24-184 View the New Web Page for Medicare Medical Policies
Date: 02/14/24
Added clinical policies and updated Concert Genetics policies to the new web page
The medical policies listed in this update were approved by Centene’s National Medicare Quality Improvement Utilization Management Committee and are effective as of January 1, 2024. For a complete description of the background, criteria, references, and coding implications for these Medicare medical policies, go to the new Medicare Prior Authorization Medical Clinical Policies.
Apply the Medicare National Coverage Decisions (NCDs) and applicable Local Coverage Decisions (LCDs) local policies for primary coverage guidance.
Updated clinical policies effective January 1
The following Medicare Clinical Policies contain changes to their previous versions and have been approved for use. The listed policies are in numeric order and are effective as of January 1, 2024.
- MC.CP.MP.22 Stereotactic Body Radiation Therapy (PDF)
- MC.CP.MP.57 Lung Transplantation (PDF)
- MC.CP.MP.69 Intensity-Modulated Radiotherapy (PDF)
- MC.CP.MP.101 Donor Lymphocyte Infusion (PDF)
- MC.CP.MP.106 Endometrial Ablation (PDF)
- MC.CP.MP.108 Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and Beta-thalassemia (PDF)
- MC.CP.MP.160 Wireless Pulmonary Artery Monitoring (PDF)
- MC.CP.MP.170 Peripheral Nerve Blocks (PDF)
- MC.CP.MP.182 Short Inpatient Stay (PDF)
- CP.PP.206 Skilled Nursing Facility Leveling (PDF)
- MC.CP.MP.246 Pediatric Kidney Transplantation (PDF)
The following Concert Genetic Testing policies apply to Medicare:
Concert Genetics – Genetic Testing
Policy Name | Policy Name | Policy Name |
|---|---|---|
Algorithmic Testing | Aortopathies and Connective Tissue Disorders | Cancer Screening |
Cardiac Disorders | Dermatologic Conditions | Epilepsy, Neurodegenerative, and Neuromuscular Disorders |
Exome and Genome Sequencing for the Diagnosis of Genetic Disorders | Eye Disorders | Gastroenterologic Disorders (Non-Cancerous) |
General Approach to Genetic and Molecular Testing | Hearing Loss | Hematologic Conditions (Non-Cancerous) |
Hereditary Cancer Susceptibility | Immune, Autoimmune, and Rheumatoid Disorders | Kidney Disorders |
Lung Disorders | Metabolic, Endocrine, and Mitochondrial Disorders | Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay |
Non-Invasive Prenatal Screening (NIPS) | Pharmacogenetics | Preimplantation Genetic Testing |
Prenatal and Preconception Carrier Screening | Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss | Skeletal Dysplasia and Rare Bone Disorders |
Concert Genetics – Oncology
Policy Name | Policy Name | Policy Name |
|---|---|---|
Cytogenetic Testing | Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) | Molecular Analysis of Solid Tumors and Hematologic Malignancies |
Additional information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Provider Services Center
at 800-929-9224.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers and Behavioral Health Providers.