Medicare Medical Policy Search

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Name	Type	State	Effective
Adcetris	Drug Policy	KY Medicare	07/15/2018
Adcetris	Drug Policy	OH Medicare	07/15/2018
Alimta	Drug Policy	NC Medicare	07/15/2018
Ambulance (Ground)	Medical Policy	OH Medicare	09/16/2019
Ambulance Services (Air)	Medical Policy	OH Medicare	09/16/2019
Ambulance Services (Air/Ground)	Medical Policy	NC Medicare	09/16/2019
Ambulance Services (Ground) (L35162)	Medical Policy	PA Medicare	09/07/2020
Ambulance Services(Air)	Medical Policy	PA Medicare	09/07/2020
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 (NCD 20.19)	Medical Policy	PA Medicare	09/07/2020
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	04/13/2020
Biomarkers Overview	Medical Policy	PA Medicare	12/09/2019
Botox (OnabotulinumtoxinA) Injections	Drug Policy	PA Medicare	09/07/2020
Brineura	Drug Policy	NC Medicare	09/16/2019
Brineura	Drug Policy	OH Medicare	09/16/2019
Bronchial Thermoplasty	Medical Policy	NC Medicare	07/15/2019
Bronchial Thermoplasty	Medical Policy	PA Medicare	07/27/2020
Bronchial Thermoplasty	Medical Policy	OH Medicare	07/15/2019
Cardiac Event Detection Monitoring	Medical Policy	OH Medicare	03/18/2019
Cardiac Event Detection Monitoring	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	03/16/2020
Carpal Tunnel	Medical Policy	NC Medicare	09/16/2019
Carpal Tunnel	Medical Policy	OH Medicare	09/16/2019
Carpal Tunnel	Medical Policy	PA Medicare	09/07/2020
Cataract Extraction	Medical Policy	PA Medicare	04/13/2020
Cataract Extraction	Medical Policy	NC Medicare	07/15/2019
Cataract Extraction	Medical Policy	OH Medicare	07/15/2019
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) (L35062)	Medical Policy	PA Medicare	08/17/2020
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP)	Medical Policy	NC Medicare	08/12/2019
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP)	Medical Policy	OH Medicare	08/12/2019
Cochlear Implantation	Medical Policy	NC Medicare	05/20/2019
Cochlear Implantation	Medical Policy	OH Medicare	05/20/2019
Cochlear Implantation	Medical Policy	PA Medicare	05/18/2020
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
CV Nuclear Medicine	Medical Policy	OH Medicare	07/15/2019
Electrical Nerve Stimulator	Medical Policy	NC Medicare	05/06/2019
Electrical Nerve Stimulator	Medical Policy	OH 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	04/13/2020
Esophagogastroduodenoscopy (EGD)	Medical Policy	NC Medicare	08/01/2018
Esophagogastroduodenoscopy (EGD)	Medical Policy	OH Medicare	08/01/2018
Esophagogastroduodenoscopy (EGD)	Medical Policy	PA Medicare	03/16/2020
Exondys 51	Drug Policy	NC Medicare	10/21/2019
Exondys 51	Drug Policy	OH Medicare	10/21/2019
Faslodex	Drug Policy	NC Medicare	07/15/2018
Faslodex	Drug Policy	OH Medicare	07/15/2018
Fecal Transplant	Medical Policy	NC Medicare	02/18/2019
Fecal Transplant	Medical Policy	PA Medicare	02/17/2020
Fecal Transplant	Medical Policy	OH Medicare	02/18/2019
G-CSF	Drug Policy	OH Medicare	01/15/2019
G-CSF	Drug Policy	NC Medicare	01/15/2019
Glucose Monitoring	Medical Policy	NC Medicare	08/12/2019
Glucose Monitoring	Medical Policy	OH Medicare	08/12/2019
Glucose Monitoring	Medical Policy	PA Medicare	08/17/2020
Home Oxygen Therapy	Medical Policy	NC Medicare	01/15/2019
Home Oxygen Therapy	Medical Policy	OH Medicare	01/15/2019
Home Oxygen Therapy (L33797)	Medical Policy	PA Medicare	09/07/2020
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	12/09/2019
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	01/20/2020
Leadless Pacemaker	Medical Policy	NC Medicare	03/18/2019
Leadless Pacemaker	Medical Policy	OH Medicare	03/18/2019
Leadless Pacemaker	Medical Policy	PA Medicare	03/16/2020
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	NC Medicare	08/12/2019
Noninvasive Assessment of Liver Fibrosis	Medical Policy	OH Medicare	08/12/2019
Noninvasive Venous Studies	Medical Policy	KY Medicare	06/01/2018
Noninvasive Venous Studies	Medical Policy	OH 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
Perjeta	Drug Policy	NC Medicare	07/15/2018
Pharmacogenomic Testing for Warfarin Response	Medical Policy	PA Medicare	11/18/2019
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
Outpatient Sleep Studies	Medical Policy	PA Medicare	07/27/2020
