Arthrotomy for Temporomandibular Joint (TMJ) Evaluation of Hearing Impairment or Loss
Effective 1 de febrero de 2025, CPT codes 92562, 92572 and 92576 will continue to be not covered for Medicare Advantage plans and not medically necessary for commercial, which will be supported by additional policy statements under the Policy Statements section. For additional details related to this policy, please click here.
Blood Product Molecular Antigen Typing
Effective 1 de febrero de 2025, CPT code 0084U will be added to this policy. Prior authorization will continue to be required for Medicare Advantage plans and recommended for commercial products utilizing the medical necessity criteria in this policy instead of the medical necessity criteria in policy, Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA). For additional details related to this policy, please click here.
Fetal Surgery for Prenatally Diagnosed Malformations
Effective 1 de febrero de 2025, HCPCS code S2404 will change from not covered for Medicare Advantage plans and not medically necessary for commercial products to covered when medical criteria are met for both Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
New Technology and Miscellaneous Services
Effective 1 de febrero de 2025, CPT codes that are covered for both Medicare Advantage plans and commercial products will be removed from this policy. For additional details related to this policy, please click here.
Prior Authorization via Web-Based Tool for Procedures
Effective 1 de febrero de 2025, prior authorization will be added to the following CPT codes and lines of business:
- 33285: Commercial products only
- 57288: Medicare Advantage plans and commercial products
- 64640: Medicare Advantage plans and commercial products
- 64633: Medicare Advantage plans and commercial products
- 64635: Medicare Advantage plans and commercial products
Medical criteria will come from the content in the online authorization tool. For additional details related to this policy, please click here.
Pediatric Dental Services - Essential Health Benefit
enero de 2025 CDT code updates will be made to this policy as follows:
- New CDT codes D6180 and D6193 will be added to and deleted CDT code D6095 will be deleted from Implant Services
- New CDT code D7252 will be added to Oral Surgery
- New CDT code D8091 and D8671 will be added to Orthodontic Services
Applicable text revisions effective 1 de enero de 2025 will also be applied. For additional details related to this policy, please click here.