Medicare Medical Policy Search



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Name
Type
State
Effective
Adcetris Drug PolicyKY Medicare07/15/2018
Adcetris Drug PolicyOH Medicare07/15/2018
Alimta Drug PolicyNC Medicare07/15/2018
Ambulance (Ground) Medical PolicyOH Medicare09/16/2019
Ambulance Services (Air) Medical PolicyOH Medicare09/16/2019
Ambulance Services (Air/Ground) Medical PolicyNC Medicare 09/16/2019
Ambulance Services (Ground) (L35162) Medical PolicyPA Medicare 09/07/2020
Ambulance Services(Air) Medical PolicyPA Medicare09/07/2020
Ambulatory Blood Pressure Monitors Medical PolicyNC Medicare07/15/2019
Ambulatory Blood Pressure Monitors Medical PolicyOH Medicare07/15/2019
Ambulatory Blood Pressure Monitors (NCD 20.19) Medical PolicyPA Medicare09/07/2020
Assessing Suitability for Electrical Nerve Stimulation Therapy Medical PolicyNC Medicare05/20/2019
Assessing Suitability for Electrical Nerve Stimulation Therapy Medical PolicyOH Medicare05/20/2019
Assessing Patient’s Suitability for Electrical Nerve Stimulation Therapy (160.7.1 & 160.7) Medical PolicyPA Medicare02/15/2021
Automatic External Defibrillators Medical PolicyNC Medicare 05/06/2019
Automatic External Defibrillators Medical PolicyOH Medicare 05/06/2019
Automatic External Defibrillators(AED) (1.33690) Medical PolicyPA Medicare 04/19/2021
Biomarkers Overview (L35062) Medical PolicyPA Medicare12/21/2020
Brineura Drug PolicyNC Medicare09/16/2019
Brineura Drug PolicyOH Medicare09/16/2019
Bronchial Thermoplasty Medical PolicyNC Medicare07/15/2019
Bronchial Thermoplasty Medical PolicyPA Medicare07/27/2020
Bronchial Thermoplasty Medical PolicyOH Medicare07/15/2019
Cardiac Event Detection Monitoring Medical PolicyOH Medicare03/18/2019
Cardiac Event Detection Monitoring Medical PolicyNC Medicare03/18/2019
Cardiac Pacemaker Evaluation Services Medical PolicyNC Medicare03/18/2019
Cardiac Pacemaker Evaluation Services Medical PolicyOH Medicare03/18/2019
Cardiac Radionuclide Imaging Medical PolicyNC Medicare06/01/2018
Cardiac Rhythm Device Evaluation (L34833) Medical PolicyPA Medicare03/15/2021
Carpal Tunnel Medical PolicyNC Medicare09/16/2019
Carpal Tunnel Medical PolicyOH Medicare09/16/2019
Carpal Tunnel Medical PolicyPA Medicare09/07/2020
Cataract Extraction (including Complex Cataract Surgery) Medical PolicyPA Medicare04/19/2021
Cataract Extraction Medical PolicyNC Medicare07/15/2019
Cataract Extraction Medical PolicyOH Medicare07/15/2019
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) (L35062) Medical PolicyPA Medicare08/17/2020
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) Medical PolicyNC Medicare08/12/2019
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) Medical PolicyOH Medicare08/12/2019
Cochlear Implantation Medical PolicyNC Medicare05/20/2019
Cochlear Implantation Medical PolicyOH Medicare05/20/2019
Cochlear Implantation (NCD 50.3) Medical PolicyPA Medicare05/17/2021
CPAP for Obstructive Sleep Apnea (OSA) Medical PolicyNC Medicare06/17/2019
CPAP for Obstructive Sleep Apnea (OSA) Medical PolicyOH Medicare06/17/2019
CV Nuclear Medicine Medical PolicyOH Medicare07/15/2019
Electrical Nerve Stimulator Medical PolicyNC Medicare05/06/2019
Electrical Nerve Stimulator Medical PolicyOH Medicare 05/06/2019
Electrocardiographic Services Medical PolicyNC Medicare 05/06/2019
Electrocardiographic Services Medical PolicyOH Medicare 05/06/2019
Electrocardiographic Services(NCD 20.15) Medical PolicyPA Medicare 04/19/2021
