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Medical Policy Update for March 7, 2023 March 07, 2023
Medical GuidelinesReason for Update
Ablation and Neural Therapy Procedures for Headache and Pain ManagementPolicy Guidelines updated.  Specialty Matched Consultant Advisory Panel review 2/15/2023.
Ambulance and Medical Transport ServicesSpecialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy.
Balloon Ostial Dilation (Balloon Sinuplasty)Specialty Matched Consultant Advisory Panel review 2/15/2023. 
Bone Morphogenetic ProteinSpecialty Matched Consultant Advisory Panel review 2/15/2023.
Chelation TherapyDescription of Procedure or Service updated for clarity. References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy statement.
Clinical Trial ServicesDescription of Procedure or Service updated for clarity. References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy.
Complementary and Alternative MedicineRelated policies updated. References updated.  Specialty Matched Consultant Advisory Panel review 02/2023. Medical Director review 2/2023. No change to policy statement.
Dynamic PosturographySpecialty Matched Consultant Advisory Panel review 2/15/2023.
Electrical Stimulation for the Treatment of ArthritisReferences updated. Description section updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy statement.
Implantable Bone Conduction Hearing AidsThe following was removed from the Benefits Application section:  “This health benefit plan provides coverage for MEDICALLY NECESSARY hearing aids, including implantable bone-anchored hearing aids (BAHA), and related services that are ordered by a DOCTOR or a licensed audiologist for each MEMBER under the age of 22. Benefits are provided for one hearing aid per hearing-impaired ear, and replacement hearing aids when alterations to an existing hearing aid are not adequate to meet the MEMBER’S needs. This benefit is limited to once every 36 months for MEMBERS under age 22. Benefits are also provided for the evaluation, fitting, and adjustments of hearing aids or replacement of hearing aids, and for supplies, including ear molds”.  Specialty Matched Consultant Advisory Panel review 2/15/2023. 
Infusion Therapy in the HomeMinor edit to When Covered section for clarity. References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy.

Inpatient Interfacility Transfers

New policy developed. BCBSNC will provide coverage for Inpatient Interfacility Transfers when it is determined to be medically necessary because the medical criteria and guidelines are met. Medical Director Review 12/2022. Notification given 12/30/2022 for effective date 3/7/2023.
Intravenous Antibiotic Therapy for Lyme DiseaseSpecialty Matched Consultant Advisory Panel review 2/15/2023. 
Microprocessor-Controlled Prostheses for the Lower LimbSpecialty Matched Consultant Advisory Panel review 2/15/2023. 
Observation Room ServicesReferences updated. Added the following codes to Billing/Coding section: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy statement.
Orthopedic Applications of Stem Cell TherapySpecialty Matched Consultant Advisory Panel review 2/15/2023. 
OrthoticsSpecialty Matched Consultant Advisory Panel review 2/15/2023. 
Powered Exoskeleton for Ambulation in Patients with Lower Limb DisabilitiesRegulatory Status updated.  Policy Guidelines updated.  E1399 removed from Billing/Coding section.  Specialty Matched Consultant Advisory Panel review 2/15/2023. 
Private Duty Nursing ServicesReferences updated. Specialty Matched Consultant Advisory Panel review 2/2023. Removed the following statement from Policy Guidelines: “All PDN requests will be discussed with a Medical Director.” Medical Director review 2/2023. No change to policy statement.
Semi-Implantable and Fully Implantable Middle Ear Hearing AidSpecialty Matched Consultant Advisory Panel review 2/15/2023.
Skilled Nursing Facility CareReferences updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy statement.
Skilled Nursing ServicesReferences updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy statement. 
Subtalar ArthroereisisSpecialty Matched Consultant Advisory Panel review 2/15/2023. 
Synthetic Cartilage Implants for Joint PainSpecialty Matched Consultant Advisory Panel review 2/15/2023. 
Three Dimensional Printed Orthopedic ImplantsSpecialty Matched Consultant Advisory Panel review 2/15/2023.
Ultrasound Accelerated Fracture Healing DeviceSpecialty Matched Consultant Advisory Panel review 2/15/2023. 
Vestibular Function TestingSpecialty Matched Consultant Advisory Panel review 2/15/2023.