NEW POLICIES EFFECTIVE FEBRUARY 5, 2023

Number

Policy Name

 Policy Description

Line of Business

CP.MP.97

Testing for Select Genitourinary Conditions (previously Diagnosis of Vaginitis)

Medical necessity criteria for testing for vaginitis and bacterial vaginosis with direct DNA probe tests and amplified DNA probe tests.

Medicaid

CP.MP.38

Ultrasound in Pregnancy

This policy outlines the medical necessity criteria for ultrasound use in pregnancy. Ultrasound is the most common fetal imaging tool used today. Ultrasound is accurate at determining gestational age, fetal number, viability, and placental location; and is necessary for many diagnostic purposes in obstetrics. Determining the time and type of ultrasound should allow for a specific clinical question(s) to be answered. Ultrasound exams should be conducted only when indicated and must be appropriately documented.

Medicaid

CP.MP.100

Allergy Testing

The policy outlines the payment rules for allergy tests and immunotherapy treatments. It aims to incentivize providers to order tests only when necessary.

Medicaid

CP.MP.181

Polymerase Chain Reaction Respiratory Viral Panel Testing

Respiratory viral panels (RVPs) testing for 3-5 targets is considered medically necessary when performed in the outpatient setting and meeting the specific diagnostic requirements outlined in the policy or when performed in a healthcare setting that cares for critically ill patients. RVPs testing for six pathogens or more is only considered medically necessary when performed in healthcare settings that care for critically ill patients, such as the emergency department or inpatient hospital, including those in observation status.

Medicaid

CP.MP.110

Bronchial Thermoplasty

This policy provides a statement of medical necessity for bronchial thermoplasty (BT).

Medicaid