Policy updates include:

• Updated week requirement criteria I.B.4.a.-c

Policy updates include:

• Revised criteria II.D.3.c. added “after bronchodilator (if able to obtain);
• Under II.E.2.b. added “or upper urinary tract infection
• Updated II.E.2.f. “over” with “during the previous”
• Under II.G. removed “Failure” and replaced with “Disease”
• Under II.I.2.a. removed “up to” and replaced with “the last”

Intestinal and Multivisceral Transplant

(CP.MP.58)

Policy updates include:

• Expanded criteria under II.A.4. to include (e.g. opioid dependency, or pseudo-obstruction)
• Updated contraindication under II.B.3. Glomerular filtration rate < 40 mL/min/1.73m2 to <30mL/min/1.73m2
• Expanded contraindication under II.B.4.a-II.B.4.c. to include CD4 cell count >200 cells/mm3; Absence of active AIDS-defining opportunistic infection (unless treated efficaciously or prevented, can be included on the heart transplant waiting list) or malignancy; Member/enrollee is currently on effective ART (antiretroviral therapy)

Policy updates include:

• Removed contraindications under II.F. including uncontrolled cardiac arrhythmias, unstable angina, joint replacement in a location targeted by FES and seizure disorder

Policy updates include:

• Added HIV points a. - c., under I.C.2

Policy updates include:

• Verbiage updated in criteria I.A.4.b
• Removed criteria I.A.4.c. and d. Criteria updated to include mammogram requirement for members/enrollees < 40 years of age with symptoms of breast cancer or high-risk factors for breast cancer in what is now I.A.4.c
• Clarifying language added to Criteria II.A.2
• Criteria II.B.3. updated to include clarifying language and to include gynecomastia that persists for more than three months after unsuccessful medical treatment for pathological gynecomastia
• Criteria II.B.4. updated to include clarifying language