Medicare Policy Search

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Name	Type	State	Effective
4Kscore Test Algorithm (L37792)	Medical Policy	PA Medicare	03/01/2025
Acupuncture for Chronic Low Back Pain (NCD 30.3.3)	Medical Policy	PA Medicare	01/01/2025
Ambulance Services (Air)	Medical Policy	PA Medicare	08/01/2025
Ambulatory Blood Pressure Monitor (NCD 20.19)	Medical Policy	PA Medicare	09/01/2024
Ambulatory Electrocardiograph (AECG) Monitoring (L39490)	Medical Policy	PA Medicare	04/01/2025
Assays for Vitamins and Metabolic Function (L34914)	Medical Policy	PA Medicare	03/01/2025
Assessing Patient’s Suitability for Electrical Nerve Stimulation Therapy (160.7.1 & 160.7)	Medical Policy	PA Medicare	02/01/2025
Automatic External Defibrillators (AED) (L33690)	Medical Policy	PA Medicare	06/01/2025
Biomarkers Overview (L35062)	Medical Policy	PA Medicare	12/01/2025
Blood Glucose Testing (NCD 190.20)	Medical Policy	PA Medicare	06/01/2025
Bronchial Thermoplasty	Medical Policy	PA Medicare	09/01/2024
Cardiac Rhythm Device Evaluation (L34833)	Medical Policy	PA Medicare	03/01/2025
Carpal Tunnel Surgery	Medical Policy	PA Medicare	11/01/2024
Cataract Extraction (including Complex Cataract Surgery)	Medical Policy	PA Medicare	04/01/2025
Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP)	Medical Policy	PA Medicare	08/01/2025
Cochlear Implantation (NCD 50.3)	Medical Policy	PA Medicare	05/01/2025
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)	Medical Policy	PA Medicare	09/01/2025
Cosmetic and Reconstructive Surgery (L35090)	Medical Policy	PA Medicare	08/01/2025
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) (L34636)	Medical Policy	PA Medicare	07/01/2025
Electrocardiographic Services (NCD 20.15)	Medical Policy	PA Medicare	04/01/2025
Fecal Microbiota Transplant	Medical Policy	PA Medicare	02/01/2025
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (L38229)	Medical Policy	PA Medicare	04/01/2025
Home Oxygen Therapy (L33797)	Medical Policy	PA Medicare	06/01/2025
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (L38385)	Medical Policy	PA Medicare	04/01/2025
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495)	Medical Policy	PA Medicare	01/01/2025
Medication Prior Authorization Criteria Part B	Medical Policy	PA Medicare	01/01/2024
Implantable Continuous Glucose Monitors (I-CGM) (L38617)	Medical Policy	PA Medicare	01/01/2025
Micro-Invasive Glaucoma Surgery (MIGS) (L38223)	Medical Policy	PA Medicare	03/01/2025
Negative Pressure Wound Therapy (NPWT) Pumps (L33821)	Medical Policy	PA Medicare	10/01/2024
Observation and Inpatient Admissions	Medical Policy	PA Medicare	03/01/2026
Observation Care (Hospital Outpatient)	Medical Policy	PA Medicare	10/01/2025
Osteogenic Stimulators (150.2)	Medical Policy	PA Medicare	12/01/2025
Percutaneous Transluminal Angioplasty (PTA) (NCD 20.7)	Medical Policy	PA Medicare	07/01/2025
Peripheral Nerve Stimulation (L37360)	Medical Policy	PA Medicare	03/01/2025
Peripheral Venous Ultrasound (L35341)	Medical Policy	PA Medicare	08/01/2024
Pharmacogenomic Testing for Warfarin Response (NCD 90.1)	Medical Policy	PA Medicare	11/01/2024
Post-Acute Care	Medical Policy	PA Medicare	03/01/2026
Pulmonary Rehabilitation (PR)	Medical Policy	PA Medicare	07/01/2025
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (LCD 34998)	Medical Policy	PA Medicare	05/01/2025
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)	Medical Policy	PA Medicare	07/01/2024
Speech-Generating Devices ((L33739)	Medical Policy	PA Medicare	03/01/2025
Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) (NCD 20.35)	Medical Policy	PA Medicare	12/01/2025
Testing for Genetic Disease	Medical Policy	PA Medicare	11/01/2024
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)	Medical Policy	PA Medicare	04/01/2025
Vitamin D Deficiency Screening	Medical Policy	PA Medicare	07/01/2023

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.

Medicare Policy Search

Name

Type

State

Effective