Low-Level Laser Therapy  PF 

Effective 1 de noviembre de 2022, additional CPT codes and ICD-10 diagnosis codes will be added to the medically necessary coding section. Please refer to the medical policy for details here.

Surgical and Debulking Treatments for Lymphedema  PF 

Effective 1 de noviembre de 2022, criteria regarding lymph node transplant will be updated. Please refer to the medical policy for details here.

Treatment for Duchenne Muscular Dystrophy, formerly known as Exondys (eteplirsen) and Vyondys (golodirsen) for Duchenne Muscular Dystrophy   PF

Effective 1 de noviembre de 2022, criteria has changed to include two additional drugs: viltolarsen and casimersen. Please refer to the medical policy for details here.  

Immunization Adult and Pediatric  PF 

Effective 1 de julio de 2022 the FDA has approved the following:   

• 90626 – Tick-borne encephalitis virus vaccine, inactivated: 0.25 mL dosage, for intramuscular use
• 90627 – Tick-borne encephalitis virus vaccine, inactivated: 0.5 mL dosage, for intramuscular use
• 90759 – Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use

Please refer to the policy for additional details here.

Covid vaccinations   PF 

Updated vaccines for administration codes for pediatric 6 months thru four years and boosters for age 18 and over. Please refer to the policy for additional details here.

Preventive services for Medicare Advantage plans   PF 

We have updated the Medicare Advantage service grid to include Low Dose CT scan criteria, reduced age limit and smokers’ history and packs per year. Please review the policy for additional details by clicking here.