Medicaid Policy Search

Last Updated: Thursday, December 18, 2025

Please access the Prior Authorization Code Lookup to determine if a drug/HCPCS code requires authorization. To submit authorization requests, please visit the Highmark Wholecare Provider Portal via Navinet: https://navinet.navimedix.com.

Ambulance Services – Air	Medical Policy	PA Medicaid	04/01/2025
Ambulance Services – Ground	Medical Policy	PA Medicaid	08/01/2025
Artificial Pancreas	Medical Policy	PA Medicaid	03/01/2026
Automated Ambulatory Blood Pressure Monitoring (ABPM)	Medical Policy	PA Medicaid	10/01/2025
Bariatric Surgery	Medical Policy	PA Medicaid	05/01/2025
BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia	Medical Policy	PA Medicaid	03/01/2025
BRAF Mutation Analysis	Medical Policy	PA Medicaid	10/01/2025
BRCA1 and BRCA2 Genetic Mutation Testing	Medical Policy	PA Medicaid	06/01/2025
Breast Reconstructive Surgery	Medical Policy	PA Medicaid	07/01/2025
Breast Scintimammography	Medical Policy	PA Medicaid	12/01/2025
Bronchial Thermoplasty	Medical Policy	PA Medicaid	10/01/2024
Bronchial Valves	Medical Policy	PA Medicaid	12/01/2025
Capsule Endoscopy	Medical Policy	PA Medicaid	03/01/2025
Cardiac Contractility Modulation (CCM) Therapy	Medical Policy	PA Medicaid	12/01/2025
Cardiac Monitors	Medical Policy	PA Medicaid	04/01/2025
Cardiac Rehabilitation, Phase II Outpatient	Medical Policy	PA Medicaid	08/01/2025
Cardiovascular Disease Laboratory Testing	Medical Policy	PA Medicaid	12/01/2025
Carpal Tunnel Surgery	Medical Policy	PA Medicaid	06/01/2025
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	12/01/2025
Cochlear Implants	Medical Policy	PA Medicaid	12/01/2025
Colorectal Cancer Screening	Medical Policy	PA Medicaid	10/01/2024
Concurrent Care	Medical Policy	PA Medicaid	12/01/2025
Cosmetic Procedures	Medical Policy	PA Medicaid	04/01/2025
Deep Brain Stimulation (DBS)	Medical Policy	PA Medicaid	07/01/2025
Drug Testing	Medical Policy	PA Medicaid	09/01/2025
Dual-Energy X-ray Absorptiometry (DXA) for Vertebral Fracture Assessment	Medical Policy	PA Medicaid	12/01/2025
Electrical Bone Growth Stimulators (Noninvasive/Invasive, Spinal, & Ultrasound)	Medical Policy	PA Medicaid	12/01/2025
Electrical Stimulation for Oropharyngeal Dysphagia	Medical Policy	PA Medicaid	12/01/2025
Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP)	Medical Policy	PA Medicaid	12/01/2025
Enteral Feeding In-Line Cartridge (EFIC™)	Medical Policy	PA Medicaid	01/01/2025
Exhaled Nitric Oxide Measurement in the Management of Respiratory Disorders	Medical Policy	PA Medicaid	12/01/2025
Experimental/Investigational Laboratory Services	Medical Policy	PA Medicaid	10/01/2025
Experimental/Investigational Services	Medical Policy	PA Medicaid	12/01/2025
Fecal Microbiota Transplant	Medical Policy	PA Medicaid	10/01/2025
Fetal Aneuploidy Testing Using Noninvasive Cell-Free Fetal DNA	Medical Policy	PA Medicaid	04/01/2025
Gastric Electrical Stimulation (GES)	Medical Policy	PA Medicaid	12/01/2025
Gastrointestinal Pathogen Assays	Medical Policy	PA Medicaid	04/01/2025
Gender Affirmation Services	Medical Policy	PA Medicaid	06/01/2025
Gene Expression and Biomarker Prostate Cancer Testing	Medical Policy	PA Medicaid	12/01/2025
Gene Expression Testing for Cancer Treatment (Breast, Colon, Prostate)	Medical Policy	PA Medicaid	03/01/2026
Genetic Testing for Cystic Fibrosis	Medical Policy	PA Medicaid	01/01/2025
Genetic Testing for Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Attenuated FAP and MYH-associated Polyposis	Medical Policy	PA Medicaid	11/01/2024
Genetic Testing for Warfarin and Clopidogrel Therapy	Medical Policy	PA Medicaid	08/01/2025
Home Oxygen Therapy (HOT)	Medical Policy	PA Medicaid	12/01/2025
Hyperbaric Oxygen Therapy (HBOT)	Medical Policy	PA Medicaid	12/01/2025
