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 July 1, 2019

  • Thyroid-Related Procedures - 91621
    Thyroidectomy was previously considered not medically necessary for all non-obstructive nodules with Bethesda Class II cytopathology regardless of nodule size. Thyroidectomy is now considered medically necessary for Bethesda Class II nodules when ≥ 4 cm.
  • Enteral Nutritional Therapy - 91278
    Priority Health will begin coverage for RELiZORB™ a digestive enzyme cartridge for patients ages 5 years and above. 
  • Lung Volume Reduction Surgery - 91472
    Added coverage criteria for Bronchoscopic (non-surgical) lung volume reduction (BLVR) utilizing the Pulmonx Zephyr® Endobronchial Valves.

Effective June 27, 2019

  • Hearing Augmentation - 91544
    Priority Health added coverage for unilateral conductive hearing loss and mixed hearing loss. In addition, criteria were added for audiology conductive and mix hearing loss and unilateral sensorineural hearing loss. 

    Clarification added around coverage for Medicaid and Healthy Michigan Plan members.