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Additions and revisions may affect your practice
For complete information, visit Wellmark.com (Provider > Medical Policies & Authorization).
New Policies
Revised Policies
Cetuximab*
Wellmark considers cetuximab medically necessary for treatment of non-small cell lung cancer. Previously considered investigational.
Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
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Removed prior approval recommendation from continuous monitoring effective immediately. Wellmark will continue to apply medical policy requirements and monitor utilization.
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Removed age minimum of 18 years old from medically necessary language for continuous interstitial glucose monitoring.
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No changes made to medical policy for intermittent monitoring.
Small Bowel Transplant*
Wellmark considers the transplant of living donor intestine medically necessary for patients who otherwise meet the criteria in the medical policy.
Small Bowel/Liver and Multivisceral Transplant*
Wellmark considers the transplant of living donor intestine medically necessary for patients who otherwise meet the criteria in the medical policy.
Minimally Invasive Spinal Fusion using Axial Lumbar Interbody Fusion or Extreme Lateral Interbody Fusion*
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We have incorporated the medical policies for all spinal fusions, including minimally invasive approaches, into one Spinal Fusion medical policy.
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We now recommend prior approval for all spinal fusions.
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XLIF® (a minimally invasive approach) is now considered medically necessary if the criteria in the policy are met. AxiaLif® remains investigational.
Tocilizumab (Actemra)*
Wellmark considers tocilizumab medically necessary for active systemic idiopathic juvenile arthritis, also known as Still’s disease, in children age 2 years and older.
*Prior Approval or Treatment Request recommended.
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