Medical Policy Updates

Notification of Policy Revisions Effective August 13, 2019 (Posted June 11, 2019)

Medical Policy Revision
BioZorb® "Notification" New policy developed. BioZorb three-dimensional (3D) bioabsorbable tissue marker is considered investigational. References added. Medical Director review 6/2019. Policy noticed 6/11/19 for effective date 8/13/19.
Diagnosis of Idiopathic Environmental Intolerance AHS - G2056 "Notification" Reviewed by Avalon 1st Quarter 2019 CAB. Related Policies added to Description section. When Not Covered policy statement extensively revised as follows: revised item #2: a-y and added items #3-7. Policy guidelines updated to support revised policy statement. Billing/Coding section revised with the addition of Reimbursement items 1-10 along with the following codes: 82127, 82139, 82380, 82441, 82507, 82542, 82656, 82715, 83150, 83497, 83918, 83919, 83921, 84585, 84600, 86001, 83015, 83018, 82108, 82300, 83735, 83885, 83785, 82726, 89125, 82710, 84590, 84446, and 83655. References updated. Policy noticed 6/11/19 with effective date of 8/13/19. Medical Director review 5/2019.
Helicobacter Pylori Testing AHS - G2044 "Notification" Reviewed by Avalon 1st Quarter 2019 CAB. Under the When Covered section, added "either" to item #3. Under the When Not Covered section, added the following statement to item #6: "The use of nucleic acid testing for H. pylori, including polymerase chain reaction (PCR), 16S rRNA, 23S rRNA, and next-generation sequencing (NGS) of" H. Pylori, is considered not medically necessary as it is not practical for routine diagnosis. Policy guidelines and references extensively revised. Under the Coding/Billing section, the following changes were made: 86677 - changed to Not Covered, and added code 87149, 87150, 87153, 0008U to the policy as Not Covered. References updated. Policy noticed 6/11/19 for effective date of 8/13/19. Medical Director reviewed 5/2019.