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Medical Policy Update for April 16, 2025
Medical GuidelinesReason for Update
Ablative Techniques for the Myolysis of Uterine FibroidsReferences added. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Bone Mineral Density StudiesReplaced “patient” with “individual” throughout policy. Policy Guidelines updated. References updated. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to Policy statement.
Bronchial ThermoplastyMinor edits throughout policy. References updated. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Convection-Enhanced Delivery of Therapeutic Agents to the BrainSpecialty Matched Consultant Advisory Panel review 3/2025. Updated and added references. No change to policy statement.
Cord Blood as a Source of Stem CellsSpecialty Matched Consultant Advisory Panel review 3/2025. References added.
Electromagnetic Navigation BronchoscopyDescription, Policy Guidelines, and References updated. Updated “patient” to “individual” where applicable throughout policy. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Endobronchial ValvesDescription, Policy Guidelines, and References updated. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Heart-Lung TransplantationDescription and Policy Guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 3/2025.  Medical Director review 3/2025. No change to policy statement.
Hormone Pellet Implantation for Treatment of Menopause Related SymptomsSpecialty Matched Consultant Advisory Panel review 3/2025. Medical Director Review 3/2025. References updated. No change to policy statement.
Infertility Diagnosis and Treatment – B0006Updated link in Policy Guidelines to reflect updated version of current guidance on the limits to the number of embryos to transfer. References updated. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025.  No change to policy statement.
Lung and Lobar Lung TransplantationDescription and Policy Guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Lung Volume Reduction SurgeryDescription and Policy Guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Maternal and Fetal DiagnosticsReferences updated. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Monoclonal Antibody Imaging for Prostate CancerSpecialty Matched Consultant Advisory Panel review 3/2025. References added.
Noninvasive Respiratory Assist DevicesUpdated “patient” to “individual” where applicable throughout policy. References added. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.
Oncologic Applications of Photodynamic Therapy, Including Barrett’s EsophagusSpecialty Matched Consultant Advisory Panel review 3/2025. References added.
Oscillatory Devices for the Treatment of Respiratory ConditionsMinor updates to Policy Guidelines. References added. Specialty Matched Consultant Advisory Panel review 3/2025.  Medical Director review 3/2025. No changes to policy statement.
Ovarian and Internal Iliac Vein Embolization, Ablation and SclerotherapyDescription and Policy Guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director Review 3/2025. No change to policy statement.
Phrenic Nerve Stimulation for Central Sleep ApneaDescription and Regulatory Status updated. References added. Specialty Matched Consultant Advisory Panel 3/2025.  Medical Director review 3/2024. No changes to policy statement.
Sleep Apnea: Diagnosis and Medical ManagementDescription updated. Updated “patient” to “individual” where applicable throughout policy. References added. Specialty Matched Consultant Advisory Panel Review 3/2025. Medical Director Review 3/2025. No change to policy statement.
Surgery for Obstructive Sleep Apnea and Upper Airway Resistance SyndromeReferences added. Specialty Matched Consultant Advisory Panel review 3/2025. Medical Director review 3/2025. No change to policy statement.