Medical policy updates

Below are links to updated or new policies. Remember, you can always find the latest updates to policies, as well as brief descriptions of what changed, in the Medical Policies section of the Provider Manual in the Pending/retired/updated medical policy list.

Effective January 1, 2018

Computerized Tomographic Angiography Coronary Arteries (CCTA) - 91614

Language added to reflect FFR-CT does not require prior authorization. Fractional Flow Reserve (FFR-CT) is not covered for Medicaid products.

Effective January 29, 2018

Autism Spectrum Disorder - 91615

Under Diagnosis and Evaluation, the criteria was updated and reflects only the Autism Diagnostic Observation Schedule-2 (ADOS-2) for standardized behavior observational assessment. The Autism Diagnostic Observation Scale (ADOS) was removed from this criteria.

Drug Testing - 91611

Language added to reflect when presumptive (qualitative; semi-quantitative) urine drug testing is a covered benefit. In addition, language added to clarify definitive (confirmatory; quantitative) urine drug testing purpose and when it is a covered benefit. Additional language also added to reflect benefits not covered.

Infusion Services & Equipment - 91414

Criteria updated to reflect the Drugs in Appendix A of the policy may be covered in the home, a hospital outpatient infusion center, or an alternative Priority Health-approved site of service for Medicaid/Healthy Michigan members. Appendix A also updated with a few drugs effective 1/1/18.

Markers for Digestive Disorders - 91583

Criteria updated to reflect vedolizumab (VDZ) and Anser VDZ are a covered benefit.

NEW Prostatic Artery Embolization for Benign Prostatic Hyperplasia (BPH) - 91620

Prostatic Artery Embolization (PAE) for BPH is covered when specific criteria are met. PAE for all other conditions is considered experimental and investigational and not a covered benefit.

Ventricular Assist Devices & Artificial Hearts - 91509

Language added to clarify that percutaneous left ventricular assist devices (e.g., the TandemHeart and the Impella) are covered for FDA approved indications. Language also updated to reflect percutaneous right ventricular assist devices (e.g. Impella RP) are considered experimental and investigational and not a covered benefit. There is insufficient evidence to determine safety and efficacy for treatment of right ventricular failure.