Medical Policy Updates

Notification of Policy Revisions Effective January 14, 2020 (Posted November 12, 2019)

 

Medical Policy Revision
Bundling Guidelines  "Notification" Revised information for Office Visit to read: (99211) is considered mutually exclusive to 95115-95117 (allergen immunotherapy) and not eligible for separate reimbursement. Modifiers are not allowed. Notification 11/12/2019 to effective date 1/14/2020.
Monoclonal Antibodies for Non-Hodgkin Lymphoma and Acute Myeloid Leukemia In the Non-Hematopoietic Stem Cell Transplant Setting "Notification" Under "When Covered" for Rituxan (rituximab), added Truxima (rituximab-abbs) and Ruxience (rituximab-pvvr) biosimilars with same indications as Rituxan (rituximab). Updated policy statements for rituximab and rituximab biosimilars to provide clarification and consistency with FDA labeling where appropriate, with no change to policy intent. Added HCPCS codes C9399, J3490, J3590, J9999, and Q5115 to Billing/Coding section. References added. Medical Director review 11/2019. Policy notification given 11/12/2019 for effective date 1/14/2020.
Oncologic Uses of Bevacizumab (Avastin®) and Bevacizumab Biosimilars "Notification" New policy developed. Bevacizumab (Avastin) and bevacizumab biosimilars (bevacizumab-awwb, bevacizumab-bvzr) may be considered medically necessary for the following FDA approved oncologic uses: metastatic colorectal cancer; unresectable, locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer; recurrent glioblastoma in adults; metastatic renal cell carcinoma; persistent, recurrent, or metastatic cervical cancer; and epithelial ovarian, fallopian tube, or primary peritoneal cancers; and for the following off-label indications: malignant pleural mesothelioma and HER2-negative breast cancer, when the medical criteria and guidelines are met. Added HCPCS codes C9257, J9035, Q5107, Q5118, S0353, and S0354 to Billing/Coding section. References added. Medical Director review 11/2019. Policy notification given 11/12/2019 for effective date 1/14/2020. (krc)