Medical Policy Updates

Medical Policy Update for August 23, 2022

Medical Guidelines	Reason for Update
Capsule Endoscopy, Wireless	Typo corrected under When Not Covered section. No change to policy statement.
Diagnosis of Vaginitis including Multi-target PCR Testing AHS – M2057	Added the following statement to When Not Covered section “Reimbursement is not allowed for screening of bacterial vaginosis using Aptima BV.” Medical Director review 8/2022.
Facet Joint Denervation	Criteria moved from Policy Guidelines section to When Covered section for clarity. No change to policy statement. Medical Director review 8/2022.
Quantose Impaired Glucose Tolerance (IGT) Test AHS - G2135	Test no longer available. Medical director review. Policy archived.
Therapeutic Radiopharmaceuticals in Oncology	Policy statement updated to include coverarge of Lutetium 177 (Lu 177) vipivotide tetraxetan (Pluvicto). No change to policy intent. Medical Director review 8/2022.