Medicare Medical Policy Search

Name	Type	State	Effective
Adcetris	Drug Policy	KY Medicare	07/15/2018
Adcetris	Drug Policy	OH Medicare	07/15/2018
Adcetris	Drug Policy	PA Medicare	07/15/2018
Alimta	Drug Policy	NC Medicare	07/15/2018
Alimta	Drug Policy	PA Medicare	07/15/2018
Ambulance (Ground)	Medical Policy	KY Medicare	09/15/2018
Ambulance (Ground)	Medical Policy	OH Medicare	09/15/2018
Ambulance Services (Air)	Medical Policy	KY 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
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
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	NC Medicare	05/20/2019
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	OH Medicare	05/20/2019
Assessing Suitability for Electrical Nerve Stimulation Therapy	Medical Policy	PA Medicare	05/20/2019
Automatic External Defibrillators	Medical Policy	NC Medicare	05/06/2019
Automatic External Defibrillators	Medical Policy	OH Medicare	05/06/2019
Automatic External Defibrillators	Medical Policy	PA Medicare	05/06/2019
Biomarkers Overview	Medical Policy	PA Medicare	12/15/2018
Botox	Drug Policy	NC Medicare	07/15/2018
Botox	Drug Policy	PA Medicare	07/15/2018
Brineura	Drug Policy	NC Medicare	02/18/2019
Brineura	Drug Policy	OH Medicare	02/18/2019
Brineura	Drug Policy	PA Medicare	02/18/2019
Bronchial Thermoplasty	Medical Policy	NC Medicare	07/15/2019
Bronchial Thermoplasty	Medical Policy	PA Medicare	07/15/2019
Bronchial Thermoplasty	Medical Policy	OH Medicare	07/15/2019
Cardiac Event Detection	Medical Policy	OH Medicare	03/18/2019
Cardiac Event Detection	Medical Policy	NC Medicare	03/18/2019
Cardiac Pacemaker Evaluation Services	Medical Policy	NC Medicare	03/18/2019
Cardiac Pacemaker Evaluation Services	Medical Policy	OH Medicare	03/18/2019
Cardiac Radionuclide Imaging	Medical Policy	NC Medicare	06/01/2018
Cardiac Rhythm Device Evaluation	Medical Policy	PA Medicare	03/18/2019
Carpal Tunnel	Medical Policy	KY Medicare	09/15/2018
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
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
Chromosomal Microarray	Medical Policy	KY Medicare	09/01/2018
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
Cochlear Implantation	Medical Policy	NC Medicare	05/20/2019
Cochlear Implantation	Medical Policy	OH Medicare	05/20/2019
Cochlear Implantation	Medical Policy	PA Medicare	05/20/2019
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	NC Medicare	06/17/2019
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	OH Medicare	06/17/2019
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicare	06/17/2019
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	NC Medicare	06/17/2019
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicare	06/17/2019
Custom Made Oral Appliances for Obstructive Sleep Apnea (OSA)	Medical Policy	OH Medicare	06/17/2019
CV Nuclear Medicine	Medical Policy	OH Medicare	07/15/2019
CV Nuclear Medicine	Medical Policy	PA Medicare	07/15/2019
Electrical Nerve Stimulator	Medical Policy	NC Medicare	05/06/2019
Electrical Nerve Stimulator	Medical Policy	OH Medicare	05/06/2019
Electrical Nerve Stimulator	Medical Policy	PA Medicare	05/06/2019
Electrocardiographic Services	Medical Policy	NC Medicare	05/06/2019
Electrocardiographic Services	Medical Policy	OH Medicare	05/06/2019
Electrocardiographic Services	Medical Policy	PA Medicare	05/06/2019
Esophagogastroduodenoscopy (EGD)	Medical Policy	KY Medicare	08/01/2018
Esophagogastroduodenoscopy (EGD)	Medical Policy	NC Medicare	08/01/2018
