Medical Policy Updates

Home ❯ Providers ❯ Medical Policies and Coverage ❯ Back to Medical Policy Updates ❯ Medical Policy Update May 03, 2022

Medical Policy Update May 03, 2022

Medical Guidelines Reason for Update
Diagnosis and Treatment of Sacroiliac Joint Pain References added. Related policies updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 4/2022
Epidural Steroid Injections for Back Pain Policy guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No change to policy statement.
Facet Joint Denervation References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director Review 4/2022. No change to policy statement
Hemodialysis Treatment for ESRD Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022.
Infertility Diagnosis and Treatment – B0006 Codes 0664T-0670T from Billing/Coding section and investigational statement F. under “When not Covered” section: “Uterine transplant is considered investigational as a treatment of infertility” inadvertently removed during 10/19/21 update. Codes and statement re-added.
Intradialytic Parenteral Nutrition Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022.
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No Change to policy statement.
Neural Therapy References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No change to policy statement.
Neurostimulation, Electrical References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No change to policy statement.
Percutaneous Electrical Nerve Stimulation (PENS) or Neuromodulation Therapy and Percutaneous Electrical Nerve Field Stimulation (PENFS) References updated. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No change to policy statement.
Prolotherapy Related policy added. References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No change to policy statement.
Radiofrequency Ablation of the Renal Nerves as a Treatment of Hypertension References updated. Specialty Matched Advisory Panel review 4/2022. Medical Director review 4/2021.
Renal (Kidney) Transplantation References updated. Specialty Matched Specialty Advisory Panel review 4/2022. Medical Director review 4/2022.
Skin and Soft Tissue Substitutes Updated information to When Skin and Soft Tissue Substitutes are covered. Criteria to include clarification of 2nd degree burn products: “Kerecis* (formerly known as MariGen™*).
TENS (Transcutaneous Electrical Nerve Stimulator) Regulatory status updated. References added. Specialty Matched Consultant Advisory Panel review 4/2022. Medical Director review 4/2022. No change to policy statement.