Medical policy updates
Below are links to updated or new policies. Remember, you can always find the latest updates to policies, as well as brief descriptions of what changed, in the Medical Policies section of the Provider Manual in the Pending/retired/updated medical policy list.
Effective July 1, 2019
- Gastroesophageal Reflux Disease (GERD) and Barrett's Esophagus - 91483
Criteria added for high-resolution manometry (HRM) distal esophageal motility metrics for magnetic sphincter augmentation (MSA) with the LINX device.
- Thyroid-Related Procedures - 91621
Thyroidectomy was previously considered not medically necessary for all non-obstructive nodules with Bethesda Class II cytopathology regardless of nodule size. Thyroidectomy is now considered medically necessary for Bethesda Class II nodules when ≥ 4 cm.
- Hyperbaric Oxygen Therapy - 91151
Added irradiation cystitis as a covered indication.
- Enteral Nutritional Therapy - 91278
Priority Health will begin coverage for RELiZORB™ a digestive enzyme cartridge for patients ages 5 years and above.
- Implantable Loop Recorder (ILR) - 91618
Added a clause to all other indications for these devices as experimental and investigational.
- Lung Volume Reduction Surgery - 91472
Added coverage criteria for Bronchoscopic (non-surgical) lung volume reduction (BLVR) utilizing the Pulmonx Zephyr® Endobronchial Valves.
- Stimulation Therapy and Devices - 91468
Clarification: Pulsed Electrical Stimulation (BioniCare®) is not covered for any indication.
Effective June 27, 2019
- Hearing Augmentation - 91544
Priority Health added coverage for unilateral conductive hearing loss and mixed hearing loss. In addition, criteria were added for audiology conductive and mix hearing loss and unilateral sensorineural hearing loss.
Clarification added around coverage for Medicaid and Healthy Michigan Plan members.