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| Medical Guidelines | Reason for Update |
|---|---|
| Ambulatory Event Monitors | Minor edits to Description section. Billing/Coding section and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Anesthesia Services | References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement. |
| Baroreflex Stimulation Devices | Description, Policy Guidelines and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Cardiac Monitoring Devices in the Outpatient Setting | Description, Regulatory Status and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Carotid Intimal-Medial Thickness | Minor edits to Description section for clarity, References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Computed Tomography to Detect Coronary Artery Calcification | Policy Guidelines edited for clarity. References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Dental Criteria for use of Hospital Inpatient or Outpatient Facility Services or Ambulatory Surgery Center Facility Services | Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement. |
| Dental Reconstructive Services | Added the following statement to When Covered section: “When the procedures are the direct or indirect result of cancer treatments, including chemotherapy, biotherapy, or radiation therapy” to align with HB 646. Typo corrected in Billing/Coding section. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. |
| Electronic Brachytherapy for Nonmelanoma Skin Cancer | Removed CPT codes 77767, 77768 from Billing/Coding section for clarity. Reference added. No change to policy intent/statement. |
| Enhanced External Counterpulsation (EECP) | References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Hyperbaric Oxygen Therapy | Minor updates to policy guidelines. References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. No change to policy statement. |
| Orthodontics for Pediatric Patients | Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement. |
| Orthognathic Surgery | Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement. |
| Prenatal Screening (Genetic) AHS-M2179 | Policy title updated to include “AHS-M2179” to align with Avalon. |
| Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia | Description section, Policy Guidelines and References updated. No change to policy statement. Specialty Advisory Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Signal-Averaged ECG | References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Spinal Manipulation Under Anesthesia | Minor updates made to description. Moved statement related to evidence reviews from When not Covered to Policy Guidelines for clarity. Specialty Matched Consultant Advisory Panel Review 10/2022. Medical Director Review 10/2022. References updated. No change to policy statement. |
| Stem-cell Therapy for Peripheral Arterial Disease | References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
| Temporomandibular Joint Dysfunction (TMJD) | Minor updates to description for clarity. Regulatory status updated. Related policies added. Policy Guidelines updated. References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement. |
| Wearable Cardioverter Defibrillators | Description section including Regulatory Status, Policy Guidelines and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. |
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