Medical Policy Updates

Medical Policy Update for November 26, 2019

Medical Guidelines Reason for Update
Artificial Intervertebral Disc Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Axial Lumbosacral Interbody Fusion Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Biochemical Markers of Alzheimers Disease AHS - G2048 Specialty Matched Consultant Advisory Panel Review 10/16/2019. Coding table removed from Billing/Coding section. 
Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases AHS - G2123 Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty) Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Electrodiagnostic Studies Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Genetic Testing for Epilepsy AHS - M2075 Specialty Matched Consultant Advisory Panel review 10/16/2019.  Coding table removed from Billing/Coding section. 
Genetic Testing for Familial Alzheimer's Disease AHS - M2038 Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Genetic Testing for Lactase Insufficiency AHS - M2080 Reviewed by Avalon 2nd Quarter 2019 CAB. Minor revision to Description section. Added the following to the Policy Statement as investigational: "and genetic testing of the LCT gene and/or MCM6 gene". Added second statement to the When Not Covered section: "Genetic testing of the LCT gene and/or MCM6 gene for lactose intolerance and/or lactase insufficiency is considered investigational." Policy guidelines updated to support additional investigational indication. Billing/Coding section updated, removing code table. References updated. Policy noticed 9/10/2019 for effective date of 11/12/2019. Medical Director review 8/2019.
Interferential Stimulation Specialty Matched Consultant Advisory Panel review 10/16/2019.
Navigated Transcranial Magnetic Stimulation (nTMS) Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Nerve Fiber Density Testing AHS - M2112 Specialty Matched Consultant Advisory Panel review 10/16/2019.  Coding table removed from Billing/Coding section. 
Neurostimulation, Electrical Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Percutaneous Electrical Nerve Stimulation (PENS) or Neuromodulation Therapy Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Quantitative Sensory Testing Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Sphenopalatine Ganglion Block for Headache Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Spinal Cord and Dorsal Root Ganglion Stimulation Specialty Matched Consultant Advisory Panel review 10/16/2019. 
Total Facet Arthroplasty Specialty Matched Consultant Advisory Panel review 10/16/2019.