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Medical Policy Update for August 23, 2022 August 23, 2022
Medical GuidelinesReason for Update
Capsule Endoscopy, WirelessTypo corrected under When Not Covered section. No change to policy statement.
Diagnosis of Vaginitis including Multi-target PCR Testing AHS – M2057Added the following statement to When Not Covered section “Reimbursement is not allowed for screening of bacterial vaginosis using Aptima BV.” Medical Director review 8/2022.
Facet Joint DenervationCriteria moved from Policy Guidelines section to When Covered section for clarity. No change to policy statement. Medical Director review 8/2022.
Quantose Impaired Glucose Tolerance (IGT) Test AHS - G2135Test no longer available. Medical director review. Policy archived.
Therapeutic Radiopharmaceuticals in OncologyPolicy statement updated to include coverage of Lutetium 177 (Lu 177) vipivotide tetraxetan (Pluvicto). No change to policy intent. Medical Director review 8/2022.