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	11/18/2019
Alimta	Drug Policy	NC Medicare	07/15/2018
Alimta	Drug Policy	PA Medicare	11/18/2019
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)	Medical Policy	PA Medicare	09/16/2019
Ambulance Services(Air)	Medical Policy	PA Medicare	09/16/2019
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
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	12/09/2019
Botox	Drug Policy	PA Medicare	10/21/2019
Brineura	Drug Policy	NC Medicare	09/16/2019
Brineura	Drug Policy	OH Medicare	09/16/2019
Brineura	Drug Policy	PA Medicare	09/16/2019
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	NC Medicare	09/16/2019
Carpal Tunnel	Medical Policy	OH Medicare	09/16/2019
Carpal Tunnel	Medical Policy	PA Medicare	09/16/2019
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	PA Medicare	08/12/2019
Chromosomal Microarray	Medical Policy	NC Medicare	08/12/2019
Chromosomal Microarray	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	05/20/2019
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
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
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	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	NC Medicare	10/21/2019
Exondys 51	Drug Policy	OH Medicare	10/21/2019
Exondys 51	Drug Policy	PA Medicare	10/21/2019
Faslodex	Drug Policy	NC Medicare	07/15/2018
Faslodex	Drug Policy	OH Medicare	07/15/2018
Faslodex	Drug Policy	PA Medicare	11/18/2019
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	PA Medicare	01/20/2020
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	08/12/2019
Herceptin	Drug Policy	PA Medicare	11/18/2019
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	01/20/2020
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
Keytruda	Drug Policy	PA Medicare	11/18/2019
Kyprolis	Drug Policy	PA Medicare	11/18/2019
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	NC Medicare	08/12/2019
Noninvasive Assessment of Liver Fibrosis	Medical Policy	OH Medicare	08/12/2019
Noninvasive Assessment of Liver Fibrosis	Medical Policy	PA Medicare	08/12/2019
Noninvasive Venous Studies	Medical Policy	KY Medicare	06/01/2018
Noninvasive Venous Studies	Medical Policy	OH Medicare	06/01/2018
Noninvasive Venous Studies	Medical Policy	PA Medicare	06/17/2019
Ocrevus	Medical Policy	PA Medicare	10/21/2019
Opdivo	Drug Policy	PA Medicare	10/21/2019
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
Perjeta	Drug Policy	NC Medicare	07/15/2018
Perjeta	Drug Policy	PA Medicare	11/18/2019
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
Plethysmography	Medical Policy	PA Medicare	05/20/2019
Outpatient Sleep Studies	Medical Policy	PA Medicare	06/17/2019
Outpatient Sleep Studies	Medical Policy	NC Medicare	06/17/2019
Outpatient Sleep Studies	Medical Policy	OH Medicare	06/17/2019
Portrazza	Drug Policy	PA Medicare	11/18/2019
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
Remicade	Drug Policy	PA Medicare	02/17/2020
Rituxan	Drug Policy	PA Medicare	11/18/2019
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	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	03/18/2019
Testing of Genetic Disease	Medical Policy	PA Medicare	10/21/2019
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	NC Medicare	10/21/2019
Tysabri	Drug Policy	OH Medicare	10/21/2019
Tysabri	Drug Policy	PA 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
Vimizim	Drug Policy	PA 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	10/21/2019
Yervoy	Drug Policy	KY Medicare	07/15/2018
Yervoy	Drug Policy	OH Medicare	07/15/2018
Yervoy	Drug Policy	PA Medicare	11/18/2019
Scanning Computerized Ophthalmic Screening	Medical Policy	PA Medicare	07/15/2019
Scanning Computerized Ophthalmic Screening	Medical Policy	OH Medicare	07/15/2019
Scanning Computerized Ophthalmic Screening	Medical Policy	NC Medicare	07/15/2019
Vitamin D Deficiency	Medical Policy	PA Medicare	08/12/2019
Panniculectomy, Abdominoplasty/ Lipectomy	Medical Policy	PA Medicare	08/12/2019
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	10/01/2019
Negative Pressure Wound Therapy	Medical Policy	PA Medicare	10/21/2019
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
Spinraza	Medical Policy	PA 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	2/17/2020