New and Amended Medical Policies
Medical Policy Number
|
Medical Policy Name |
Effective Date of Change |
Description of Changes |
BI011 |
Computer Aided Diagnosis (CAD) Mammography |
08/01/17 |
Included verbiage from BI436 and BI476, which are to be retired. State legislature added requirements for ultrasound to be included as a preventive screening (if needed) along with mammogram or breast tomosynthesis. |
BI152 |
Strabismus Surgery |
10/01/17 |
Updated indication for adults having strabismus surgery. |
BI165 |
Multiple Sclerosis |
10/01/17 |
Added to policy a new drug and a new code: C9494. |
BI496 |
PCSK9 Inhibitors |
10/01/17 |
Added diagnoses with criteria for coverage on HeFH and ASCVD. Added reauthorization criteria. |
BI555 |
Bavencio |
10/01/17 |
Added new HCPCS code. |
BI556 |
Imfinzi |
10/01/17 |
Added new HCPCS code. |
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