Medical Policy Update

New:

MYvantage® Hereditary Comprehensive Cancer Panel

Doula Services — Medicaid

Revised:

Urine Drug/Alcohol Testing

  • Removed guideline applicability solely to HMO
  • Clarified test types/technical methodologies
  • Updated Parent Drugs and Metabolite Chart in Appendix

Gene Expression Profiling

  • Added Clonoseq® for Medicare members
  • Removed MYvantage from Limitations/Exclusions and added link to the MYvantage® Hereditary Comprehensive Cancer Panel Medical Guideline

Obstructive Sleep Apnea Diagnosis and Treatment

  • Added the following indications to the attended PSG section for adults:
    • cognitive/physical impairment
    • suspected/established diagnosis of:
      • central sleep apnea
      • periodic limb movement disorder
      • narcolepsy
      • idiopathic hypersomnia
      • parasomnia or nocturnal seizures
    • chronic opiate use
    • oxygen dependency
  • Added positive coverage criteria for hypoglossal nerve stimulation (HGNS)

Acupuncture – Medicare benefit update
Beginning on January 1, 2019 Acupuncture is a covered benefit for the following Medicare plans:

  • EmblemHealth VIP Essential (HMO)
  • VIP Dual (HMO SNP)
  • VIP Premier (HMO)
  • VIP Rx Carve Out (HMO) - Group Medicare plans for City of New York retirees
  • Affinity Medicare Passport Essentials (HMO)
  • Affinity Medicare Passport Essentials NYC (HMO)

To provide acupuncture benefits to these Medicare members, you must be a participating provider of EmblemHealth VIP Prime Network.