| Policy |
Update |
| Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation (#91596) |
- Added medical necessity criteria for balloon dilation of eustachian tube dysfunction
- Expanded the title of the policy
- Changed position on balloon dilation for eustachian tube dysfunction to medically necessary when criteria are met.
|
| Spine Procedures (#91581) |
- Added inclusion and exclusion criteria for intraosseous basivertebral radiofrequency nerve ablation
- CPT codes 64628 and 64629 are associated with this procedure
- Currently no prior authorization requirement
|
| Surgical Treatments for Lipedema and Lymphedema (#91631) |
- Added new policy that contains detailed medical necessity criteria for surgical treatment of lipedema
- Clarifies surgical treatments for lymphedema considered experimental, investigational or unproven
|
| Durable Medical Equipment (#91110) |
- Clarified coverage for pneumatic compression devices.
- Added requests for calibrated gradient pressure devices require documentation of treatment failure with non-calibrated gradient pressure devices
|
| Incontinence Supplies for Medicaid Members (#91502) |
- Updated criteria for short-term and long-term pull-on briefs
- Added example of what MDHHS considers “measurable progress”
- Expanded medical conditions that MDHSS considers allowable for long-term use.
|
| Infertility Diagnosis and Treatment/Assisted Reproduction/Artificial Conception (#91163) |
- Add Sperm & Oocyte Retrieval and Storage (#91393) policy language to this policy and retiring #91393 policy
- Added term gestational carrier to page 3 of the policy
|
| Lung Volume Reduction (Surgical and Non-Surgical) (#91472) |
- Deleted distinction between intrabronchial vs. endobronchial valves
- Deleted spiration valve as an exclusion
- Added fissure integrity of less than 85% as an exclusion for endobronchial valve placement
|
| Surgical Treatment of Obesity (#91595) |
- Clarified that the reported BMI should be based upon measurement of height and weight within one month of beginning the medical weight management program
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