November 2018 ~

UnitedHealthcare (UHC) has released its most recent medical policy updates for November 2018 which includes complete details on UHC medical policy, medical benefit drug policy, coverage determination guidelines (CDG), utilization review guideline (URG), and/or quality of care guideline (QOCG) updates, as well as new, updated, revised, replaced and retired health services policies.

These updates are as follows:

Medical Policy Updates

NEW

• Negative Pressure Wound Therapy – Effective Jan. 1, 2019
• Therapeutic Radiopharmaceuticals – Effective Jan. 1, 2019

UPDATED

• Apheresis – Effective Nov. 1, 2018
• Athletic Pubalgia Surgery – Effective Nov. 1, 2018
• Autologous Chondrocyte Transplantation in the Knee – Effective Nov. 1, 2018
• Bone or Soft Tissue Healing and Fusion Enhancement Products – Effective Nov. 1, 2018
• Breast Imaging for Screening and Diagnosing Cancer – Effective Nov. 1, 2018
• Bronchial Thermoplasty – Effective Nov. 1, 2018
• Carrier Testing for Genetic Diseases – Effective Nov. 1, 2018
• Chelation Therapy for Non-Overload Conditions – Effective Nov. 1, 2018
• Chemosensitivity and Chemoresistance Assays in Cancer – Effective Nov. 1, 2018
• Cochlear Implants – Effective Nov. 1, 2018
• Cognitive Rehabilitation – Effective Nov. 1, 2018
• Collagen Crosslinks and Biochemical Markers of Bone Turnover – Effective Nov. 1, 2018
• Computerized Dynamic Posturography – Effective Nov. 1, 2018
• Corneal Hysteresis and Intraocular Pressure Measurement – Effective Nov. 1, 2018
• Cytological Examination of Breast Fluids for Cancer Screening – Effective Nov. 1, 2018
• Discogenic Pain Treatment – Effective Nov. 1, 2018
• Electrical Bioimpedance for Cardiac Output Measurement – Effective Nov. 1, 2018
• Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome – Effective Nov. 1, 2018
• Epidural Steroid and Facet Injections for Spinal Pain – Effective Nov. 1, 2018
• Extracorporeal Shock Wave Therapy (ESWT) – Effective Nov. 1, 2018
• Fecal Calprotectin Testing – Effective Nov. 1, 2018
• Gastrointestinal Motility Disorders, Diagnosis and Treatment – Effective Nov. 1, 2018
• Gender Dysphoria Treatment – Effective Nov. 1, 2018
• Gene Expression Tests for Cardiac Indications – Effective Nov. 1, 2018
• Glaucoma Surgical Treatments – Effective Nov. 1, 2018
• Hearing Aids and Devices Including Wearable, Bone-Anchored and Semi-Implantable – Effective Dec. 1, 2018
• Hip Resurfacing and Replacement Surgery (Arthroplasty) – Effective Nov. 1, 2018
• Home Traction Therapy – Effective Nov. 1, 2018
• Intraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) – Effective Nov. 1, 2018
• Intrauterine Fetal Surgery – Effective Nov. 1, 2018
• Laser Interstitial Thermal Therapy – Effective Nov. 1, 2018
• Light and Laser Therapy for Cutaneous Lesions and Pilonidal Disease – Effective Nov. 1, 2018
• Macular Degeneration Treatment Procedures – Effective Nov. 1, 2018
• Magnetic Resonance Spectroscopy (MRS) – Effective Nov. 1, 2018
• Manipulation Under Anesthesia – Effective Nov. 1, 2018
• Manipulative Therapy – Effective Nov. 1, 2018
• Meniscus Implant and Allograft – Effective Nov. 1, 2018
• Motorized Spinal Traction – Effective Nov. 1, 2018
• Neuropsychological Testing Under the Medical Benefit – Effective Nov. 1, 2018
• Occipital Neuralgia and Headache Treatment – Effective Nov. 1, 2018
• Outpatient Cardiac Telemetry – Effective Nov. 1, 2018
• Pharmacogenetic Testing – Effective Nov. 1, 2018
• Platelet Derived Growth Factors for Treatment of Wounds – Effective Nov. 1, 2018
• Preterm Labor Management – Effective Nov. 1, 2018
• Prolotherapy for Musculoskeletal Indications – Effective Nov. 1, 2018
• Skin and Soft Tissue Substitutes – Effective Nov. 1, 2018
• Spinal Ultrasonography – Effective Nov. 1, 2018
• Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins – Effective Nov. 1, 2018
• Thermography – Effective Nov. 1, 2018
• Total Artificial Disc Replacement for the Spine – Effective Nov. 1, 2018
• Total Artificial Heart – Effective Nov. 1, 2018
• Transpupillary Thermotherapy – Effective Nov. 1, 2018
• Umbilical Cord Blood Harvesting and Storage for Future Use – Effective Nov. 1, 2018
• Ablative Treatment for Spinal Pain – Effective Dec. 1, 2018
• Genetic Testing for Hereditary Cancer – Effective Dec. 1, 2018
• Implanted Electrical Stimulator for Spinal Cord – Effective Dec. 1, 2018
• Obstructive Sleep Apnea Treatment – Effective Jan. 1, 2019
• Omnibus Codes – Effective Jan. 1, 2019
• Sodium Hyaluronate – Effective Jan. 1, 2019

UPDATED

• Alpha1-Proteinase Inhibitors – Effective Nov. 1, 2018
• Enzyme Replacement Therapy – Effective Nov. 1, 2018
• Ilaris^® (Canakinumab) – Effective Nov. 1, 2018

REVISED

• Buprenorphine (Probuphine^® & Sublocade^™) – Effective Nov. 1, 2018
• Clotting Factors and Coagulant Blood Products – Effective Nov. 1, 2018
• Denosumab (Prolia^® & Xgeva^®) – Effective Nov. 1, 2018
• Gonadotropin Releasing Hormone Analogs – Effective Nov. 1, 2018
• Immune Globulin (IVIG and SCIG) – Effective Nov. 1, 2018
• Ocrevus^™ (Ocrelizumab) – Effective Nov. 1, 2018
• White Blood Cell Colony Stimulating Factors – Effective Nov. 1, 2018

Coverage Determination Guideline (CDG) Updates

UPDATED

• Breast Reconstruction Post Mastectomy – Effective Nov. 1, 2018
• Breast Repair/Reconstruction Not Following Mastectomy – Effective Nov. 1, 2018

Utilization Review Guideline (URG) Updates

NEW

• Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Care – Effective Jan. 1, 2019

For complete details on the above updates, refer to UHC’s November 2018 Medical Policy Update Bulletin.

 

 

Source(s): UnitedHealthcare Network Bulletin November 2018; UnitedHealthcare Commercial Medical Policy Update Bulletin: November 2018;