Policy outlines medical necessity criteria for cystic fibrosis (CF) and spinal muscular atrophy (SMA) carrier screening as well as carrier screening for members of Ashkenazi Jewish Ancestry (AJA) as recommended by the American College of Medical Genetics (ACMG) and the American College of Obstetricians and Gynecologists (ACOG).
Medical Policy Number
Medical Policy Name
Effective Date of Change
Description of Changes
Liver Lesion Treatment
Added radiopharmaceutical therapy admin codes (which currently pay without pre-authorization).
Testing for Drugs of Abuse
OON testing excluded for all plans 07/01/2019.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.