Electrical Stimulation and Electromagnetic Therapy for Wound Treatment
Effective 1 de junio de 2023, this policy was updated to reflect that low-intensity direct current electrical stimulation, high-voltage pulsed current electrical stimulation, alternating current electrical stimulation, and transcutaneous electrical nerve stimulation will not be medically necessary for commercial products. Additionally, electrical stimulation performed by individuals in the home setting for the treatment of wounds will not be medically necessary for commercial products. Please refer to the policy for additional details here.
Prostatic Urethral Lift
Effective 1 de junio de 2023, criteria regarding excluding the diagnosis of prostate cancer has been removed. Please refer to the policy for additional details here.
Bariatric Surgery
Effective 1 de junio de 2023, CPT code 43843 has been added to the coding section of the policy. Please refer to the policy for additional details here.
Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy
Effective 1 de junio de 2023, we added a statement regarding computer-based optical imaging devices to the policy. Please refer to the policy for additional details here.
Behavioral Health Integration Services including the Collaborative Care Model
Effective 1 de junio de 2023, we made an update to the policy statement within the policy. We removed the requirement regarding capability to provide reporting on the following measure upon request: Unhealthy Alcohol and Drug Use Screening and Brief Counseling (OHIC aligned primary care measure set behavioral health domain). Please refer to the policy for additional information here.
Prior authorization of drugs
Effective 1 de febrero de 2023 the following codes have been updated:
- HCPCS code C9069 was deleted and replaced with J9037
- J9044 – removed this code
- C9073 was deleted and replaced with Q2053
- C9097 was deleted and replaced with J9332
Please refer to the policy for additional information by clicking here.
Cranial Electrotherapy Stimulation and Auricular Electrostimulation
Effective 1 de junio de 2023, CPT code 0783T (new code effective 1 de enero de 2023) will be added to the policy. 0783T is currently included in the New Technology and Miscellaneous Services policy. CPT code 0783T will change from requiring prior authorization to not covered for Medicare Advantage plans. This service will remain not medically necessary for commercial products. Please refer to the policy for additional information here.
Enteral/Parenteral Nutrition Therapy
Effective 1 de junio de 2023, all information pertaining to digestive enzyme cartridges (e.g., Relizorb) will be removed from this policy and will be placed into its own separate policy, Digestive Enzyme Cartridges. HCPCS code B4187 (lipids) will be added to the list of covered services in the coding section. Please refer to the policy for additional information here.
Digestive Enzyme Cartridges
Effective 1 de junio de 2023, all information pertaining to digestive enzyme cartridges (e.g., Relizorb) will be removed from the policy, and will be in this separate policy. Coverage for Medicare Advantage plans will be changing from not covered to covered when filed with a covered diagnosis. There will be no changes for commercial products. Please refer to the policy for additional information here.
Therapeutic Eyeglasses and Contact Lenses
Effective 1 de febrero de 2023, this policy was updated to indicate coverage of therapeutic eyeglasses and contact lenses is based on a look-back period of nine months of claims for presence of cataract surgery codes. Please refer to the policy for additional information here.
Genetic Testing Services
Effective 1 de junio de 2023, CPT codes 81418 and 81441 will change from being reviewed against criteria in this policy to being reviewed against criteria in the web-based authorization tool for Medicare Advantage plans and commercial products. Please refer to the web-based authorizations policy for additional information.
Non-Reimbursable Health Service Codes
Effective 1 de junio de 2023, this policy will be updated to include Q0081 (Infusion therapy, using other than chemotherapy drugs, per visit) with an indicator of “Use Alternate Code" for both professional and facility for Commercial and Medicare Advantage products.