PAYMENT POLICY UPDATES

Date: 02/19/25

PAYMENT POLICY UPDATES

Wellcare reviews all clinical policies at least annually. This review is done to ensure medical necessity review criteria is current and appropriate for members and the scope of the services. On a
quarterly basis, prior to updates, clinical policies are reviewed and approved by the National Medicare Quality Improvement & Management Committee (QI/UMC).

All new polices and policies with updates may be found on our Medical Clinical Policy Updates page. The full list of policies may be found on the Medical Clinical Policies page.

Please reach out to your Provider Engagement Administrator if you have any questions.

Policy Updates: Effective: April 20, 2025

MEDICAL CLINICAL POLICIES WITH CHANGES

• Outpatient Oxygen Use MC.CP.MP.190
• Concert Genetic Testing: Pharmacogenetics (Version A) V.2025.1
• Concert Genetic Testing: Aortopathies and Connective Tissue Disorders V.2025.1
• Concert Genetic Testing: Cardiac Disorders V.2025.1
• Concert Genetic Testing: Dermatologic Conditions V.2025.1
• Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions
• V.2025.1
• Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic
• Disorders V.2025.1
• Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic
• Disorders V.2025.1
• Concert Genetic Testing: Eye Disorders V.2025.1
• Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous) V.2025.1
• Concert Genetic Testing: General Approach to Genetic and Molecular Testing V.2025.1
• Concert Genetic Testing: Hearing Loss V.2025.1
• Concert Genetic Testing: Hematologic Conditions (non-cancerous) V.2025.1
• Concert Genetic Testing: Hereditary Cancer Susceptibility V.2025.1
• Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders V.2025.1
• Concert Genetic Testing: Kidney Disorders V.2025.1
• Concert Genetic Testing: Lung Disorders V.2025.1
• Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders V.2025.1
• Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and
• Developmental Delay V.2025.1
• Concert Genetic Testing: Non-invasive Prenatal Screening (NIPS) V.2025.1
• Concert Genetic Testing: Preimplantation Genetic Testing V.2025.1
• Concert Genetic Testing: Prenatal and Preconception Carrier Screening V.2025.1
• Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and
• Pregnancy Loss V.2025.1
• Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders V.2025.1
• Concert Genetics Oncology: Algorithmic Testing V.2025.1
• Concert Genetics Oncology: Cancer Screening V.2025.1
• Concert Genetics Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid
• Biopsy) V.2025.1
• Concert Genetics Oncology: Cytogenetic Testing V.2025.1
• Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic
• Malignancies V.2025.1

RETIRED

• Short Inpatient Hospital Stay MC.CP.MP.182