Amniotic Membrane and Amniotic Fluid
Effective 1 de agosto de 2022, this policy statement will be updated to address treatment following Mohs microsurgery. Additionally, code A2001 will be added to the policy. Please refer to the medical policy for details here.
Dermatologic Applications of Photodynamic Therapy
Effective 1 de agosto de 2022, diagnosis coding in this policy will be edited to reflect that the testing is medically necessary as a treatment of actinic keratoses, carcinoma in situ of skin, and other malignant neoplasms of skin (including basal and squamous cell). This policy is applicable to commercial plans only. Please refer to the medical policy for details here.
Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
Effective 1 de agosto de 2022, medical necessity criteria for Oncotype DX, Oncotype DX AR-V7, and Prolaris for Medicare Advantage plans will be revised. These services remain not medically necessary for commercial plans. Additionally, Decipher RP will be added to the policy as not covered for Medicare Advantage Plans and not medically necessary for commercial plans. Please refer to the medical policy for details here.
Corneal Collagen Cross-Linking
Effective 1 de agosto de 2022, this policy will be applicable to both Medicare and commercial plans. Treatment of progressive keratoconus or corneal ectasia after refractive surgery in patients who have failed conservative treatment with corneal collagen cross-linking (0402T) is considered medically necessary when the criteria in the policy has been met and authorization has been obtained via the web-based tool for procedures. Please refer to the medical policy for details here.
Focal Treatments for Prostate Cancer PF
Effective 1 de agosto de 2022, for Medicare Advantage plans only, ablation with high-intensity focused ultrasound (HIFU) treatment for prostate cancer (CPT code 55880) will require prior authorization and will be considered medically necessary when the criteria using the web-based tool for procedures has been met. All other focal treatments for prostate cancer will not be covered, including focal laser ablation (CPT code 0655T). For commercial plans, all focal treatments for prostate cancer will remain not medically necessary. Please refer to the medical policy for details here.
Oral Appliances and Medical Management for Sleep Apnea and Temporomandibular Joint Disease
Effective 1 de agosto de 2022, this policy has been updated to include other not covered/not medically necessary services for medical treatment of sleep apnea. Please refer to the medical policy for details here.
CA-125
Effective 1 de julio de 2022, this policy has been updated to include two additional ICD-10 diagnosis codes for medical necessity. Please refer to the medical policy for details here.
Prior authorization via web-based tool for procedures
Effective 1 de agosto de 2022, hypoglossal nerve stimulation for the treatment of obstructive sleep apnea (CPT codes 64582 and 64583) for Medicare Advantage plans and high-intensity focused ultrasound treatment in prostate cancer (CPT code 55880) for Medicare Advantage plans will require prior authorization and be considered medically necessary when the criteria using the web-based tool for procedures has been met.
Additionally, corneal collagen cross-linking (0402T) be considered medically necessary when the criteria using the web-based tool for procedures has been met for both Medicare Advantage and commercial plans. Please refer to the medical policy for details here.
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Effective 1 de agosto de 2022, hypoglossal nerve stimulation for the treatment of obstructive sleep apnea (CPT codes 64582 and 64583) will require prior authorization and will be considered medically necessary for commercial plans when the criteria in the BCBSRI medical policy has been met. For Medicare Advantage plans, please use the web-based tool for procedures. Please refer to the medical policy for details here.
Glucose Monitoring – Continuous
The Glucose Monitoring – Continuous policy has been updated to reflect coverage of adjunctive continuous glucose monitoring devices for Medicare Advantage and commercial plans, and associated new HCPCS codes effective 1 de abril de 2022 for the device (E2102) and supplies (A4238). Please refer to the medical policy for details here.
Radiopharmaceuticals
This policy was updated on 13 de abril de 2022, to include HCPCS A9595 effective 1 de enero de 2022. Please refer to the payment policy for details.
Temporary COVID-19 Diagnostic Testing
This policy was updated on 20 de abril de 2022, to include CPT code 87913 effective 21 de febrero de 2022. Please refer to the payment policy for details.
Medicare Advantage Plans Laboratory Network Hospital Outpatient Allowable List
This policy was updated on 20 de abril de 2022, to include CPT code 87913 effective 21 de febrero de 2022. Please refer to the payment policy for details.
COVID-19 Vaccinations
This policy was updated on 20 de abril de 2022, to include new Moderna booster vaccine CPT code 91309 and administration code CPT 0094A effective 29 de marzo de 2022. Please refer to the payment policy for details.
Doula Maternity Services
This policy was updated on 4 de mayo de 2022, to include Place of Service 10. Please refer to the payment policy for details.