Medical and Payment Policies

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Draft Medical Policies
Poteligeo (mogamulizumab-kpkc)
Medical
Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
Patient-Controlled End of Range Motion Stretching Devices
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
Percutaneous Electrical Nerve Stimulation and Percutaneous Neuromodulation Therapy
Peripheral Artery Disease (PAD) Rehabilitation
Peripheral Subcutaneous Field Stimulation
Phototherapy for the Treatment of Seasonal Affective Disorder
Phototherapy in the Home for the Treatment of Dermatological Conditions
Post Payment Audits
Post-partum Hospital Stays Mandate
Preventive Services for BlueCHiP for Medicare 2019
Preventive Services for Commercial Members
Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia
Prophylactic Mastectomy
Prostate Specific Antigen (PSA) Screening/Testing Mandate
Prostatic Urethral Lift
Pulsed Radiofrequency for the Treatment of Chronic Pain
Payment
Payment Adjustments for Error and Hospital Acquired Conditions
Payments for Outpatient Service Performed when a Member is Admitted as an Inpatient to a Different Hospital
Pharmacy Prescription Early Refill
Phototherapeutic Keratectomy
Physical and Occupational Therapy
Physical and Occupational Therapy Payment Cap
Physician Concierge Services
Preventive Medicine and Other Evaluation and Management Office/Outpatient Services
Professional Reporting Requirements for Services Not Personally Performed (AKA Incident to Services)
Prolonged Physician Services
Provider Guidelines for Requesting Point of Service Payment and Maintaining Patient Credit Card Information
Provider Reimbursement for Care Plan Management
Psychological and Neuropsychological Testing
Prior Authorization
Parsabiv (etelcalcetide)
PathFinderTG® Molecular Testing
Pediatric Dental Services Essential Health Benefit -Dental Review
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Percutaneous Tibial Nerve Stimulation
Polivy (polatuzumab vedotin-piiq)
Prior Authorization - Cardiology Services Effective 10/1/2019
Prior Authorization High-Tech Radiology Imaging Eff 10_1_2019
Prior Authorization of Drugs
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME)
Prior Authorization via Web-Based Tool for Procedures
Private Duty Nursing
Progesterone Therapy as a Technique to Reduce Preterm Birth in High-Risk Pregnancies
Prolia and Xgeva (Denosumab)
Proprietary Laboratory Analyses (PLA)
Proteogenomic Testing for Patients with Cancer
Provenge (Sipuleucel-T)
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