| Medical Guidelines | Reason for Update |
|---|---|
| Leadless Cardiac Pacemakers | Policy Guidelines and References updated. Updates to When Covered section: removed "The Micra" and replaced with "Single chamber (right ventricular)", statement now reads "Single chamber (right ventricular) transcatheter pacing systems may be considered medically necessary in individuals when both conditions below are met..." Updates to the Not Covered section: removed "The Micra" and replaced with "Single chamber (right ventricular)", statement now reads "Single chamber (right ventricular) transcatheter pacing systems are considered investigational in all other situations in which the above criteria are not met." Removed "The Aveir™" from coverage criteria and statement now reads "Right atrial single chamber transcatheter pacing systems are considered investigational for all indications." Removed "The Aveir™ DR" from coverage criteria and statement now reads "Dual chamber transcatheter pacing systems are considered investigational for all indications." Specialty Matched Consultant Advisory Panel review 6/2025. Medical Director review 6/2025. |
| Paraspinal Surface Electromyography (SEMG) | Policy archived. |
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