Home Health Care Services – Skilled Services
Effective 1 de enero de 2024, home health care services (HCPCS codes S9122, S9123, S9124, S9127, S9128, S9129, S9131, S9470, G0151, G0152, G0153, G0156, G0157, G0158, G0299 and G0300) will no longer require notification or prior authorization for Medicare Advantage plans or commercial products and will be covered. For additional details related to this policy, click here.
Immunizations Adult and Pediatric
Effective 1 de julio de 2023, RSV monoclonal antibody codes 90380 and 90381 are covered for commercial plans.
Effective 14 de agosto de 2023, new COVID administration and vaccines codes 90480 and 91318-91322 are covered for commercial and Medicare Advantage plans.
Effective 1 de octubre de 2023, RSV vaccine codes 90678 and 90679 are covered for commercial.
(Note: RSV vaccines codes are covered for Medicare Advantage members’ Part D benefit. Medicare Part D coverage is determined by the formulary, not listed in the immunization policy. Effective dates under Part D Medicare may differ from dates for commercial plans.) For additional details related to this policy, click here.
Non-Reimbursable Health Service Codes
Effective 1 de enero de 2024, codes 0002M and 0003M will be removed from this policy. For additional details related to this policy, click here.
Doula Maternity Services
This policy was updated to reflect the Credentialing requirements for become a participating Doula with BSBRI. For additional details related to this policy, click here.
Immunizations Adult and Pediatric
Effective 1 de octubre de 2023, RSV vaccine administration codes 96380 and 96381 are covered for Commercial and Medicare Advantage plans. For additional details related to this policy, click here.
Preventive Services for Commercial Members
Effective 1 de octubre de 2023, RSV vaccine administration codes 96380 and 96381 have been added to this policy. For additional details related to this policy, click here.
Infertility Services
Effective 1 de enero de 2024, the definition of female infertility for members, ages 40 and older, without exposure to sperm has been changed from 6 unsuccessful intrauterine insemination (IUI) cycles to 3 unsuccessful IUI cycles. Also, the policy will address 5 services related to male infertility: Intracytoplasmic Sperm Injection (ICSI), Microsurgical Epididymal Sperm Aspiration, Testicular Sperm Extraction, Testicular Sperm Aspiration and Hyaluronan Binding Assay for sperm evaluation. Lastly, prior authorization is required for Medicare Advantage Plans and recommended for Commercial Products for codes 89258, 89259, 89335, 89337, 89342, 89343, 89344, 89346, 89354, 89356, S4027 and S4040, which includes cryopreservation of testicular tissue, cryopreservation of ovarian tissue and storage of testicular/ovarian tissue. These services will be considered medically necessary when related to iatrogenic infertility. For all other diagnoses, these services will be non-covered. For additional details related to this policy, click here.
Gender Affirming Care
Effective 1 de enero de 2024, there will be an expansion of covered gender affirming care services to include services such as facial surgeries, lipoplasty, vocal cord surgery and hair removal when eligibility criteria are met, when the services are performed for the purpose of gender affirming care, when gender affirming care is a covered benefit under the member's plan and when the services are filed with a gender dysphoria diagnosis code. For additional details related to this policy, click here.