Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective March 11, 2014 (Posted December 31, 2013)

Medical Policy Revision
Lipid Apheresis "Notification" "New policy developed. LDL apheresis is covered for patients with homozygous familial hypercholesterolemia as an alternative to plasmapheresis. LDL apheresis is covered for patients with heterozygous familial hypercholesterolemia who have failed a 6-month trial of diet therapy and maximum tolerated combination drug therapy AND who meet the following FDA approved indications: (All LDL levels represent the best achievable LDL level after a program of diet and drug therapy.) 1. Functional hypercholesterolemic heterozygotes with LDL > 300 mg/dL 2. Functional hypercholesterolemic heterozygotes with LDL > 200 mg/dL AND documented coronary artery disease. LDL apheresis is not covered for all other clinical indications, with the exception of those listed above. HDL delipidation is not covered for any clinical indication. Medical Director review 11/2013. Notification given 12/31/2013 for effective date 3/11/2014."
Sleep Apnea: Diagnosis and Medical Management "Notification" Clarification added for a single night for a home sleep study. PAP-NAP studies are considered investigational. Reference added. Specialty Matched Consultant Advisory Panel review 8/21/13. Senior Medical Director review. Notification given 12/31/13 for policy effective date 3/11/14.