Medical Policy Updates

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Medical Policy Update for March 9, 2021

Medical Guidelines Reason for Update
Ablation and Neural Therapy Procedures for Headache and Pain Management References added. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 2/17/2021.
Ambulance and Medical Transport Services Specialty Matched Consultant Advisory Panel review 2/17/2021. No change to policy.
Beta-Hemolytic Streptococcus Testing AHS – G2159 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Bioimpedance Devices for Detection of Lymphedema Reference added.
Bone Morphogenetic Protein Reference added. Specialty Matched Consultant Advisory Panel review 2/17/2021.
Bundling Guidelines Routine policy review. Medical Director approved 12/2020. No changes to policy statement. Deleted code 0396T was replaced with unlisted code 27599. New code 99439 and G2214 added to “Topics of Frequent Interest” section Care Management Services. Definition of new patient updated within New Frequency Visit section. Policy notification given 12/31/2020 for effective date 3/9/2021.
Diagnostic Testing of Influenza AHS – G2119 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Diagnostic Testing of Iron Homeostasis and Metabolism AHS – G2011 Specialty Matched Consultant Advisory Panel 02/17/2021. No changes to policy.
Diagnostic Testing of Sexually Transmitted Infections AHS – G2157 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Electrostimulation and Electromagnetic Therapy for Wounds Reference added.
Epidural Steroid Injections for Back Pain Codes 62321 and 62323 added to Billing/Coding section.
Folate Testing AHS – G2154 Specialty Matched Consultant Advisory Panel 2/17/2021. No changes to policy.
Hepatitis C AHS – G2036 Specialty Matched Consultant Advisory Panel review 2/17/2021.
HIV Genotyping and Phenotyping AHS – M2093 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies AHS - G2105 Added therapeutic drug levels to Policy statement for clarification. Specialty Matched Consultant Advisory Panel review 2/16/2021. No change to policy statement.
Intravenous Antibiotic Therapy for Lyme Disease Reference added. Specialty Matched Consultant Advisory Panel review 2/17/2021. No change to policy statements.
Lyme Disease AHS – G2143 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Microprocessor-Controlled Prostheses for the Lower Limb Specialty Matched Consultant Advisory Panel review 2/17/2021.
Multiple Procedure Payment Reduction on the Technical Component (TC) of Diagnostic Cardiovascular and Ophthalmology Procedures Routine policy review. Medical Director approved 12/2020. New codes 92229, 93241, 93242, 93243, 93245, 93246, and 93247 added to Coding section.  Added codes 0506T, 0507T, 0508T, 93985, and 93986. Removed code 92275. No changes to policy statement. Policy notification given 12/31/2020 for effective date 3/9/2021.
Orthopedic Applications of Stem Cell Therapy Specialty Matched Consultant Advisory Panel review 2/17/2021.
Orthotics Specialty Matched Consultant Advisory Panel review 2/17/2021.
Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection AHS – M2116 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Powered Exoskeleton for Ambulation in Patients with Lower Limb Disabilities Specialty Matched Consultant Advisory Panel review 2/17/2021.
Professional Pathology Billing Guidelines AHS – R2169 New medical policy. Extensive revisions to “Description” and “Service Guidelines” sections. Added “Billing Guidelines” section. Cytology codes 88104-88199 and Pathology Consultation codes 80500-80502 added to “Billing/Coding/Physician Documentation Information” section. “Scientific Background and Reference Sources” section updated to “Reference Sources”. Routine policy review. Medical Director approved 12/2020. Notification given 9/22/20 for effective date 3/9/21.
Radiology Services Reimbursement Policy Routine policy review. Coding section updated with new code 71271. Added codes 74712, 76391, 76978, 76981, 76982, 77046, 77047, 77048, 77049. Removed codes 77058 and 77059. Medical Director approved 12/2020. No changes to policy statement. Policy notification given 12/31/2020 for effective date 3/9/2021.
Skin and Soft Tissue Substitutes Description updated for clarification. Coverage criteria added for Dural reconstruction/repair to When covered section. DuraGen® and Durepair Regeneration Matrix® removed from When not covered section. References added. Medical Director review.
Subtalar Arthroereisis Specialty Matched Consultant Advisory Panel review 2/17/2021.
Synthetic Cartilage Implants for Joint Pain Reference added. Specialty Matched Consultant Advisory Panel review 2/17/2021.
Testing for Diagnosis of Active or Latent Tuberculosis AHS – G2063 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Testing for Mosquito or Tick-Related Infections AHS – G2158 Specialty Matched Consultant Advisory Panel review 2/17/2021.
Three Dimensional Printed Orthopedic Implants Reference added. Description section updated. Specialty Matched Consultant Advisory Panel review 2/17/2021.
Ultrasound Accelerated Fracture Healing Device Specialty Matched Consultant Advisory Panel review 2/17/2021.
Vectra DA Blood Test for Rheumatoid Arthritis AHS – G2127 Specialty Matched Consultant Advisory Panel review 2/16/2021. No change to policy statement.
ZIKA Virus Risk Assessment AHS – G2133 Specialty Matched Consultant Advisory Panel review 2/17/2021.