Medical Policy Updates

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Notification of Policy Revisions Effective May 31, 2022 (Posted March 31, 2022)

Medical Guidelines Revision
Balloon Ostial Dilation (Balloon Sinuplasty) Medical Director review. Added “air fluid levels or opacification to support the diagnosis of sinusitis” to criteria 3 of the When Covered statement. Added “air fluid levels or opacification for” to the first Policy Guidelines sentence. Notification given March 31, 2022 for policy effective date May 31, 2022.
Radiosurgery, Stereotactic Approach Under Policy Guidelines section, added Radiology Maximum Units guidelines for SBRT treatment course. Under Billing/Coding section, added CPT codes 77431 and 77470. Added Radiation Therapy Services Reimbursement Policy to Related Policies section. Medical Director review 3/2022. Notification given 3/31/22 for effective date 5/31/22.