Esophagogastroduodenoscopy (EGD)	Medical Policy	OH Medicare	08/01/2018
Esophagogastroduodenoscopy (EGD)	Medical Policy	PA Medicare	08/01/2018
Exondys 51	Drug Policy	KY Medicare	07/15/2018
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
Faslodex	Drug Policy	KY Medicare	07/15/2018
Faslodex	Drug Policy	NC Medicare	07/15/2018
Faslodex	Drug Policy	OH Medicare	07/15/2018
Faslodex	Drug Policy	PA Medicare	07/15/2018
Fecal Transplant	Medical Policy	NC Medicare	02/18/2019
Fecal Transplant	Medical Policy	PA Medicare	02/18/2019
Fecal Transplant	Medical Policy	OH Medicare	02/18/2019
Fetal Aneuploidy	Medical Policy	NC Medicare	07/15/2018
Fetal Aneuploidy	Medical Policy	PA Medicare	10/01/2018
G-CSF	Drug Policy	OH Medicare	01/15/2019
G-CSF	Drug Policy	PA Medicare	01/15/2019
G-CSF	Drug Policy	NC Medicare	01/15/2019
Genetic Testing for Warfarin Therapy	Medical Policy	KY Medicare	06/01/2018
Genetic Testing for Warfarin Therapy	Medical Policy	NC Medicare	06/01/2018
Genetic Testing for Warfarin Therapy	Medical Policy	OH Medicare	06/01/2018
Genetic Testing for Warfarin Therapy	Medical Policy	PA Medicare	06/01/2018
Glucose Monitoring	Medical Policy	KY Medicare	09/01/2018
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
Herceptin	Drug Policy	PA Medicare	07/15/2018
Home Oxygen Therapy	Medical Policy	NC Medicare	01/15/2019
Home Oxygen Therapy	Medical Policy	OH Medicare	01/15/2019
Home Oxygen Therapy	Medical Policy	PA Medicare	01/15/2019
Hyperbaric Oxygen Therapy	Medical Policy	KY Medicare	02/15/2018
Hyperbaric Oxygen Therapy	Medical Policy	NC Medicare	12/15/2018
Hyperbaric Oxygen Therapy	Medical Policy	OH Medicare	12/15/2018
Hyperbaric Oxygen Therapy	Medical Policy	PA Medicare	12/15/2018
Implantable Automatic Defibrillators	Medical Policy	KY Medicare	04/15/2018
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
Implantable Cardioverter Defibrillator	Medical Policy	KY Medicare	04/15/2018
Implantable Cardioverter Defibrillator	Medical Policy	NC Medicare	04/15/2018
Implantable Cardioverter Defibrillator	Medical Policy	OH Medicare	04/15/2018
Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	04/15/2018
Interleukin-5 Inhibitors	Drug Policy	NC Medicare	01/15/2019
Interleukin-5 Inhibitors	Drug Policy	OH Medicare	01/15/2019
Interleukin-5 Inhibitors	Drug Policy	PA Medicare	01/15/2019
Keytruda	Drug Policy	PA Medicare	07/15/2018
Kyprolis	Drug Policy	PA Medicare	07/15/2018
Leadless Pacemaker	Medical Policy	NC Medicare	03/18/2019
Leadless Pacemaker	Medical Policy	OH Medicare	03/18/2019
Leadless Pacemaker	Medical Policy	PA Medicare	03/18/2019
MolDX: Molecular Diagnostic Tests	Medical Policy	NC Medicare	12/15/2018
MolDX: Molecular Diagnostic Tests	Medical Policy	OH Medicare	12/15/2018
Noninvasive Assessment of Liver Fibrosis	Medical Policy	KY Medicare	09/15/2017
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
Noninvasive Peripheral Venous Studies	Medical Policy	KY Medicare	06/01/2018
Noninvasive Peripheral Venous Studies	Medical Policy	OH Medicare	06/01/2018
Noninvasive Peripheral Venous Studies	Medical Policy	PA Medicare	06/17/2019
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
Ocrevus	Drug Policy	KY Medicare	07/15/2018
Ocrevus	Drug Policy	NC Medicare	07/15/2018
Ocrevus	Drug Policy	OH Medicare	07/15/2018
Ocrevus	Drug Policy	PA Medicare	07/15/2018
Opdivo	Drug Policy	PA Medicare	10/01/2018
Outpatient Sleep Studies	Medical Policy	PA Medicare	06/01/2018
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