Esophagogastroduodenoscopy (EGD) Medical PolicyNC Medicare08/01/2018
Esophagogastroduodenoscopy (EGD) Medical PolicyOH Medicare08/01/2018
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)(L35350) Medical PolicyPA Medicare03/15/2021
Exondys 51 Drug PolicyNC Medicare10/21/2019
Exondys 51 Drug PolicyOH Medicare10/21/2019
Faslodex Drug PolicyNC Medicare07/15/2018
Faslodex Drug PolicyOH Medicare07/15/2018
Fecal Transplant Medical PolicyNC Medicare02/18/2019
Fecal Microbiota Transplant Medical PolicyPA Medicare 02/15/2021
Fecal Transplant Medical PolicyOH Medicare02/18/2019
G-CSF Drug PolicyOH Medicare01/15/2019
G-CSF Drug PolicyNC Medicare01/15/2019
Glucose Monitoring Medical PolicyNC Medicare08/12/2019
Glucose Monitoring Medical PolicyOH Medicare08/12/2019
Glucose Monitoring Medical PolicyPA Medicare03/15/2021
Home Oxygen Therapy Medical PolicyNC Medicare01/15/2019
Home Oxygen Therapy Medical PolicyOH Medicare01/15/2019
Home Oxygen Therapy (L33797) Medical PolicyPA Medicare09/07/2020
Hyperbaric Oxygen Therapy (NCD 20.29) Medical PolicyNC Medicare12/21/2020
Hyperbaric Oxygen Therapy Medical PolicyOH Medicare12/15/2018
Hyperbaric Oxygen Therapy Medical PolicyPA Medicare12/09/2019
Interleukin-5 Inhibitors Drug PolicyNC Medicare01/15/2019
Interleukin-5 Inhibitors Drug PolicyOH Medicare01/15/2019
Leadless Pacemaker Medical PolicyNC Medicare03/18/2019
Leadless Pacemaker Medical PolicyOH Medicare03/18/2019
Leadless Pacemaker (NCD 20.8.4) Medical PolicyPA Medicare03/15/2021
MolDX: Molecular Diagnostic Tests Medical PolicyNC Medicare12/15/2018
MolDX: Molecular Diagnostic Tests Medical PolicyOH Medicare12/15/2018
Noninvasive Assessment of Liver Fibrosis Medical PolicyNC Medicare08/12/2019
Noninvasive Assessment of Liver Fibrosis Medical PolicyOH Medicare08/12/2019
Noninvasive Venous Studies Medical PolicyKY Medicare06/01/2018
Noninvasive Venous Studies Medical PolicyOH Medicare06/01/2018
Percutaneous Transluminal Angioplasty (PTA) Medical PolicyNC Medicare07/15/2019
Percutaneous Transluminal Angioplasty (PTA) Medical PolicyOH Medicare07/15/2019
Perjeta Drug PolicyNC Medicare07/15/2018
Pharmacogenomic Testing for Warfarin Response (NCD 90.1) Medical PolicyPA Medicare11/16/2020
Pharmacogenomic Testing for Warfarin Response Medical PolicyNC Medicare11/15/2018
Pharmacogenomic Testing for Warfarin Response Medical PolicyOH Medicare11/15/2018
Plethysmography Medical PolicyNC Medicare05/20/2019
Plethysmography Medical PolicyOH Medicare05/20/2019
Outpatient Sleep Studies Medical PolicyPA Medicare 07/27/2020
Outpatient Sleep Studies Medical PolicyNC Medicare06/17/2019
Outpatient Sleep Studies Medical PolicyOH Medicare06/17/2019
Pulmonary Rehabilitation Medical PolicyNC Medicare07/15/2019
Pulmonary Rehabilitation Medical PolicyOH Medicare07/15/2019
Self-contained Cardiac Pacemakers Medical PolicyNC Medicare 05/06/2019
Self-contained Cardiac Pacemakers Medical PolicyOH Medicare 05/06/2019
Self-Contained Pacemaker Monitors (NCD 20.82) Medical PolicyPA Medicare 04/19/2021
Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (NCD 20.8.3) Medical PolicyPA Medicare03/15/2021
Single and Dual Cardiac Pacemakers Medical PolicyNC Medicare03/18/2019
Single and Dual Cardiac Pacemakers Medical PolicyOH Medicare03/18/2019
Soliris Drug PolicyNC Medicare01/15/2018
Spinal Cord Stimulation (Dorsal Column Stimulation)(1.35450) Medical PolicyPA Medicare 04/19/2021
Spinal Cord Stimulators for Chronic Pain Medical PolicyNC Medicare06/01/2018
Spinraza Drug PolicyNC Medicare10/21/2019
