease	Medical Policy	OH Medicare	12/01/17
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	KY Medicare	11/15/18
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	NC Medicare	11/15/18
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	PA Medicare	11/15/18
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	OH Medicare	11/15/18
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	KY Medicare	10/01/17
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	NC Medicare	10/01/17
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	OH Medicare	10/01/17
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	PA Medicare	10/01/17
Velcade	Drug Policy	OH Medicare	01/15/2019
G-CSF	Drug Policy	KY Medicare	01/15/2019
Interleukin-5 Inhibitors	Drug Policy	KY Medicare	01/15/2019
Velcade	Drug Policy	KY Medicare	01/15/2019
Home Oxygen Therapy	Medical Policy	KY Medicare	01/15/2019
Brineura	Drug Policy	KY Medicare	02/18/2019
Fecal Transplant	Medical Policy	KY Medicare	02/18/2019
Self-contained Cardiac Pacemakers	Medical Policy	KY Medicare	05/06/2019
Transtelephonic Monitoring	Medical Policy	KY Medicare	05/06/2019
Automatic External Defibrillators	Medical Policy	KY Medicare	05/06/2019
Electrocardiographic Services	Medical Policy	KY Medicare	05/06/2019
Electrical Nerve Stimulator	Medical Policy	KY Medicare	05/06/2019
Cochlear Implantation	Medical Policy	KY Medicare	05/20/2019
Plethysmography	Medical Policy	KY Medicare	05/20/2019
TMS	Medical Policy	KY Medicare	05/20/2019
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	KY Medicare	05/20/2019
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	KY Medicare	06/17/2019
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	KY Medicare	06/17/2019
Polysomnography and Other Sleep Studies	Medical Policy	KY Medicare	06/17/2019
Pulmonary Rehabilitation	Medical Policy	KY Medicare	07/15/2019
CV Nuclear Medicine	Medical Policy	KY Medicare	07/15/2019
Percutaneous Transluminal Angioplasty (PTA)	Medical Policy	KY Medicare	07/15/2019
Ambulatory Blood Pressure Monitors	Medical Policy	KY Medicare	07/15/2019
Cataract Extraction	Medical Policy	KY Medicare	07/15/2019
Bronchial Thermoplasty	Medical Policy	KY Medicare	07/15/2019
Noninvasive Assessment of Liver Fibrosis	Medical Policy	KY Medicare	08/12/2019
Chromosomal Microarray	Medical Policy	KY Medicare	08/12/2019
Glucose Monitoring	Medical Policy	KY Medicare	08/12/2019
Carpal Tunnel	Medical Policy	KY Medicare	09/16/2019
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	KY Medicare	09/16/2019
Ambulance (Ground)	Medical Policy	KY Medicare	09/16/2019
Ambulance Services (Air)	Medical Policy	KY Medicare	09/16/2019
Exondys 51	Drug Policy	KY Medicare	09/16/2019
Tysabri	Drug Policy	KY Medicare	09/16/2019
Faslodex	Drug Policy	KY Medicare	09/16/2019
Vimizim	Drug Policy	KY Medicare	09/16/2019
Spinraza	Drug Policy	PA Medicare	10/01/2018
Fetal Aneuploidy	Medical Policy	PA Medicare	10/21/2019
Fetal Aneuploidy	Medical Policy	NC Medicare	10/21/2019
Implantable Automatic Defibrillators	Medical Policy	KY Medicare	10/21/2019
Spinraza	Drug Policy	KY Medicare	11/18/2019
Hyperbaric Oxygen Therapy	Medical Policy	KY Medicare	11/18/2019
Genetic Testing for Warfarin Therapy	Medical Policy	KY Medicare	11/18/2019
Implantable Cardioverter Defibrillator	Medical Policy	KY Medicare	11/18/2019
Upper Gastrointestinal Endoscopy	Medical Policy	KY Medicare	11/18/2019
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	12/09/2019
CV Nuclear Medicine	Medical Policy	PA Medicare	01/20/2020
Noninvasive Liver Assessment	Medical Policy	PA Medicare	03/16/2020
Electrical Stimulators	Medical Policy	PA Medicare	03/16/2020
Faslodex	Drug Policy	PA Medicare	04/13/2020
Herceptin	Drug Policy	PA Medicare	04/13/2020
G-CSF	Drug Policy	PA Medicare	04/13/2020
Adcetris	Drug Policy	PA Medicare	04/13/2020
Kyprolis	Drug Policy	PA Medicare	04/13/2020
Yervoy	Drug Policy	PA Medicare	04/13/2020
Keytruda	Drug Policy	PA Medicare	04/13/2020
Portrazza	Drug Policy	PA Medicare	04/13/2020
Opdivo	Drug Policy	PA Medicare	04/13/2020
Perjeta	Drug Policy	PA Medicare	04/13/2020
Alimta	Drug Policy	PA Medicare	04/13/2020
Plethysmography	Medical Policy	PA Medicare	05/18/2020
ADAKVEO	Medical Policy	PA Medicare	07/01/2020
Exondys 51	Drug Policy	PA Medicare	07/01/2020
Tysabri	Drug Policy	PA Medicare	07/01/2020
Vimizim	Drug Policy	PA Medicare	07/01/2020
Spinraza	Medical Policy	PA Medicare	07/01/2020
Ocrevus	Medical Policy	PA Medicare	07/01/2020
Rituxan	Drug Policy	PA Medicare	07/01/2020
Brineura	Drug Policy	PA Medicare	07/01/2020
Soliris	Medical Policy	PA Medicare	07/01/2020
Interleukin-5 Inhibitors	Drug Policy	PA Medicare	01/01/2021
Xolair	Drug Policy	PA Medicare	01/01/2021
Velcade	Drug Policy	PA Medicare	01/01/2021
Botox (OnabotulinumtoxinA) Injections	Drug Policy	PA Medicare	01/01/2021
Remicade	Drug Policy	PA Medicare	01/01/2021

Gateway Health Policy Disclaimer

The Policies neither constitutes nor substitutes for medical advice. Gateway Health’s Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of Gateway Health. If members have a specific question about their medical condition, they should consult with their provider.
In the event of a conflict between the Policy and Member Handbook or Evidence of Coverage, the express terms of the Member Handbook or Evidence of Coverage will govern. The existence of a medical guideline is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the medical guideline. The Policies are used in making decisions as to medical necessity only and they do not guarantee payment of services. Policies serve as one of the sets of guidelines for coverage decisions.
The information on this website may not reflect a recent policy change or all of the applicable medical guidelines.