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Reminder: Clinical Policies Available on Our Website

Date: 03/30/22

As part of Louisiana Healthcare Connections commitment to ensure that we comply with industry standards, we continually review and update our payment and utilization policies. Louisiana Healthcare Connections would like to remind providers to reference the following policies for important information when providing care to our members.

  • ADHD-LA.CP.MP.124 (PDF)
    Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in children and also occurs with an increasing prevalence of diagnosis in adults. ADHD affects the cognitive, academic, emotional, and social well-being of individuals and can persist throughout life. While there is no single test to diagnose ADHD, a clinical assessment based on defined clinical parameters establishes criteria for diagnosis in children and adults.
  • Allergy testing-LA.CP.MP.100 (PDF)
    Allergy testing is performed to determine immunologic sensitivity or reaction to antigens for the purpose of identifying the cause of the allergic state.
  • Evoked Potential Testing-LA.CP.MP.134 (PDF)
    Monitoring of neurophysiologic evoked potentials intraoperatively helps prevent neurologic injury during neurological, orthopedic, and other types of surgeries. This policy describes the medically necessary indications for neurophysiologic evoked potentials
  • Urodynamic Testing-LA.CP.MP.98 (PDF)
    Urodynamic testing is an important part of the comprehensive evaluation of voiding dysfunction. The clinician must exercise clinical judgment in the appropriate selection of urodynamic tests following an appropriate evaluation and symptom characterization. The purpose of this policy is to define medical necessity criteria for commonly used urodynamic studies.
  • Bronchial Thermoplasty-LA.CP.MP.110 (PDF)
    Bronchial Thermoplasty (BT), is a bronchoscopic procedure that utilizes radiofrequency ablation to reduce airway smooth muscle cells. It is designed to serve as a therapeutic option to reduce severe bronchoconstriction for severe persistent asthma.
  • Cardiac Biomarker Testing-LA.CP.MP.156 (PDF)
    This policy discusses the release of cardiac biomarkers is among the cascade of events that occur during acute coronary syndromes and cardiac ischemia. This policy discusses the medical necessity requirements for testing of these cardiac biomarkers
  • Polymerase Chain Reaction Respiratory Viral Panel Testing-LA.CP.MP.181 (PDF)
    This policy idescibes the medical necessity for multiplex respiratory polymerase chain reaction(PCR) testing.
  • 25-hydroxyvitamin D Testing in Children and Adolescents-LA.CP.MP.157 (PDF)
    It is the policy of Louisiana Healthcare Connections that 25-hydroxyvitamin D testing in healthy, including obese but otherwise healthy, children (age ≥ 1 and ≤ 18) is not medically necessary because these tests have not been demonstrated to have a clear clinical benefit. 
  • Homosysteine Testing-LA.CP.MP.121(PDF)
    The purpose of this policy is to discuss that Homocysteine testing is medically necessary for homocystinuria caused by cystathionine beta-synthase deficiency.
  • Ambulatory Electroencephalography(EGG)-LA.CP.MP.96 (PDF)
    This policy discusses that EGG is a diagnostic test used to evaluate an individual in whom a seizure disorder or possibly nonepileptic attacks are suspected but not conclusively confirmed by the person's medical history, physical examination, and a previous routine or standard (awake and asleep) EEG. Ambulatory EEG monitoring allows extended interictal EEG recording outside of a clinic or a hospital and can allow patients to “mark” events experienced on the EEG recording.
  • Thyroid Testing in Pediatrics-LA.CP.MP.154 (PDF)
    This policy discusses that thyroid hormone testing in healthy, including obese but otherwise healthy, children (age ≥ 1 and ≤ 18) is not medically necessary because these tests have not been demonstrated to have a clear clinical benefit.
  • Ultrasound in Pregnacy-LA.CP.MP.38 (PDF)
    This policy outlines how ultrasound is the most common fetal imaging tool used today. Ultrasound is accurate at determining gestational age, fetal number, viability, and placental location; and is necessary for many diagnostic purposes in obstetrics. The determination of the time and type of ultrasound should allow for a specific clinical question(s) to be answered. Ultrasound exams should be conducted only when indicated and must be appropriately documented.

Providers can find all clinical policies on our website for additional information.