Medicare Medical Policy Search

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Name	Type	State	Effective
Cochlear Implantation (NCD 50.3)	Medical Policy	PA Medicare	05/01/2023
Acupuncture for Chronic Low Back Pain (NCD 30.3.3)	Medical Policy	PA Medicare	06/01/2022
4Kscore Test Algorithm (L37792)	Medical Policy	PA Medicare	04/01/2023
Cardiac Event Detection Monitoring (L34953)	Medical Policy	PA Medicare	04/01/2023
Cardiac Rhythm Device Evaluation (L34833)	Medical Policy	PA Medicare	04/01/2023
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)	Medical Policy	PA Medicare	04/01/2023
Micro-Invasive Glaucoma Surgery (MIGS) (L38223)	Medical Policy	PA Medicare	04/01/2023
Peripheral Nerve Stimulation (L37360)	Medical Policy	PA Medicare	04/01/2023
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (LCD 34998)	Medical Policy	PA Medicare	05/01/2023
Assessing Patient’s Suitability for Electrical Nerve Stimulation Therapy (160.7.1 & 160.7)	Medical Policy	PA Medicare	03/01/2023
Blood Glucose Testing (NCD 190.20)	Medical Policy	PA Medicare	03/01/2023
Fecal Microbiota Transplant	Medical Policy	PA Medicare	03/01/2023
Speech-Generating Devices (L33739)	Medical Policy	PA Medicare	03/01/2023
Cataract Extraction (including Complex Cataract Surgery)	Medical Policy	PA Medicare	04/01/2023
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (L38229)	Medical Policy	PA Medicare	05/01/2023
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (L38385)	Medical Policy	PA Medicare	04/01/2023
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)	Medical Policy	PA Medicare	04/01/2023
Electrocardiographic Services (NCD 20.15)	Medical Policy	PA Medicare	04/01/2023
Automatic External Defibrillators (AED) (L33690)	Medical Policy	PA Medicare	07/01/2022
Vitamin D Deficiency Screening	Medical Policy	PA Medicare	07/01/2022
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)	Medical Policy	PA Medicare	08/01/2022
Non-Invasive Peripheral Venous Studies (L35451)	Medical Policy	PA Medicare	08/01/2022
Percutaneous Transluminal Angioplasty (PTA) (NCD 20.7)	Medical Policy	PA Medicare	08/01/2022
Pulmonary Rehabilitation (PR)	Medical Policy	PA Medicare	08/01/2022
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP)	Medical Policy	PA Medicare	09/01/2022
Cosmetic and Reconstructive Surgery (L35090)	Medical Policy	PA Medicare	09/01/2022
Ambulatory Blood Pressure Monitor (NCD 20.19)	Medical Policy	PA Medicare	10/01/2022
Ambulance Services (Ground) (L35162)	Medical Policy	PA Medicare	10/01/2022
Ambulance Services (Air)	Medical Policy	PA Medicare	10/01/2022
Bronchial Thermoplasty	Medical Policy	PA Medicare	10/01/2022
Carpal Tunnel Surgery	Medical Policy	PA Medicare	10/01/2022
Home Oxygen Therapy (L33797)	Medical Policy	PA Medicare	10/01/2022
Negative Pressure Wound Therapy (NPWT) Pumps (L33821)	Medical Policy	PA Medicare	11/01/2022
Observation Care (Hospital Outpatient)	Medical Policy	PA Medicare	11/01/2022
Testing for Genetic Disease	Medical Policy	PA Medicare	12/01/2022
Pharmacogenomic Testing for Warfarin Response (NCD 90.1)	Medical Policy	PA Medicare	12/01/2022
Osteogenic Stimulators (150.2)	Medical Policy	PA Medicare	12/01/2022
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495)	Medical Policy	PA Medicare	01/01/2023
Acupuncture for Chronic Low Back Pain (NCD 30.3.3)	Medical Policy	PA Medicare	01/01/2023
Biomarkers Overview (L35062)	Medical Policy	PA Medicare	01/01/2023
Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) (NCD 20.35)	Medical Policy	PA Medicare	01/01/2023
Hyperbaric Oxygen Therapy (HBOT) (NCD 20.29)	Medical Policy	PA Medicare	01/01/2023
Ambulance Services (Ground) (L35162)	Medical Policy	PA Medicare	02/01/2023
Implantable Continuous Glucose Monitors (I-CGM) (L38617)	Medical Policy	PA Medicare	02/01/2023

Highmark Wholecare Policy Disclaimer

The Policies neither constitutes nor substitutes for medical advice. Highmark Wholecare’s Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of Highmark Wholecare. If members have a specific question about their medical condition, they should consult with their provider.
In the event of a conflict between the Policy and Member Handbook or Evidence of Coverage, the express terms of the Member Handbook or Evidence of Coverage will govern. The existence of a medical guideline is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the medical guideline. The Policies are used in making decisions as to medical necessity only and they do not guarantee payment of services. Policies serve as one of the sets of guidelines for coverage decisions.
The information on this website may not reflect a recent policy change or all of the applicable medical guidelines.

This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 14 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.

Medicare Medical Policy Search

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