Tumor Treating Fields Therapy
Effective 1 de marzo de 2023, the above referenced policy will be archived, as requests for HCPCS code E0766 will require prior authorization for commercial products using InterQual criteria found in the online authorization tool, which may differ from criteria found in this policy. Effective 1 de marzo de 2023, medical criteria for Medicare Advantage plans can be found in the online authorization tool. You can refer to prior authorization via web-based tool for procedures for additional details here.
Prior authorization via web-based tool for procedures
Effective 1 de marzo de 2023, for both Medicare Advantage plans and commercial products, CPT codes 63661, 63662, and 63688 will be reviewed via the web-based tool.
Effective 1 de marzo de 2023, for Medicare Products only, criteria regarding Kyphoplasty or Vertebroplasty has been modified.
Please refer to the medical policy for additional details here.
Prior authorization via web-based tool for durable medical equipment (DME)
Effective 1 de marzo de 2023, HCPCS code E0766 and the applicable subset; Tumor Treatment Field Therapy (TTFT) Devices, will be transitioned to this policy. Please note that HCPCS code E0766 will continue to require prior authorization for both Medicare Advantage plans and commercial products using the criteria found in the online authorization tool. Please refer to the medical policy for additional details here.
Removal of Implantable Devices
Effective 1 de marzo de 2023, prior authorization will be required to CPT codes 63661, 63662, and 63688. Please refer to the medical policy for additional details here.
Retinal Telescreening for Diabetic Retinopathy
Effective 1 de marzo de 2023, the coding section will be updated due to text revisions to several CPT codes. Please refer to the medical policy for additional details here.
Evaluation of Biomarkers for Alzheimer’s Disease
Effective 1 de marzo de 2023, the coding section will be updated to include ICD-10 codes to the preexisting CPT codes in the policy. Please refer to the medical policy for additional details here.
Allergy Testing
Effective 1 de marzo de 2023, the covered diagnosis lists for CPT codes 86003 and 86008 for both Medicare Advantage plans and commercial products will be updated based on ICD-10 code updates. ICD-10 codes T40.7X5A, T40.7X5D, and T40.7X5S were deleted and replaced by ICD-10 codes T40.715A, T40.715D, and T40.715S. Please refer to the medical policy for additional details here.
Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
Effective 1 de marzo de 2023, the medical criteria for Medicare Advantage plans and commercial products will be revised for Radiofrequency Ablation (RFA) to treat an isolated peripheral non-small-cell lung cancer lesion and for RFA to treat malignant non pulmonary tumor(s) metastatic to the lung. Please refer to the medical policy for additional details here.
Spinal Cord Stimulation
Effective 1 de marzo de 2023, this policy is applicable for commercial products only. Please use the criteria in this policy in lieu of the criteria in the web-based tool for Spinal Cord Stimulation. As indicated above, CPT code 63664 will require prior authorization starting 1 de marzo de 2023. Please refer to the draft medical policy for details for commercial products. Please refer to the medical policy for additional details here.
Genetic Testing for Diagnosis and Management of Mental Health Conditions
Effective 1 de marzo de 2023, for Medicare Advantage plans only, the medical criteria will be revised for the GeneSight Psychotropic panel and NeuroIDgenetix testing will have medical criteria (previously not covered). The Psychotropic Pharmacogenomics Gene Panel (Mayo Clinic) will be added to the policy with medical necessity criteria for Medicare Advantage plans. This will be not medically necessary for commercial products. CPT code 0345U (effective 1 de octubre de 2022) for the GeneSight Psychotropic panel will also be added. Please refer to the medical policy for additional details here.
Percutaneous Tibial Nerve Stimulation
Effective 1 de marzo de 2023, this policy will apply to commercial products only and will have no change in medical criteria. For Medicare Advantage plans, the medical criteria in this policy will be replaced with medical criteria in the web-based tool. Please refer to the medical policy for additional details here.
High-Risk Pregnancy Services
This payment policy was updated to make corrections to the diagnosis code range mentioned in policy statement section of the policy. Please refer to the payment policy to review the changes here.
TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of COVID-19
This policy was updated to specify that providers must file the diagnosis codes on the claim line level in the first position in order for the waiver of cost share to apply. Please refer to the payment policy to review the changes here.
Non-Reimbursable Health Service Codes
Two updates are in effect for this policy:
Effective 1 de marzo de 2023, 92227 (Imaging of Retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral) will become a not separately reimbursable (NSR) code for professional and facility providers for both Medicare and commercial products.
The below CPT codes have been added to the policy and are now NSR codes effective 1 de octubre de 2022:
A2014-A2018, A4596, A9602, C1834, E0183, G0310-G0314, T1032-T1033
Please refer to the payment policy to review the changes here.