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Commercial Medical Policy Update for March 20, 2024
Medical GuidelinesReason 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.