Aetna Medicare Plan (HMO), all Aetna HealthFund®products, Aetna Health Network Only℠, Aetna Health Network Option℠, Aetna Open Access®Elect Choice®, Aetna Open Access HMO, Aetna Open Access Managed Choice®, Open Access Aetna Select℠, Elect Choice, HMO, Managed Choice POS, Op...
Furthermore, a recently published Medicare National Coverage Determination (February 8, 2016) considers LAA closure devices not reasonable and necessary and only allows coverage within certain clinical trials (CMS, 2016). The CMS Decision Memorandum states: "At this time, there is insufficient evidence...
(MLR) going up to 89.6% from 86.2%. These were attributed to increased utilization, the decline in Medicare Advantage Star ratings, Medicaid acuity, and a revised risk adjustment in the individual exchange business. Something in this immediately doomed now former president Brian Kane, who joined ...
Replacement of oral appliances is considered medically necessary at the end of their 5-year RUL. Replacement of these items is considered medically necessary prior to the end of the 5-year RUL due to a change in the member’s condition. Replacement needed due to misuse or abuse are not cove...
These researchers stated that the personalized BD appeared to create a comparable response between patients that have already been recommended knee joint replacement surgery and those that have not been recommended; thus, potentially providing an alternative solution for this population. If these findings...
they compared Medicare beneficiaries with ESRD to a 5 % sample of Medicare beneficiaries without ESRD. The primary outcome was survival after LVAD placement. Among the patients with ESRD, the mean age was 58.4 (12.1) years and 62.0 % (96) were men. Among those without ESRD, the mean age ...
This Clinical Policy Bulletin addresses testosterone undecanoate (Aveed) injection for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of testosterone undecanoate injection (Aveed) is required of all Aetna participating providers ...
Medicare Coverage Database. Baltimore, MD: CMS; January 27, 2005. Center for Medicare and Medicaid Services (CMS). Implantable cardioverter defibrillators (ICDs) (#CAG-0057N). Decision memorandum. National Coverage Analyses. Baltimore, MD: CMS; June 6, 2003. Center for Medicare and Medicaid ...
Policy Scope of Policy This Clinical Policy Bulletin addresses parenteral immunoglobulins for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of intravenous immunoglobulins (IVIG) [Alyglo, Asceniv, Bivigam, Flebogamma DIF, Ga...