24-1257m Review Changes to Medicare Medical Policies - November 2024
Date: 11/27/24
See the new clinical policies and updates to existing polices to maintain compliance
The medical policies listed in this update were approved by Centene’s National Medicare Quality Improvement Utilization Management Committee and approved by Health Net. The listed policies are effective as of November 1, 2024.
For a complete description of the background, criteria, references, and coding implications for these Medicare medical policies, go to the Medicare Prior Authorization Medical Clinical Policies page.
Apply the Medicare National Coverage Decisions (NCDs) and applicable Local Coverage Decisions (LCDs) local policies for primary coverage guidance.
Clinical policies effective November 1, 2024
The following are Medicare clinical policies that have been approved for use. The listed policies are in alphabetical order and are effective as of November 1, 2024.
New policies added
Policy number | Name |
MC.CP.MP.209 | GI pathogen Nucleic Acid Detection Panel Testing |
MC.CP.MP.250 | Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy |
MC.CP.MP.181 | Polymerase Chain Reaction Resp Viral Panel Testing |
MC.CP.MP.185 | Skin and Soft Tissue Substitutes for Chronic Wounds |
Changes to existing policies
The following policies have been reviewed and multiple updates were made with some rewording applied for clarity.
Policy number | Name |
CPG Grid | Adoptive Clinical Practice and Preventive Health Guidelines |
MC.CP.MP.101 | Donor Lymphocyte Infusion |
MC.CP.MP.160 | Wireless Pulmonary Artery Monitoring |
MC.CP.MP.69 | Intensity-Modulated Radiotherapy |
MC.CP.MP.57 | Lung Transplantation |
MC.CP.MP.246 | Pediatric Kidney Transplant |
MC.CP.MP.170 | Peripheral Nerve Blocks |
CP.CPC.03 (CPC=Corporate Policy Committee) | Preventive Health and Clinical Practice Guideline Policy |
MC.CP.MP.182 | Short Inpatient Stay |
Concert Genetics (CG) policies, V2.2024
Policy number and title |
CG Aortopathies Connective Tissue Disorders |
CG Cardiac Disorders |
CG Dermatologic Conditions |
CG Epilepsy Neurodegenerative and Neuromuscular Conditions |
CG Exome and Genome Sequencing for Diagnosis of Genetic Disorders |
CG Eye Disorders |
CG Gastroenterologic Disorders (non-Cancerous) |
CG General Approach to Genetic Testing |
CG Hearing Loss |
CG Hematologic Conditions (non-Cancerous) |
CG Hereditary Cancer Susceptibility |
CG Immune, Autoimmune, and Rheumatoid Disorders |
CG Kidney Disorders |
CG Lung Disorders |
CG Metabolic, Endocrine and Mitochondrial Disorders |
CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay |
CG Non-invasive Prenatal Screening |
CG Oncology: Algorithmic Testing |
CG Oncology: Cancer Screening |
CG Oncology: Circulating Tumor DNA and Circulating Tumor Cells Liquid Biopsy |
CG Oncology: Cytogenetic Testing |
CG Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies |
CG Pharmacogenetics |
CG Preimplantation Genetic Testing |
CG Prenatal and Preconception Carrier Screening |
CG Prenatal Diagnosis via Amniocentesis, CVS or PUBS and Pregnancy Loss |
CG Skeletal Dysplasia and Rare Bone Disorders |
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.