Clinical Policy Annual Review

Fecha: 11/04/24

The following clinical policies have undergone an annual review with some added criteria requirements that may impact the prior authorization process. Please see the revision log within each policy to review the changes:

• Hyperhidrosis Treatments
• NICU Apnea Bradycardia Guidelines
• Implantable Intrathecal or Epidural Pain Pump
• Outpatient Oxygen Use
• Implantable Loop Recorder
• Facility-based Sleep Studies for Obstructive Sleep Apnea
• CG Hereditary Cancer Susceptibility
• CG Metabolic, Endocrine, and Mitochondrial Disorders
• CG Prenatal and Preconception Carrier Screening
• Applied Behavioral Analysis
• Concert Genetics Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss
• Concert Genetics Genetic Testing: Aortopathies and Connective Tissue Disorders
• Concert Genetics Genetic Testing: Cardiac Disorders
• Concert Genetics Genetic Testing: Dermatologic Conditions
• Concert Genetics Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Disorders
• Concert Genetics Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders
• Concert Genetics Genetic Testing: Eye Disorders
• Concert Genetics Genetic Testing: Gastroenterologic Disorders (Non-Cancerous)
• Concert Genetics Genetic Testing: General Approach to Genetic and Molecular Testing
• Concert Genetics Genetic Testing: Hearing Loss
• Concert Genetics Genetic Testing: Hematologic Conditions (Non-Cancerous)
• Concert Genetics Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders
• Concert Genetics Genetic Testing: Kidney Disorders
• Concert Genetics Genetic Testing: Lung Disorders
• Concert Genetics Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
• Concert Genetics Genetic Testing: Non-Invasive Prenatal Screening (NIPS)
• Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies
• Concert Genetics Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy)
• Concert Genetics Oncology: Algorithmic Testing
• Concert Genetics Oncology: Cancer Screening
• Concert Genetics Oncology: Cytogenetic Testing
• Concert Genetics Genetic Testing: Pharmacogenetics
• Concert Genetics Genetic Testing: Preimplantation Genetic Testing 
• Concert Genetics Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders
• Mechanical Stretching Devices for Joint Stiffness
• Burn Surgery
• Transplant Service Documentation Requirements
• Stereotactic Body Radiation Therapy

For more information review the Clinical & Payment Policies page.