Ambulance Services – Air Medical Policy PA Medicaid 05/01/2024
Ambulance Services – Ground Medical Policy PA Medicaid 09/01/2023
Artificial Pancreas Medical Policy PA Medicaid 05/01/2024
Automated Ambulatory Blood Pressure Monitoring (ABPM) Medical Policy PA Medicaid 09/01/2023
Bariatric Surgery Medical Policy PA Medicaid 05/01/2024
BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia Medical Policy PA Medicaid 03/01/2024
BRAF Mutation Analysis Medical Policy PA Medicaid 10/01/2023
BRCA1 and BRCA2 Genetic Mutation Testing Medical Policy PA Medicaid 03/01/2024
Breast Reconstructive Surgery Medical Policy PA Medicaid 03/01/2023
Breast Scintimammography Medical Policy PA Medicaid 12/01/2023
Bronchial Thermoplasty Medical Policy PA Medicaid 10/01/2023
Bronchial Valves Medical Policy PA Medicaid 12/01/2023
Capsule Endoscopy Medical Policy PA Medicaid 03/01/2024
Cardiac Contractility Modulation (CCM) Therapy Medical Policy PA Medicaid 12/01/2023
Cardiac Rehabilitation, Phase II Outpatient Medical Policy PA Medicaid 07/01/2023
Carpal Tunnel Surgery Medical Policy PA Medicaid 07/01/2022
Chromosomal Microarray Analysis (CMA): Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) Medical Policy PA Medicaid 03/01/2024
Clinical Trials Medical Policy PA Medicaid 05/01/2024
Cochlear Implants Medical Policy PA Medicaid 12/01/2023
Colorectal Cancer Screening Medical Policy PA Medicaid 11/01/2023
Concurrent Care Medical Policy PA Medicaid 12/01/2023
Cosmetic Procedures Medical Policy PA Medicaid 03/01/2024
Deep Brain Stimulation (DBS) Medical Policy PA Medicaid 07/01/2023
Deep Bronchial Thermoplasty Medical Policy PA Medicaid 10/01/2022
Drug Testing Medical Policy PA Medicaid 09/01/2023
Dual-Energy X-ray Absorptiometry (DXA) for Vertebral Fracture Assessment Medical Policy PA Medicaid 12/01/2023
Electrical Bone Growth Stimulators (Noninvasive/Invasive, Spinal, & Ultrasound) Medical Policy PA Medicaid 12/01/2023
Electrical Stimulation for Oropharyngeal Dysphagia Medical Policy PA Medicaid 02/01/2024
Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) Medical Policy PA Medicaid 10/01/2023
Enteral Feeding In-Line Cartridge (EFIC™) Medical Policy PA Medicaid 07/01/2023
Exhaled Nitric Oxide Measurement in the Management of Respiratory Disorders Medical Policy PA Medicaid 12/01/2023
Experimental/Investigational Laboratory Services Medical Policy PA Medicaid 12/01/2023
Experimental/Investigational Services Medical Policy PA Medicaid 09/01/2023
Fecal Microbiota Transplant Medical Policy PA Medicaid 12/01/2023
Fetal Aneuploidy Testing Using Noninvasive Cell-Free Fetal DNA Medical Policy PA Medicaid 10/01/2023
Gastric Electrical Stimulation (GES) Medical Policy PA Medicaid 03/01/2024
Gastrointestinal Pathogen Assays Medical Policy PA Medicaid 04/01/2023
Gender Affirmation Services Medical Policy PA Medicaid 04/01/2023
Gene Expression and Biomarker Prostate Cancer Testing Medical Policy PA Medicaid 11/01/2023
Gene Expression Testing for Cancer Treatment (Breast, Colon, Prostate) Medical Policy PA Medicaid 12/01/2023
Genetic Testing for Cystic Fibrosis Medical Policy PA Medicaid 12/01/2023
Genetic Testing for Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Attenuated FAP and MYH-associated Polyposis Medical Policy PA Medicaid 11/01/2023
Genetic Testing for Warfarin and Clopidogrel Therapy Medical Policy PA Medicaid 08/01/2023
Home Oxygen Therapy (HOT) Medical Policy PA Medicaid 09/01/2023
Hyperbaric Oxygen Therapy (HBOT) Medical Policy PA Medicaid 11/01/2023
Hypoglossal Nerve Stimulation Implantation in the Treatment of Obstructive Sleep Apnea Medical Policy PA Medicaid 03/01/2024
Hysterectomy for Benign Conditions Medical Policy PA Medicaid 08/01/2023
Intraoperative Neurophysiologic Monitoring Medical Policy PA Medicaid 06/01/2024
Laboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease Medical Policy PA Medicaid 09/01/2023
