The following policies have been updated outside of their annual review:
Total Joint Arthroplasty - Hip & Knee PF
Effective 1 de diciembre de 2022, additional criteria is needed to be met regarding Diabetes control, Body Mass Index (BMI) and smoking status. Please refer to the medical policy for details here.
Intensity Modulated Radiotherapy - Central Nervous System Tumors PF
Effective 1 de diciembre de 2022, criteria was added regarding hippocampal-avoiding intensity-modulated radiotherapy. Please refer to the draft medical policy for details here.
Intensity Modulated Radiotherapy - Abdomen, Pelvis and Chest PF
Effective 1 de diciembre de 2022, the above referenced policy title was updated to include “Chest." All criteria within the policy remains unchanged. Please refer to the draft medical policy for details here.
Intensity Modulated Radiotherapy - Head, Neck and Thyroid PF
Effective 1 de diciembre de 2022, the criteria within the policy was updated regarding both Head/Neck and Thyroid. Please refer to the draft medical policy for details here.
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation PF
Effective 1 de diciembre de 2022, we updated the coding section as CPT codes 33267 and 33269 are now addressed in the Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation policy. Please refer to the draft medical policy for details here.
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME) PF
Effective 1 de enero de 2023, for commercial products only, standing frames will require authorization. Please refer to the draft medical policy for details here.
Serum Tumor Markers for Breast and Gastrointestinal Malignancies PF
Effective 3 de agosto de 2022, ICD-10 code C84.7 was added to the diagnosis list for CPT code 86300. For additional details related to this policy update, please click here.
Cochlear Implants PF
Effective 3 de agosto de 2022, there is now a participating provider for cochlear implant services. We removed the note from the coding section that stated “There are no participating providers for batteries for cochlear devices. Therefore, batteries are paid as an in-network benefit relating to out-of-network providers since there is now a contracted provider for this service." For additional details related to this policy update, please click here.
COVID-19 Vaccinations PF
This policy was updated to include the FDA emergency use authorization for the Novavax COVID-19 vaccine, in patients 18 years and older, effective 13 de julio de 2022. For additional details related to this policy update, please click here.
Post Payment Audits PF
This policy was updated to include clarifying language regarding how BCBSRI obtains medical records for auditing purposes and how extrapolation methodology may be used. The policy was also updated to maintain consistent with an update to RIGL § 27-19-56 and § 27-20-51, effective 27 de junio de 2022. For additional details related to this policy update, please click here.
TEMPORARY COVID-19 Diagnostic Testing PF
This policy was updated to clarify our home testing policy, including coverage for over-the-counter home tests without assessment from a healthcare provider and the eight test per month per member cap. For additional details related to this policy update, please click here.
Telemedicine/Telephone Services for Commercial Members PF
This policy was updated with additions to the coding section including POS 10 and modifier FQ, effective 1 de abril de 2022. For additional details related to this policy update, please click here.
Telemedicine/Telephone Services for Medicare Advantage Plans During a Public Health Emergency PF
This policy was updated with additions to the coding section including POS 10 and modifier FQ, effective 1 de abril de 2022 For additional details related to this policy update, please click here.
COVID-19 Diagnostic Testing Vaccine and Antibody Treatment Administration Reimbursement PF
This policy was updated to clarify BCBSRI’s reimbursement policy regarding COVID-19 antibody treatment after notice that the United States government would no longer supply Bebtelovimab to providers. For additional details related to this policy update, please click here.
COVID-19 Monoclonal Antibody Treatment and Antiviral IV Medications PF
This policy was updated to clarify BCBSRI’s reimbursement policy regarding COVID-19 antibody treatment after notice that the United States government would no longer supply Bebtelovimab to providers. For additional details related to this policy update, please click here.
Medical Record Standards PF
This policy was updated to include language regarding how BCBSRI obtains medical records. For additional details related to this policy update, please click here.
Non-Reimbursable Health Service Codes PF
This policy was corrected to align with our current business practices for codes 99495 and 99496. For additional details related to this policy update, please click here.