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| Medical Guidelines | Reason for Update |
|---|---|
| Balloon Ostial Dilation (Balloon Sinuplasty) | Regulatory Status, Policy Guidelines, and References sections updated. No change to policy intent. Medical Director review 2/2024. Specialty Matched Consultant Advisory Panel review 2/2024. |
| Dynamic Posturography | Related policy added. References updated. Specialty Matched Consultant Advisory Panel review 2/2024. Medical Director review 2/2024. |
| Implantable Bone Conduction Hearing Aids | Regulatory Status, Policy Guidelines and References updated. No change to policy intent. Clarified When Covered section by adding the individual’s age and pure tone average bone-conduction threshold measurement for the OSIA device per the FDA approval. Terminated CPT codes 69715 and 69718 removed from Billing/Coding section. Specialty Matched Consultant Review 2/2024. Medical Director review 2/2024. |
| Intravenous Antibiotic Therapy for Lyme Disease | Added section headers to the When Covered section for clarity. The following HCPCS codes were added to the Billing/Coding section: S9500, S9501, S9502, S9503, S9504. The following ICD 10 dx codes were added to the Billing/Coding section: A69.20, B60.00, B60.01, B60.02, B60.03, B60.09 Medical Director review 2/2024. Specialty Matched Consultant Advisory Panel review 2/2024. |
| Semi-Implantable and Fully Implantable Middle Ear Hearing Aid | Updated Description, Regulatory Status, Policy Guidelines, and References. No change to policy intent. Specialty Matched Consultant Review 2/2024. Medical Director review 2/2024. |
| Vestibular Function Testing | Regulatory Status and References updated. Added Related Policy. Specialty Matched Consultant Advisory Panel review 2/2024. Medical Director review 2/2024. |
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