Medical Policy Update for August 29, 2023
| Medical Guidelines | Reason for Update |
|---|---|
| Abdominoplasty and Panniculectomy (PDF) | References updated. Specialty Matched Consultant Review 8/2023. Medical Director review 8/2023. No change to policy statement. |
| Absorbable Nasal Implant for Treatment of Nasal Valve Collapse (PDF) | References updated. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. |
| Breast Surgeries (PDF) | Updated Related Policies section. References updated. Updated “When Reduction Mammaplasty is covered” section D to change “risk factor” to “contributing factor”. Updated “Reconstructive Breast Surgery After Mastectomy” description. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement. |
| Colorectal Cancer Screening AHS-B0001 (PDF) | Reviewed by Avalon Q1 2023 CAB. No changes to policy statement. |
| Composite Allotransplantation of the Hand and Face (PDF) | References updated. Specialty Matched Consultant Advisory Panel 8/2023. Medical Director review 8/2023. No change to policy statement. |
| Extracorporeal Photopheresis (PDF) | Specialty Matched Consultant Advisory Panel review 8/16/2023. Updated description section. References added. No change to policy statement. |
| Laser Treatment of Port Wine Stains (PDF) | References updates. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement. |
| Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification AHS-B0002 (PDF) | General review per Avalon CAB Q2 2023. Medical Director review 8/2023. No change to policy statement. |
| Reconstructive Eyelid Surgery and Brow Lift (PDF) | Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. References updated. No change to policy statement. |
| Rhinoplasty (PDF) | Updated references. Added Related Policy. Minor edit to the Policy Guidelines. No change to policy intent. Deleted terminated code C9749 from Billing/Coding section. Medical Director Review 8/2023. Specialty Matched Consultant Advisory Panel 8/2023. |
| Septoplasty (PDF) | Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. Updated references. Added Related Policy. |
| Skin and Soft Tissue Substitutes (PDF) | References updated. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No changes to policy statement. |
| Sleep Apnea: Diagnosis and Medical Management (PDF) | When covered section updated for clarity. References added. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement. |
| Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome (PDF) | References updated. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement. |
| Surgical Treatment for Lipedema (PDF) | References updated. Medical Director review 8/2023. Specialty Matched Consultant Advisory Panel Review 8/2023. No change to policy statement. |
| Surgical Treatment of Chest Wall Deformities (Congenital or Acquired) (PDF) | Specialty Matched Consultant Advisory Panel 8/2023. Medical Director review 8/2023. References updated. No change to policy statement. |
| Tinnitus Treatment (PDF) | Reference added. Description section updated to include related policies, Minor edits to Policy Guidelines. No change to policy intent. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. |
| Tumor-Treatment Fields Therapy (PDF) | Specialty Matched Consultant Advisory Panel review 8/16/2023. Updated description policy guidelines and references. No change to policy statement. |
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