Perjeta	Drug Policy	NC Medicare	07/15/2018
Perjeta	Drug Policy	PA Medicare	07/15/2018
Pharmacogenomic Testing for Warfarin Response	Medical Policy	PA Medicare	11/15/2018
Pharmacogenomic Testing for Warfarin Response	Medical Policy	KY Medicare	11/15/2018
Pharmacogenomic Testing for Warfarin Response	Medical Policy	NC Medicare	11/15/2018
Pharmacogenomic Testing for Warfarin Response	Medical Policy	OH Medicare	11/15/2018
Plethysmography	Medical Policy	NC Medicare	05/20/2019
Plethysmography	Medical Policy	OH Medicare	05/20/2019
Plethysmography	Medical Policy	PA Medicare	05/20/2019
Polysomnography and Other Sleep Studies	Medical Policy	PA Medicare	06/17/2019
Polysomnography and Other Sleep Studies	Medical Policy	NC Medicare	06/17/2019
Polysomnography and Other Sleep Studies	Medical Policy	OH Medicare	06/17/2019
Portrazza	Drug Policy	PA Medicare	07/15/2018
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
Remicade	Drug Policy	PA Medicare	02/18/2019
Rituxan	Drug Policy	PA Medicare	07/15/2018
Self-contained Cardiac Pacemakers	Medical Policy	NC Medicare	05/06/2019
Self-contained Cardiac Pacemakers	Medical Policy	OH Medicare	05/06/2019
Self-contained Cardiac Pacemakers	Medical Policy	PA Medicare	05/06/2019
Single and Dual Cardiac Pacemakers	Medical Policy	PA Medicare	03/18/2019
Single and Dual Cardiac Pacemakers	Medical Policy	NC Medicare	03/18/2019
Single and Dual Cardiac Pacemakers	Medical Policy	OH Medicare	03/18/2019
Soliris	Medical Policy	PA Medicare	11/15/2018
Soliris	Drug Policy	NC Medicare	01/15/2018
Spinal Cord Stimulation (Dorsal Column Stimulation)	Medical Policy	PA Medicare	05/06/2019
Spinal Cord Stimulators for Chronic Pain	Medical Policy	NC Medicare	06/01/2018
Spinraza	Drug Policy	KY Medicare	07/15/2018
Spinraza	Drug Policy	NC Medicare	07/15/2018
Spinraza	Drug Policy	OH Medicare	07/15/2018
Spinraza	Drug Policy	PA Medicare	07/15/2018
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	KY 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
Supervised Exercise Therapy for PAD	Medical Policy	NC Medicare	12/15/2018
Supervised Exercise Therapy for PAD	Medical Policy	OH Medicare	12/15/2018
Supervised Exercise Therapy for PAD	Medical Policy	PA Medicare	12/15/2018
Surveillance of Implantable or Wearable Cardioverter Defibrillators	Medical Policy	NC Medicare	03/18/2019
Surveillance of Implantable or Wearable Cardioverter Defibrillators	Medical Policy	OH Medicare	03/18/2019
Cardiac Event Detection Monitoring	Medical Policy	PA Medicare	03/18/2019
Testing of Genetic Disease	Medical Policy	PA Medicare	11/15/2018
TMS	Medical Policy	NC Medicare	05/20/2019
TMS	Medical Policy	OH Medicare	05/20/2019
TMS	Medical Policy	PA Medicare	05/20/2019
Transtelephonic Monitoring	Medical Policy	NC Medicare	05/06/2019
Transtelephonic Monitoring	Medical Policy	OH Medicare	05/06/2019
Tysabri	Drug Policy	KY 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
Velcade	Drug Policy	PA Medicare	01/15/2019
Velcade	Drug Policy	NC Medicare	01/15/2019
Vimizim	Drug Policy	KY 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
Xolair	Drug Policy	KY 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
Yervoy	Drug Policy	KY Medicare	07/15/2018
Yervoy	Drug Policy	OH Medicare	07/15/2018
Yervoy	Drug Policy	PA Medicare	07/15/2018
Scanning Computerized Ophthalmic Screening	Drug Policy	PA Medicare	07/15/2019
Scanning Computerized Ophthalmic Screening	Drug Policy	OH Medicare	07/15/2019
Scanning Computerized Ophthalmic Screening	Drug Policy	NC Medicare	07/15/2019