Medical Policy Update for March 31, 2023
| Medical Guidelines | Reason for Update |
|---|---|
| Bronchial Thermoplasty (PDF) | Description and References updated. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No change to policy statement. |
| Cardiovascular Disease Risk Assessment AHS – G2050 (PDF) | Updated Billing/Coding section to add code 0377U effective 4/1/23. |
| Convection-Enhanced Delivery of Therapeutic Agents to the Brain (PDF) | Specialty Matched Consultant Advisory Panel review 3/15/2023. Updated description section and references. No change to policy statement. |
| Cord Blood as a Source of Stem Cells (PDF) | Specialty Matched Consultant Advisory Panel review 3/15/2023. Added reference for U.S. Food and Drug Administration (FDA). No change to policy statement. |
| Electromagnetic Navigation Bronchoscopy (PDF) | Specialty Matched Consultant Advisory Panel review 3/2023. Policy guidelines and Regulatory status updated. References added. Medical Director review 3/2023. No change to policy statement. |
| Endobronchial Valves (PDF) | References updated. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No change to policy statement. |
| Esophageal Pathology Testing AHS – M2171 (PDF) | Updated Billing/Coding section to add code 0386U effective 4/1/23. |
| Gene Expression Profiling and Protein Biomarkers for Prostate Cancer AHS - M2166 (PDF) | Off cycle review by Avalon. Updated policy guidelines and references. Deleted related policies section. Clarified “when covered” section and added coverage criteria for 4Kscore. Clarified and edited notes 2-5. Added PLA codes 0339U, 0359U to Billing/Coding section. Medical Director review 1/2023. |
| Heart-Lung Transplantation (PDF) | Minor updates to description. Related policies added. References added. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. |
| Hormone Pellet Implantation for Treatment of Menopause Related Symptoms (PDF) | Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director Review 3/2023. Related Policies section updated. References updated. No change to policy statement. |
| Laboratory Procedures Medical Policy AHS - R2162 (PDF) | Updated Billing/Coding section to add codes 0372U, 0375U, 0376U, 0378U, 0381U, 0382U, 0383U, 0384U and 0385U effective 4/1/2023. |
| Liquid Biopsy AHS-G2054 (PDF) | Added PLA code 0368U to Billing/Coding section. |
| Lung and Lobar Lung Transplantation (PDF) | Description and references updated. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No change to policy statement. |
| Lung Volume Reduction Surgery (PDF) | References added. When covered section updated for clarity. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No change to policy statement. |
| Maternal and Fetal Diagnostics (PDF) | References updated. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. Related policies updated. No change to policy statement. |
| Microsatellite Instability and Tumor Mutational Burden Testing AHS-M2178 (PDF) | Added PLA code 0379U to Billing/Coding section. |
| Minimal Residual Disease (MRD) AHS-M2175 (PDF) | Added PLA code 0364U to Billing/Coding section. |
| Monoclonal Antibody Imaging for Prostate Cancer (PDF) | Specialty Matched Consultant Advisory Panel review 3/15/2023. Reference added. No change to policy statement. |
| Noninvasive Respiratory Assist Devices (PDF) | Description and Billing/coding sections updated for clarity. References added. Updated coverage criteria for Severe COPD for clarity. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No change to policy statement. |
| Oncologic Applications of Photodynamic Therapy, Including Barrett’s Esophagus (PDF) | Specialty Matched Consultant Advisory Panel review 3/15/2023. References added. No change to policy statement. |
| Oscillatory Devices for the Treatment of Respiratory Conditions (PDF) | Regulatory status and policy guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No changes to policy statement. |
| Ovarian and Internal Iliac Vein Embolization, Ablation and Sclerotherapy (PDF) | Description updated for clarity. References updated. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director Review 3/2023. No change to policy statement. |
| Pathogen Panel Testing AHS – G2149 (PDF) | Updated Billing/Coding section to add codes 0369U, 0370U, 0371U, 0373U, and 0374U effective 4/1/2023. |
| Pharmacogenetics Testing AHS – M2021 (PDF) | Updated Billing/Coding section to add code 0380U effective 4/1/23. |
| Phrenic Nerve Stimulation for Central Sleep Apnea (PDF) | Description and policy guidelines updated. References added. Specialty Matched Consultant Advisory Panel 3/2023. Medical Director review 3/2023. No changes to policy statement. |
| Progesterone Therapy in High Risk Pregnancies (PDF) | Description, Regulatory Status, Policy Guidelines, and Reference sections updated. Specialty Matched Consultant Advisory Panel review 3/2023. Medical Director review 3/2023. No change to policy statement. |
| Skin and Soft Tissue Substitutes (PDF) | Billing/Coding section updated to add A2019, A2020, A2021, Q4265, Q4266, Q4267, Q4268, Q4269, Q4270, and Q4271, effective 4/1/2023. |
| Sleep Apnea: Diagnosis and Medical Management (PDF) | Added new code A7049 to Billing/Coding section effective 4/1/2023. |
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