Outpatient Sleep Studies	Medical Policy	NC Medicare	06/17/2019
Outpatient Sleep Studies	Medical Policy	OH Medicare	06/17/2019
Pulmonary Rehabilitation	Medical Policy	NC Medicare	07/15/2019
Pulmonary Rehabilitation	Medical Policy	OH Medicare	07/15/2019
Remicade	Drug Policy	PA Medicare	02/17/2020
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	04/13/2020
Single and Dual Cardiac Pacemakers	Medical Policy	PA Medicare	03/16/2020
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	Drug Policy	NC Medicare	01/15/2018
Spinal Cord Stimulation (Dorsal Column Stimulation)	Medical Policy	PA Medicare	04/13/2020
Spinal Cord Stimulators for Chronic Pain	Medical Policy	NC Medicare	06/01/2018
Spinraza	Drug Policy	NC Medicare	10/21/2019
Spinraza	Drug Policy	OH Medicare	10/21/2019
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	NC Medicare	09/16/2019
Subcutaneous Implantable Cardioverter Defibrillator	Medical Policy	OH Medicare	09/16/2019
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	12/09/2019
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	03/16/2020
Testing of Genetic Disease	Medical Policy	PA Medicare	10/19/2020
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depression	Medical Policy	NC Medicare	05/20/2019
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depression	Medical Policy	OH Medicare	05/20/2019
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depression	Medical Policy	PA Medicare	05/18/2020
Transtelephonic Monitoring	Medical Policy	NC Medicare	05/06/2019
Transtelephonic Monitoring	Medical Policy	OH Medicare	05/06/2019
Tysabri	Drug Policy	NC Medicare	10/21/2019
Tysabri	Drug Policy	OH Medicare	10/21/2019
Velcade	Drug Policy	PA Medicare	01/20/2020
Velcade	Drug Policy	NC Medicare	01/15/2019
Vimizim	Drug Policy	NC Medicare	10/21/2019
Vimizim	Drug Policy	OH Medicare	10/21/2019
Xolair	Drug Policy	KY Medicare	07/15/2018
Xolair	Drug Policy	NC Medicare	10/21/2019
Xolair	Drug Policy	OH Medicare	10/21/2019
Xolair	Drug Policy	PA Medicare	08/17/2020
Yervoy	Drug Policy	KY Medicare	07/15/2018
Yervoy	Drug Policy	OH Medicare	07/15/2018
Scanning Computerized Ophthalmic Diagnostic Imaging	Medical Policy	OH Medicare	07/15/2019
Scanning Computerized Ophthalmic Diagnostic Imaging	Medical Policy	NC Medicare	07/15/2019
Vitamin D Deficiency	Medical Policy	PA Medicare	06/22/2020
Panniculectomy, Abdominoplasty/ Lipectomy	Medical Policy	PA Medicare	08/17/2020
Vitamin D Deficiency	Medical Policy	OH Medicare	08/12/2019
Panniculectomy, Abdominoplasty/ Lipectomy	Medical Policy	OH Medicare	08/12/2019
Vitamin D Deficiency	Medical Policy	NC Medicare	08/12/2019
Panniculectomy, Abdominoplasty/ Lipectomy	Medical Policy	NC Medicare	08/12/2019
Observation Care (Hospital Outpatient)	Medical Policy	PA Medicare	10/19/2020
Negative Pressure Wound Therapy (NPWT) Pumps (L33821)	Medical Policy	PA Medicare	10/19/2020
Negative Pressure Wound Therapy	Medical Policy	OH Medicare	10/21/2019
Negative Pressure Wound Therapy	Medical Policy	NC Medicare	10/21/2019
Implantable Cardioverter Defibrillator	Medical Policy	PA Medicare	12/09/2019
Noninvasive Vascular Studies	Medical Policy	OH Medicare	10/21/2019
Ocrevus	Medical Policy	NC Medicare	10/21/2019
Ocrevus	Medical Policy	OH Medicare	10/21/2019
Implantable Cardioverter Defibrillator	Medical Policy	NC Medicare	10/21/2019
Implantable Cardioverter Defibrillator	Medical Policy	OH Medicare	10/21/2019
Botox	Medical Policy	NC Medicare	10/21/2019
Speech Generating Devices	Medical Policy	PA Medicare	02/17/2020
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
Gastrointestinal Pathogens Panels	Medical Policy	PA Medicare	04/13/2020
Hypoglossal Stimulation for the Treatment of Obstructive Sleep Apnea	Medical Policy	PA Medicare	04/13/2020
Pulmonary Rehabilitation	Medical Policy	PA Medicare	07/27/2020
CPAP for Obstructive Sleep Apnea (OSA)	Medical Policy	PA Medicare	07/27/2020
Percutaneous Transluminal Angioplasty (PTA)	Medical Policy	PA Medicare	07/27/2020
Non-Invasive Peripheral Venous Studies (L35451)	Medical Policy	PA Medicare	07/27/2020
Scanning Computerized Ophthalmic Diagnostic Imaging	Medical Policy	PA Medicare	07/27/2020
Acupuncture for Chronic Low Back Pain (NCD 30.3.3)	Medical Policy	PA Medicare	08/17/2020