Spinraza Drug PolicyOH Medicare10/21/2019
Subcutaneous Implantable Cardioverter Defibrillator Medical PolicyNC Medicare09/16/2019
Subcutaneous Implantable Cardioverter Defibrillator Medical PolicyOH Medicare09/16/2019
Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) (NCD 20.35) Medical PolicyNC Medicare12/21/2020
Supervised Exercise Therapy for PAD Medical PolicyOH Medicare12/15/2018
Supervised Exercise Therapy for PAD Medical PolicyPA Medicare12/09/2019
Surveillance of Implantable or Wearable Cardioverter Defibrillators Medical PolicyNC Medicare03/18/2019
Surveillance of Implantable or Wearable Cardioverter Defibrillators Medical PolicyOH Medicare03/18/2019
Cardiac Event Detection Monitoring (L34953) Medical PolicyPA Medicare03/15/2021
Testing of Genetic Disease Medical PolicyPA Medicare10/19/2020
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depression Medical PolicyNC Medicare05/20/2019
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depression Medical PolicyOH Medicare05/20/2019
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depression (LCD 34998) Medical PolicyPA Medicare05/17/2021
Transtelephonic Monitoring Medical PolicyNC Medicare 05/06/2019
Transtelephonic Monitoring Medical PolicyOH Medicare 05/06/2019
Tysabri Drug PolicyNC Medicare10/21/2019
Tysabri Drug PolicyOH Medicare10/21/2019
Velcade Drug PolicyNC Medicare01/15/2019
Vimizim Drug PolicyNC Medicare 10/21/2019
Vimizim Drug PolicyOH Medicare 10/21/2019
Xolair Drug PolicyKY Medicare07/15/2018
Xolair Drug PolicyNC Medicare10/21/2019
Xolair Drug PolicyOH Medicare10/21/2019
Yervoy Drug PolicyKY Medicare07/15/2018
Yervoy Drug PolicyOH Medicare07/15/2018
Scanning Computerized Ophthalmic Diagnostic Imaging Medical PolicyOH Medicare07/15/2019
Scanning Computerized Ophthalmic Diagnostic Imaging Medical PolicyNC Medicare07/15/2019
Vitamin D Deficiency Medical PolicyPA Medicare06/22/2020
Panniculectomy, Abdominoplasty/ Lipectomy Medical PolicyPA Medicare08/17/2020
Vitamin D Deficiency Medical PolicyOH Medicare08/12/2019
Panniculectomy, Abdominoplasty/ Lipectomy Medical PolicyOH Medicare08/12/2019
Vitamin D Deficiency Medical PolicyNC Medicare08/12/2019
Panniculectomy, Abdominoplasty/ Lipectomy Medical PolicyNC Medicare08/12/2019
Observation Care (Hospital Outpatient) Medical PolicyPA Medicare10/19/2020
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 PolicyPA Medicare12/21/2020
Noninvasive Vascular Studies Medical PolicyOH Medicare10/21/2019
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 PolicyPA Medicare05/17/2021
CPAP for Obstructive Sleep Apnea (OSA) Medical PolicyPA Medicare07/27/2020
Percutaneous Transluminal Angioplasty (PTA) Medical PolicyPA Medicare07/27/2020
Non-Invasive Peripheral Venous Studies (L35451) Medical PolicyPA Medicare07/27/2020
Scanning Computerized Ophthalmic Diagnostic Imaging Medical PolicyPA Medicare07/27/2020
Acupuncture for Chronic Low Back Pain
(NCD 30.3.3)
Medical PolicyPA Medicare01/01/2021
Implantable Continuous Glucose Monitors (I-CGM) (L38617) Medical PolicyPA Medicare01/18/2021
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495) Medical PolicyPA Medicare01/18/2021
Blood Glucose Testing (NCD 190.20) Medical PolicyPA Medicare02/15/2021
Oral Appliances for Obstructive Sleep Apnea (L33611) Medical PolicyPA Medicare02/15/2021
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (1.38385) Medical PolicyPA Medicare04/19/2021

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