|
Medical Policy Number
| Medical Policy Name | Effective Date of Change | Description of Changes |
|---|
|
| Immunization Coverage | 12/01/20 | Added Covid-19 Codes |
|
| Preventive Health Benefit | 01/01/22 | Covered the recommendations from the USPSTF regarding healthy weight and weight gain in pregnancy. AND screening for gestational diabetes. |
|
| Cartilage Transplants of Lower Extremity | 09/01/21 | Updated verbiage within policy and removed statement of validation needed, because there is no way to validate. |
|
| Hepatitis A Vaccine | 09/01/21 | Updated criteria for medical necessity. |
|
| Vision Therapy | 12/01/21 | Updated policy verbiage and background information. |
|
| Tykerb | 12/01/21 | Updated breast cancer criteria and added criteria for bone cancer and colorectal cancer. |
|
| Stelara | 10/01/21 | Updated age for coverage of plaque psoriasis to 6 and older. |
|
| Buprenorphine / Naloxone Combo Products | 10/01/21 | Updated requirement for prescriber to have CSA-X waiver. |
|
BI540
| Diclofenac Gel 3% | 10/01/21 | Retired |
