Effective August 1, 2024: Clinical Policies

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Home Ventilators

(MC.CP.MP.184)

Wellcare By Allwell (Medicare)

New Policy Overview:

• Medical necessity criteria for noninvasive and invasive home ventilators
• Timeframes and documentation for continued use
• Medical necessity criteria for a second or back up ventilator
• Policy Background
• Coding implications

Omisirge

(MC.CP.MP.249)

Wellcare By Allwell (Medicare)

New Policy Overview:

• Medical necessity criteria for Omisirge (Omidubicel-onlv)
• Policy Background
• Coding implications

Outpatient Oxygen Use

(MC.CP.MP.190)

Wellcare By Allwell (Medicare)

New Policy Overview:

• Medical necessity criteria and guidelines for Oxygen Therapy
• Reauthorization of oxygen therapy medical necessity criteria
• Policy Background
• Coding implications

Peripheral Nerve Blocks

(MC.CP.MP.170)

Wellcare By Allwell (Medicare)

Policy updates include:

• Added criteria III.B. regarding genicular nerve blocks

Transplant Service Documentation Requirements

(MC.CP.MP.247)

Wellcare By Allwell (Medicare)

New Policy Overview:

• Determination of medical necessity criteria for transplant procedures based on documentation
• Listing of information for initial and subsequent transplant requests
• Policy Background
• Coding implications