Medical Policy Updates

Blue Cross and Blue Shield of North Carolina Medical Policy Update October 27, 2020

Medical Guidelines Reason for Update
Ablative Techniques for the Myolysis of Uterine Fibroids Specialty Matched Consultant Advisory Panel review 9/29/2020. References added. Policy title changed from "Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids" to "Ablative Techniques for the Myolysis of Uterine Fibroids". Policy statement updated from "laparoscopic and percutaneous" to "ablative" to match title change. Policy guidelines updated. No change to policy intent.
Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms Archived. See CMP "Hematopoietic Cell Transplantation."
Allogeneic Hematopoietic Transplant for Genetic Diseases and Acquired Anemia Archived. See CMP "Hematopoietic Cell Transplantation."
Artificial Pancreas Device Systems Policy Guideline and Description updated. When covered statement criteria updated to "Device is age appropriate per FDA approved indications."
Bariatric Surgery Medical Director review. Description section updated. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) added to list of covered procedures. Code 43999 added to Billing/Coding section.
Bundling Guidelines In the "Topics of Frequent Interest" section Venipuncture and Other Central Venous Access changed to Specimen Collection, language updated, and added codes G2023 and G2024. Code 99072 added to "Topics of Frequent Interest" Status "B" codes section. CMS reference source for Wheelchair Options/Accessories added to Reference Sources.
Enzyme Replacement Therapy (ERT) for Lysosomal Storage Disorders Specialty Matched Consultant Advisory Panel review 7/15/2020.
Hematopoietic Cell Transplantation New policy developed. Combined all HCT policies into one policy for efficiency. Code review completed. Medical Director review 10/2020.
Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Cell Transplantation for CLL and SLL Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Cell Transplantation for Hodgkin Lymphoma Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplant for Non-Hodgkin Lymphomas Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults Archived. See CMP "Hematopoietic Cell Transplantation."
Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors Archived. See CMP "Hematopoietic Cell Transplantation."