Apheresis (for New Jersey Only)
Policy governing coverage and medical necessity of therapeutic apheresis procedures for members in New Jersey; describes covered indications, unproven indications, service descriptions, and applicable procedure codes.
Replaced language that therapeutic apheresis including plasma exchange or photopheresis is unproven and not medically necessary for treating or managing the [listed] conditions/diagnoses with language that it is unproven and not medically necessary for treating or managing any other conditions/diagnoses not listed as proven and medically necessary.
Added medical records documentation language clarifying that benefit coverage is determined by federal, state, or contractual requirements, that medical records may be required to assess criteria, and enumerating documentation expectations.
Added notation that CPT code 36514 is not on the State of New Jersey Medicaid Fee Schedule and therefore may not be covered by that program.
Updated Clinical Evidence, FDA, and References sections to reflect current information and archived previous policy version CS004NJ.N.
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