Medical Policy Updates

Medical Policy Update April 19, 2022

Medical Guidelines	Reason for Update
Convection-Enhanced Delivery of Therapeutic Agents to the Brain	Specialty Matched Consultant Advisory Panel review 3/16/2022. Reference added. No change to policy statement.
Cord Blood as a Source of Stem Cells	Specialty Matched Consultant Advisory Panel review 3/16/2022. No change to policy statement.
Monoclonal Antibody Imaging for Prostate Cancer	Specialty Matched Consultant Advisory Panel review 3/16/22. No change to policy statement.
Oncologic Applications of Photodynamic Therapy, Including Barrett’s Esophagus	Specialty Matched Consultant Advisory Panel review 3/16/2022. Reference added. No change to policy statement.
Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers	References added. Regulatory status updated. Policy Guidelines updated. Policy statement added that the use of lymphedema pumps applied to the head and neck to treat lymphedema is considered investigational. Notification given 2/8/2022 for policy effective date 4/19/2022.