Medical Policy Updates

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Medical Policy Update November 01, 2022

Medical Guidelines Reason for Update
Ambulatory Event Monitors Minor edits to Description section. Billing/Coding section and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Anesthesia Services References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement.
Baroreflex Stimulation Devices Description, Policy Guidelines and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Cardiac Monitoring Devices in the Outpatient Setting Description, Regulatory Status and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Carotid Intimal-Medial Thickness Minor edits to Description section for clarity, References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Computed Tomography to Detect Coronary Artery Calcification Policy Guidelines edited for clarity. References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Dental Criteria for use of Hospital Inpatient or Outpatient Facility Services or Ambulatory Surgery Center Facility Services Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement.
Dental Reconstructive Services Added the following statement to When Covered section: “When the procedures are the direct or indirect result of cancer treatments, including chemotherapy, biotherapy, or radiation therapy” to align with HB 646. Typo corrected in Billing/Coding section. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022.
Electronic Brachytherapy for Nonmelanoma Skin Cancer Removed CPT codes 77767, 77768 from Billing/Coding section for clarity. Reference added. No change to policy intent/statement.
Enhanced External Counterpulsation (EECP) References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Hyperbaric Oxygen Therapy Minor updates to policy guidelines. References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. No change to policy statement.
Orthodontics for Pediatric Patients Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement.
Orthognathic Surgery Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement.
Prenatal Screening (Genetic) AHS-M2179 Policy title updated to include “AHS-M2179” to align with Avalon.
Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia Description section, Policy Guidelines and References updated. No change to policy statement. Specialty Advisory Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Signal-Averaged ECG References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Spinal Manipulation Under Anesthesia Minor updates made to description. Moved statement related to evidence reviews from When not Covered to Policy Guidelines for clarity. Specialty Matched Consultant Advisory Panel Review 10/2022. Medical Director Review 10/2022. References updated. No change to policy statement.
Stem-cell Therapy for Peripheral Arterial Disease References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.
Temporomandibular Joint Dysfunction (TMJD) Minor updates to description for clarity. Regulatory status updated. Related policies added. Policy Guidelines updated. References updated. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director Review 10/2022. No change to policy statement.
Wearable Cardioverter Defibrillators Description section including Regulatory Status, Policy Guidelines and References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022.