Medical policy updates
Below are links to updated or new policies. Remember, you can always find the latest updates to policies in the Pending/retired/updated medical policy list.
Effective Feb. 26, 2020
- Blood Pressure Monitors Ambulatory Blood Pressure Monitors - 91503
Expansion of coverage for ABPM with additional indications (for commercial plans only) and lower BP ranges for white coat hypertension. ABPM does not require PA.
- Prostatic Urethral Lift & Transurethral Water Vapor Therapy For Benign Prostatic Hyperplasia (BPH) - 91626
This new policy combines a previously separate policy, Urolift Prostatic Urethral Lift (#91613) with criteria for Rezum. Rezum procedure does not require PA.
- Breast Related Procedures - 91545
Expansion of coverage for breast implant removal by lowering from Baker Class IV to Baker Class III contracture. Language around the medical necessity or lack thereof cosmetic breast procedures has been moved the to Cosmetic and Reconstructive Surgery Procedures policy (#91535).
- Incontinence Supplies for Medicaid Members - 91502
Updated language to match Michigan Department of Health & Human Services Medicaid Provider Manual by adding criteria for long-term use of pull on briefs for members age 21 and over.