Emergency Department Services/Waiver of Copayment                                                                   

This policy was edited to clarify the definition of emergency services. For additional information related to this policy, please click here.    

Intravitreal and Punctum Corticosteroid Implants                               

Effective 1 de noviembre de 2023, for both Medicare Advantage plans and commercial products, CPT code J1096 will be added to the coding section and will be subject to the medically necessary ICD-10 Diagnosis Code requirements. Additionally, the medically necessary ICD-10 Diagnosis Code list has been updated to mirror the policy's statements. For additional information related to this policy, please click here.    

Minimal Residual Disease Testing for Cancer                  

Effective 1 de noviembre de 2023, this policy will be updated to include the Guardant REVEAL test for which prior authorization will be required for Medicare Advantage plans and recommended for commercial products. For additional information related to this policy, please click here.    

Genetic Testing Services                                                

Effective 1 de noviembre de 2023, CPT code 81308 will change from being reviewed against criteria in the web-based authorization tool to being reviewed against criteria in this policy for Medicare Advantage plans and commercial products. For additional information related to this policy, please click here.    

Preventive Services for Commercial Members     

Effective 1 de enero de 2024, updates have been made regarding coverage of screening for anxiety disorders for adults and clarified coverage of codes 82947 and 83036 for diabetes screening that each code is covered one time per year. For additional information related to this policy, please click here.    

Non-Reimbursable Health Service Codes

Effective 1 de octubre de 2023, CPT codes 99446, 99447, 99448, 99449, and 99451 will be removed from the Non-Reimbursable Health Service Codes list for professional providers.

Also, effective 1 de noviembre de 2023, G0176 will be added to the list for professional and facility providers.

For additional information related to this policy, please click here.