| Medical Policy Name | Summary of Changes |
|---|---|
| Medicare Part C Medicare Coverage Policy Temporomandibular Joint Dysfunction Surgery |
Updated language to align with Corporate Policy. Added references to include Medicare Benefit Policy and MCG guidelines. No change to policy intent |
| Medicare Part C Medicare Coverage Policy Forsee AMD Home Monitoring |
Added references Added indication for non-coverage per external physician review No change to policy intent. |
| Medicare Part C Medicare Coverage Policy Upper Limb Prosthetics |
This policy was updated as the codes on this policy are billed under prosthetic benefit and therefore require prior approval from the Plan. No CMS guidance to update. Myoelectric codes removed as they are now billed under DME benefit. Added references No change to policy intent. |
| Medicare Part C Medicare Coverage Policy Ambulance and Medical Transport Services |
Added references No change to policy intent. |
| Medicare Part C Medical Coverage Policy Intensive Outpatient Program (IOP) Behavioral Health |
accessed on 08/18/2025 |
| Medicare Part C Medical Coverage Policy Pneumatic Compression Device for Chest, Trunk, Abdomen, Head and Neck |
|
| Medicare Part C Medical Coverage Policy Bioengineered Skin and Soft Tissue Substitute for Breast Reconstruction, Epidermolysis Bullosa Dystrophica (EBD), and Severe Burns |
Blue Cross and Blue Sheild NC Corporate Policy Skin and Soft Tissue Substitutes; Originated January 1994 via Skin and Soft Tissue Substitutes | Providers | Blue Cross NC accessed on 08/11/2025 Proposed LCD-Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL39806) accessed on 8/11/2025 Proposed Local Coverage Article (LCA) Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers Draft Article - Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DA59740) accessed on 8/11/2025 |
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