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 Patient’s Suitability for Electrical Nerve Stimulation Therapy (160.7.1 & 160.7)	Medical Policy	PA Medicare	02/15/2021
Automatic External Defibrillators	Medical Policy	NC Medicare	05/06/2019
Automatic External Defibrillators	Medical Policy	OH Medicare	05/06/2019
Automatic External Defibrillators(AED) (1.33690)	Medical Policy	PA Medicare	04/19/2021
Biomarkers Overview (L35062)	Medical Policy	PA Medicare	12/21/2020
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 (L34833)	Medical Policy	PA Medicare	03/15/2021
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 (including Complex Cataract Surgery)	Medical Policy	PA Medicare	04/19/2021
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 (NCD 50.3)	Medical Policy	PA Medicare	05/17/2021
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(NCD 20.15)	Medical Policy	PA Medicare	04/19/2021
Esophagogastroduodenoscopy (EGD)	Medical Policy	NC Medicare	08/01/2018
Esophagogastroduodenoscopy (EGD)	Medical Policy	OH Medicare	08/01/2018
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)(L35350)	Medical Policy	PA Medicare	03/15/2021
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 Microbiota Transplant	Medical Policy	PA Medicare	02/15/2021
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	03/15/2021
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 (NCD 20.29)	Medical Policy	NC Medicare	12/21/2020
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
Leadless Pacemaker	Medical Policy	NC Medicare	03/18/2019
Leadless Pacemaker	Medical Policy	OH Medicare	03/18/2019
Leadless Pacemaker (NCD 20.8.4)	Medical Policy	PA Medicare	03/15/2021
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 (NCD 90.1)	Medical Policy	PA Medicare	11/16/2020
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
Self-contained Cardiac Pacemakers	Medical Policy	NC Medicare	05/06/2019
Self-contained Cardiac Pacemakers	Medical Policy	OH Medicare	05/06/2019
Self-Contained Pacemaker Monitors (NCD 20.82)	Medical Policy	PA Medicare	04/19/2021
Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (NCD 20.8.3)	Medical Policy	PA Medicare	03/15/2021
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)(1.35450)	Medical Policy	PA Medicare	04/19/2021
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 (SET) for Symptomatic Peripheral Artery Disease (PAD) (NCD 20.35)	Medical Policy	NC Medicare	12/21/2020
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 (L34953)	Medical Policy	PA Medicare	03/15/2021
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 (LCD 34998)	Medical Policy	PA Medicare	05/17/2021
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	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
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 (NCD 20.4)	Medical Policy	PA Medicare	12/21/2020
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 (L33739)	Medical Policy	PA Medicare	02/15/2021
4Kscore Test Algorithm(L37792)	Medical Policy	PA Medicare	03/15/2021
Micro-Invasive Glaucoma Surgery (MIGS)(L38223)	Medical Policy	PA Medicare	03/15/2021
Peripheral Nerve Stimulation(L37360)(160.7)	Medical Policy	PA Medicare	03/15/2021
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (1.38229)	Medical Policy	PA Medicare	04/19/2021
Hypoglossal Stimulation for the Treatment of Obstructive Sleep Apnea	Medical Policy	PA Medicare	04/13/2020
Pulmonary Rehabilitation	Medical Policy	PA Medicare	05/17/2021
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	01/01/2021
Implantable Continuous Glucose Monitors (I-CGM) (L38617)	Medical Policy	PA Medicare	01/18/2021
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495)	Medical Policy	PA Medicare	01/18/2021
Blood Glucose Testing (NCD 190.20)	Medical Policy	PA Medicare	02/15/2021
Oral Appliances for Obstructive Sleep Apnea (L33611)	Medical Policy	PA Medicare	02/15/2021
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (1.38385)	Medical Policy	PA Medicare	04/19/2021