February 2024 medical policy updates

Our Medical Advisory Committee (MAC), comprised of network physicians contracted with Priority Health, met in February and approved the medical policy updates outlined below.

For complete descriptions of the updates made:

See our policy changes webpage

New medical policies

Laser interstitial thermal therapy (LITT) (#91640)

This new medical policy clarifies Priority Health’s medical necessity position on laser interstitial thermal therapy (LITT). Previously non-covered codes may be covered if criteria are met for applicable allowable indication (i.e., drug resistant epilepsy).

Retired medical policies

The following medical policies have been retired because they’re limited in scope to Medicaid members only and are duplicative, sharing information available in the MDHHS Medicaid Provider Manual.

  • Augmentative Communication Speech Generating Devices for Medicaid Members (#91499)
  • Enclosed Bed Systems Medicaid Members (#91498)
  • Incontinence Supplies for Medicaid Members (#91502)
  • Orthoptic Pleoptic Training Medicaid Mbrs (#91500)
  • Sterilization for Medicaid Mbrs (#91501)

The following medical policies have been retired because they’re duplicative, sharing information available in our Provider Manual:

Updated medical policies

The following policies were updated to clarify language and experimental & investigational positions, or to align with updated industry standards.

  • Autism Spectrum (#91615)
  • Blood Pressure Monitors and Ambulatory Blood Pressure Monitoring (#91503)
  • Clinical Trials for Self Funded Groups Opting Out of PPACA (#91448)
  • End Stage Renal Disease (ESRD) Renal Dialysis (#91526)
  • Enuresis Therapy (#91418)
  • Gastroparesis Testing and Treatment (#91572)
  • GERD and Barrett’s Esophagus (#91483)
  • Hearing Augmentation (#91544)
  • Hyperbaric Oxygen Therapy (#91151)
  • Lung Volume Reduction (Surgical and Non-Surgical) (#91472)
  • Medical Management Obesity (#91594)
  • Sleep Apnea: Obstructive and Central (#91333)
  • Stimulation Therapy and Devices (#91468)
  • Surgical Treatment of Obesity (#91595)
  • Ventricular Assist Devices (#91509)