Long-Term Acute Care (LTAC) Medical Policy PA Medicaid 03/01/2024
Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) Medical Policy PA Medicaid 04/01/2023
Minimally Invasive Lumbar Decompression (MILD) Medical Policy PA Medicaid 03/01/2023
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules Medical Policy PA Medicaid 10/01/2023
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) Medical Policy PA Medicaid 10/01/2023
Multimarker Serum Testing Related to Ovarian Cancer Medical Policy PA Medicaid 03/01/2024
Myoelectric Upper Extremity Orthoses Medical Policy PA Medicaid 03/01/2024
Negative Pressure Wound Therapy in the Outpatient Setting Medical Policy PA Medicaid 03/01/2024
Non-Oncologic Genetic Testing Panels Medical Policy PA Medicaid 11/01/2023
Observation Care (Hospital Outpatient) Medical Policy PA Medicaid 12/01/2023
Oncologic Genetic Testing Panels Medical Policy PA Medicaid 03/01/2024
Panniculectomy/Abdominoplasty/Lipectomy Medical Policy PA Medicaid 03/01/2024
Passive Oscillatory Devices in the Outpatient Setting Medical Policy PA Medicaid 03/01/2024
Pharmacogenetic Testing Medical Policy PA Medicaid 11/01/2023
Prescription Digital Therapeutics (e.g., reSET and reSET-O) Medical Policy PA Medicaid 03/01/2024
Prostatic Urethral Lift Medical Policy PA Medicaid 03/01/2023
Pulmonary Rehabilitation (PR) Medical Policy PA Medicaid 06/01/2024
Repetitive Transcranial Magnetic Stimulation Medical Policy PA Medicaid 09/01/2023
Scanning Computerized Ophthalmic Diagnostic Imaging Medical Policy PA Medicaid 08/01/2023
Selected Tests for Rheumatic Diseases Medical Policy PA Medicaid 09/01/2023
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus Medical Policy PA Medicaid 09/01/2023
Single-use Ambulatory Electrocardiographic Monitors (e.g., Zio Patch) Medical Policy PA Medicaid 03/01/2024
Skin Replacement Therapy for Chronic Non healing Wounds in the Outpatient Settin Medical Policy PA Medicaid 03/01/2023
Speech Generating Devices Medical Policy PA Medicaid 05/01/2024
Supervised Exercise Therapy (SET) in the Management of Peripheral Artery Disease Medical Policy PA Medicaid 03/01/2024
Surgical Treatment of Obstructive Sleep Apnea Medical Policy PA Medicaid 11/01/2023
Testing for Genetic Disease Medical Policy PA Medicaid 01/01/2024
Tumor Markers Medical Policy PA Medicaid 09/01/2023
Ultrasound Bone GrowtMultimarker Serum Testing Related to Ovarian Cancerh Stimulators Medical Policy PA Medicaid 05/01/2023
Upper Gastrointestinal Endoscopy (EGD-esophagogastroduodenoscopy) Medical Policy PA Medicaid 11/01/2023
Vitamin D Assay Testing Medical Policy PA Medicaid 06/01/2024
Wearable Cardioverter-Defibrillators in the Home Setting Medical Policy PA Medicaid 07/01/2023
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders Medical Policy PA Medicaid 10/01/2023

Highmark Wholecare Policy Disclaimer

  • The Policies neither constitutes nor substitutes for medical advice. Highmark Wholecare’s Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of Highmark Wholecare. If members have a specific question about their medical condition, they should consult with their provider.
  • In the event of a conflict between the Policy and Member Handbook or Evidence of Coverage, the express terms of the Member Handbook or Evidence of Coverage will govern. The existence of a medical guideline is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the medical guideline.  The Policies are used in making decisions as to medical necessity only and they do not guarantee payment of services. Policies serve as one of the sets of guidelines for coverage decisions.
  • The information on this website may not reflect a recent policy change or all of the applicable medical guidelines.
Last updated on 4/29/2024 5:44:04 PM

 

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