Hypoglossal Nerve Stimulation Implantation in the Treatment of Obstructive Sleep Apnea	Medical Policy	PA Medicaid	03/01/2025
Hysterectomy for Benign Conditions	Medical Policy	PA Medicaid	10/01/2025
Intraoperative Neurophysiologic Monitoring	Medical Policy	PA Medicaid	04/01/2025
Laboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease	Medical Policy	PA Medicaid	09/01/2025
Liver Fibrosis Assessment Biomarkers	Medical Policy	PA Medicaid	10/01/2025
Long-Term Acute Care (LTAC)	Medical Policy	PA Medicaid	12/01/2025
Lymphoscintigraphy	Medical Policy	PA Medicaid	12/01/2025
Magnetic Resonance-Guided Focused Ultrasound (MRgFUS)	Medical Policy	PA Medicaid	04/01/2025
Minimally Invasive Lumbar Decompression (MILD)	Medical Policy	PA Medicaid	08/01/2025
Molecular Markers for Fine Needle Aspirates of Thyroid Nodules	Medical Policy	PA Medicaid	10/01/2024
Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC)	Medical Policy	PA Medicaid	03/01/2026
Multimarker Serum Testing Related to Ovarian Cancer	Medical Policy	PA Medicaid	03/01/2025
Myoelectric Upper Extremity Orthoses	Medical Policy	PA Medicaid	03/01/2026
Negative Pressure Wound Therapy in the Outpatient Setting	Medical Policy	PA Medicaid	03/01/2025
Nerve Conduction Studies (NCS) and Electromyography (EMG)	Medical Policy	PA Medicaid	04/01/2025
Non-Oncologic Genetic Testing Panels	Medical Policy	PA Medicaid	03/01/2025
Observation and Inpatient Admissions	Medical Policy	PA Medicaid	03/01/2026
Observation Care (Hospital Outpatient)	Medical Policy	PA Medicaid	10/01/2025
Obstetrical Ultrasound	Medical Policy	PA Medicaid	12/01/2024
Oncologic Genetic Testing Panels	Medical Policy	PA Medicaid	11/01/2024
Panniculectomy/Abdominoplasty/Lipectomy	Medical Policy	PA Medicaid	03/01/2025
Passive Oscillatory Devices in the Outpatient Setting	Medical Policy	PA Medicaid	04/01/2025
Pharmacogenetic Testing	Medical Policy	PA Medicaid	12/01/2025
Prescription Digital Therapeutics (e.g., reSET and reSET-O)	Medical Policy	PA Medicaid	02/01/2025
Pulmonary Rehabilitation (PR)	Medical Policy	PA Medicaid	06/01/2025
Pulse Oximetry, Home Use	Medical Policy	PA Medicaid	12/01/2025
Repetitive Transcranial Magnetic Stimulation	Medical Policy	PA Medicaid	12/01/2025
Scanning Computerized Ophthalmic Diagnostic Imaging	Medical Policy	PA Medicaid	03/01/2026
Selected Tests for Rheumatic Diseases	Medical Policy	PA Medicaid	09/01/2025
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus	Medical Policy	PA Medicaid	10/01/2025
Single-use Ambulatory Electrocardiographic Monitors (e.g., Zio Patch)	Medical Policy	PA Medicaid	01/01/2025
Skin Replacement Therapy for Chronic Non healing Wounds in the Outpatient Setting	Medical Policy	PA Medicaid	08/01/2025
Speech Generating Devices	Medical Policy	PA Medicaid	03/01/2026
Supervised Exercise Therapy (SET) in the Management of Peripheral Artery Disease	Medical Policy	PA Medicaid	02/01/2025
Surgical Treatment of Obstructive Sleep Apnea	Medical Policy	PA Medicaid	11/01/2024
Testing for Genetic Disease	Medical Policy	PA Medicaid	01/01/2025
Treatment of the Prostate	Medical Policy	PA Medicaid	08/01/2025
Treatment of Varicose Veins/Venous Insufficiency	Medical Policy	PA Medicaid	03/01/2026
Tumor Markers	Medical Policy	PA Medicaid	02/01/2025
Upper Gastrointestinal Endoscopy (EGD-esophagogastroduodenoscopy)	Medical Policy	PA Medicaid	11/01/2024
Vitamin D Assay Testing	Medical Policy	PA Medicaid	06/01/2024
Vision Therapy (Orthoptics and Pleoptics)	Medical Policy	PA Medicaid	10/01/2025
Wearable Cardioverter-Defibrillators in the Home Setting	Medical Policy	PA Medicaid	09/01/2024
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Medical Policy	PA Medicaid	04/01/2025

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