Medical Policy Updates

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Medical Policy Update October 18, 2022

Medical Guidelines Reason for Update
Ablative Techniques for the Myolysis of Uterine Fibroids References updated. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022. No change to Policy statement.
Bone Mineral Density Studies References updated. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022. No change to Policy statement.
Cardiovascular Disease Risk Assessment AHS – G2050 Off-cycle review by Avalon 2nd Quarter 2022 CAB. Description, Related Policies, Policy Guidelines, and References updated. Coverage criteria updated to remove criteria related to genetic markers for cardiovascular disease as this has been moved to new policy Genetic Markers for Assessing Risk of Cardiovascular Disease AHS M2180. Billing/Coding section updated. Medical Director review 7/2022. Notification given on 9/13/22 for effective date 10/18/22.
Children’s Mobility and Positioning Equipment References updated. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022.
Chiropractic Services References updated. Specialty Matched Consultant Advisory Panel 9/2022. Medical Director review 9/2022.
Cosmetic and Reconstructive Surgery Updated policies in description section for clarity. References updated. Specialty Matched Consultant Advisory Panel 8/2022. Medical Director review 8/2022. No change to policy statement.
Dermatologic Applications of Photodynamic Therapy Policy Guidelines and references updated. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022. No change to policy statement.
Dry Needling of Myofascial Trigger Points Policy guidelines and References updated. Specialty Matched Consultant Advisory Panel review 09/2022. Medical Director review. 09/2022.
Durable Medical Equipment (DME) Benefits Application section updated with statement “Standard mattresses are considered an item of convenience or comfort”. References updated. Specialty Matched Consultant Advisory Panel 9/2022. Medical Director review 9/2022.
Functional Capacity Assessment and Work Hardening References updated. Specialty Matched Consultant Advisory Panel 9/2022. Medical Director review 9/2022.
Genetic Markers for Assessing Risk of Cardiovascular Disease AHS M2180 New policy developed. Genetic Markers for Assessing Risk of Cardiovascular Disease is considered investigational for [all applications}. BCBSNC does not provide coverage for investigational services or procedures. Medical Director review 7/2022. Notification given 9/13/2022 for effective date 10/18/2022.
Infertility Diagnosis and Treatment – B0006 References updated. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022. No change to policy statement.
Non-Pharmacologic Treatment of Rosacea Description and references updated. Specialty Matched Consultant Advisory Panel review 9/2022. No change to policy statement. Medical Director review 9/2022.
Patient Lifts References updated. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022.
Prenatal Screening (Genetic) New policy developed. BCBSNC will provide coverage for Prenatal Screening (genetic) when the medical criteria and guidelines outlined in the policy are met. Medical Director review 7/2022. Notification give 9/13/2022 for effective date 10/18/2022.
Prenatal Screening (Nongenetic) AHS – G2035 Reviewed by Avalon 2nd quarter 2022 CAB. Policy re-titled: Prenatal Screening (Nongenetic). Description, Related Policies, Policy Guidelines, and References updated. Coverage criteria updated to remove criteria related to genetic prenatal screening as this has been moved to new policy – Prenatal Screening (genetic). Billing/Coding section updated. Medical Director review 7/2022. Notification given on 9/13/2022 for effective date 10/18/2022.
Pressure Reducing Support Surfaces Added HCPCS code E0183 to Billing/Coding section for effective date 10/1/22. References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel 9/2022. Medical Director review 9/2022.
Rehabilitative Therapies Description section and References updated. Code 97127 removed and replaced with codes 97129 and 97130 under Billing/Coding section. No change to policy statement. Specialty Matched Consultant Advisory Panel review 9/2022. Medical Director review 9/2022.
Wheelchairs (Manual and Power Operated) References and Billing/Coding section updated. Specialty Matched Consultant Advisory Panel 9/2022. Medical Director review 9/2022.