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NotificationsKnee Orthoses05.00.47r3/8/2024 10:00 AM4/8/20243/8/2024General Description, Guidelines, or Informational Update
NotificationsAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21p3/22/2024 11:00 AM6/24/20243/22/2024Medical Coding
New PoliciesVelmanase alfa (Lamzede)08.02.043/11/20243/11/2024This is a New Policy.
Updated PoliciesDofetilide (Tikosyn®) Use in the Inpatient Setting08.00.49f3/11/20243/11/2024Medical Necessity Criteria
Updated PoliciesLanreotide (Somatuline® Depot)08.01.40f3/11/20243/11/2024Medical Necessity Criteria
Updated PoliciesOmalizumab (Xolair®)08.00.55j3/11/20243/11/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs10.01.01r3/11/20243/11/2024General Description, Guidelines, or Informational Update
Updated PoliciesAdo-Trastuzumab Emtansine (Kadcyla®)08.01.11i3/11/20243/11/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesDostarlimab-gxly (Jemperli)08.01.79e3/11/20243/11/2024Medical Necessity Criteria
Updated PoliciesSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77e3/25/20243/25/2024Medical Coding;General Description, Guidelines, or Informational Update
Reissue PoliciesNon-Surgical Spinal Decompression Therapy07.08.01f3/28/20163/6/20243/6/2024
Reissue PoliciesAllogeneic Processed Thymus Tissue-agdc (Rethymic®)08.01.885/16/20223/6/20243/6/2024
Reissue PoliciesFrenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)11.03.05e1/1/20213/6/20243/6/2024
Reissue PoliciesUblituximab-xiiy (Briumvi®) for intravenous use08.02.02a7/1/20233/6/20243/6/2024
Reissue PoliciesComputer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure11.14.17e1/1/20213/6/20243/6/2024
Reissue PoliciesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices07.02.09i10/1/20233/6/20243/6/2024
Reissue PoliciesPercutaneous Discectomy11.15.15g12/1/20173/6/20243/6/2024
Reissue PoliciesBrachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy09.00.10z7/15/20193/6/20243/6/2024
Reissue PoliciesRoutine Foot Care for Certain Medical Conditions07.07.01q10/1/20213/6/20243/6/2024
Reissue PoliciesMohs Micrographic Surgery11.08.23k10/1/20233/6/20243/6/2024
Reissue PoliciesElective Abortion11.06.02l1/2/20243/6/20243/6/2024
Reissue PoliciesGastric Electrical Stimulation (Enterra™), Gastric Pacing11.03.15k1/2/20243/20/20243/20/2024
Reissue PoliciesEndometrial Ablation11.06.05f5/20/20193/20/20243/20/2024
Reissue PoliciesFetal Fibronectin Enzyme (fFN) Immunoassay06.02.04d12/4/20153/20/20243/20/2024
Reissue PoliciesSerodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test06.02.17h4/1/20203/20/20243/20/2024
Reissue PoliciesUterine Artery Embolization11.06.04k5/20/20193/20/20243/20/2024
Reissue PoliciesParenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor07.10.04c2/22/20173/20/20243/20/2024
Reissue PoliciesManipulation Under Anesthesia11.14.24b4/30/20183/20/20243/20/2024
Archived PoliciesPartial Coherence Interferometry07.13.08e3/8/2024 1:00 PM4/8/20243/8/2024