Recent medical policy updates

Below are links to the updated or new policies. Remember, you can always find the latest updates to policies, as well as brief descriptions of what changed, under Authorizations > Medical policies > Policy changes list.

Effective January 1, 2018

Orthoptic and Pleoptic Training for Medicaid Members - 91500

  • Prior authorization required for beneficiaries over age 21.
  • Prior authorization rules will apply to Medicare members for the following services: 
    • Continuous glucose monitors
    • Dialysis
    • Insulin pumps

Effective November 29, 2017

Foot Care - 91121
Language added to clarify laser treatment of onychomycosis is not covered.&

Hospice Care - 91520

Language removed that explained number of inpatient respite days for Medicaid and Healthy Michigan Plan members.

Implantable Heart Failure Monitors - 91610

Language removed specific to Medicare as policy criteria in Section, I, A & B applies to all products.

Non-Acute Inpatient Services - 91332
Removed language of Priority Health admission criteria for coverage are not the same as Medicare criteria, therefore, just because Medicare is covering your stay does not mean the services are covered under this policy.

Obstructive Sleep Apnea - 91333
Removed language for coverage of palatal implants for Medicare.

Percutaneous Left Atrial Appendage Closure - 91605
Language removed that addressed Medicare coverage for items and services in the CMS approved CED studies.

Rehabilitative & Habilitative Medicine Services - 91318
Language added to clarify that biofeedback is not a covered benefit for Medicaid and Healthy Michigan Plan.

Stimulation Therapy and Devices - 91468
Criteria added for the coverage of Dorsal Root Ganglion Stimulators. The remedē System (Respicardia Inc.) phrenic nerve stimulator for central sleep apnea added under Non-Covered Electrical Stimulation Therapies. 

Transplantation of Solid Organs - 91272

Language removed regarding heterotopic liver transplantation for Medicare members.

Effective November 10, 2017

Renal Dialysis - 91526
Language removed defining coverage for primary and secondary under the Medicare special rules program, as it is a restatement of the NCD (national coverage determination).

Refractive Keratoplasty Lasik - 91529
Language added to clarify performance of PTK in combination with collagen cross-linkage is considered experimental and investigational.