Arthrotomy for Temporomandibular Joint (TMJ)
Effective 1 de enero de 2025, CPT code 21010 will change from requiring prior authorization to covered for both Medicare Advantage plans and commercial products. Effective 1 de julio de 2025, this policy will be archived and CPT code 21010 will remain covered for both Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Genetic Testing for Diagnosis and Management of Mental Health Conditions
Effective 1 de enero de 2025, CPT code 0392U will be changed to covered for Medicare Advantage plans and commercial products. As a result, CPT code 0392U will be removed from this policy. This change in coverage for CPT code 0392U will also be reflected in medical policy, PLA and MAAA codes and coverage, effective 1 de enero de 2025. For additional details related to this policy, please click here.
Genetic Testing Services
Effective 1 de enero de 2025, CPT code 81490 will change to a covered service for commercial products. For additional details related to this policy, please click here.
Glucose Monitoring - Continuous
Effective 1 de enero de 2025, the medical criteria for commercial products for implantable continuous glucose monitors (CGMs) will be revised. There will be no other changes for this medical policy. For additional details related to this policy, please click here.
Hydrogel Spacer Use During Radiotherapy for Prostate Cancer
Effective 1 de enero de 2025, CPT code 55874 will change from requiring prior authorization to being covered for commercial products. CPT 55874 will continue to be covered for Medicare Advantage plans. Effective 1 de julio de 2025, this policy will be archived and CPT code 55874 will remain covered for both Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Invasive Prenatal (Fetal) Diagnostic Testing
Effective 1 de enero de 2025, CPT code 0469U will continue to require prior authorization for Medicare Advantage plans and commercial products but will be added to this medical policy and will be reviewed utilizing the medical necessity criteria in this policy. For additional details related to this policy, please click here.
Identification of Microorganisms Using Nucleic Acid Probes
Effective 1 de enero de 2025, the medical criteria for Medicare Advantage plans and commercial products will be revised. There will be no other changes for this medical policy. For additional details related to this policy, please click here.
Low-Level Laser Therapy
Annual review of policy completed with a correction to the coding section of the policy. No change to policy statement or intent of policy. Correction made to remove CPT 93037, which is not a valid code, from Coding section of policy and replaced it with 97037 which is the correct and intended code. No other changes made to policy. For additional details related to this policy, please click here.
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
Effective 1 de enero de 2025, the policy statement for Medicare Advantage plans and commercial products will be revised. There will be no other changes for this medical policy. For additional details related to this policy, please click here.
Peripheral Artery Disease (PAD) Rehabilitation
Effective 1 de enero de 2025, PAD rehabilitation will be covered for commercial products when rendered as part of a supervised exercise therapy (SET) program. There will be no changes for Medicare Advantage plans. For additional details related to this policy, please click here.
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA
Effective 1 de enero de 2025, for Medicare Advantage plans and commercial products, CPT 0392U will change to a covered service. CPT 0469U will be added to the Invasive Prenatal (Fetal) Diagnostic Testing policy and will be reviewed for medical necessity using the criteria in that policy rather than the criteria in the Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA) policy for Medicare and commercial. For additional details related to this policy, please click here.
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Effective 1 de enero de 2025, the medical criteria for the commercial products for hypoglossal nerve stimulation portion of the policy will be revised. There will be no other changes for this medical policy. For additional details related to this policy, please click here.
Vitamin-D Testing
Effective 1 de enero de 2025, additional ICD-10 codes related to liver disease will be added as medically necessary for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.