Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME)
Effective July 1, 2024, HCPCS codes K0898 and L5999 will require prior authorization for Medicare Advantage plans and commercial products. For additional information related this this policy, please click here.
New Technology and Miscellaneous Services
Effective July 1, 2024, CPT codes 0766T and 0767T will be removed from this policy and will be added to the policy Transcutaneous Electrical Nerve Stimulation (TENS), below. CPT codes 0479T and 0480T will also be removed from this policy, will be added to the new policy, Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement, below. For additional information related this this policy, please click here.
Transcutaneous Electrical Nerve Stimulation (TENS)
Effective July 1, 2024, CPT codes 0766T and 0767T will be added to the policy and will continue to be not medically necessary for commercial products. For Medicare Advantage plans, CPT code 0766T will change from requiring prior authorization to not covered and CPT code 0766T will change from being covered if the primary procedure has been approved to not covered. Policy statements will also be updated to reflect that TENS for the prevention or treatment of migraine headaches is not covered for Medicare Advantage plans and is not medically necessary for commercial products. For additional information related this this policy, please click here.
Adult Intensive Services (AIS) and Child and Family Intensive Services (CFIT)
Effective April 1, 2024, the requirement for six hours per week of contact hours is transitioning to a fee-for-service model. For additional information related this this policy, please click here.
Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
Effective July 1, 2024, CPT code 82523 will change from covered for Medicare Advantage plans to covered when filed with a covered diagnosis listed in the policy. CPT code 82523 will change from not medically necessary when filed with a noncovered diagnosis for commercial products to covered when filed with a covered diagnosis listed in the policy. CPT code 83937 will change from covered for Medicare Advantage plans to not covered when filed with a noncovered diagnosis listed in the policy. No changes for CPT code 83937 for commercial products, which will continue to be not medically necessary when filed with a noncovered diagnosis listed in the policy. For additional information related this this policy, please click here.
Functional Neuromuscular Electrical Stimulation
Effective July 1, 2024, the policy statement has been revised with no change in intent. HCPCS codes E0764 and E0770 will remain not medically necessary for commercial products. There are no changes for Medicare Advantage plans.
Of note: HCPCS codes E0764 and E0770 will continue require prior authorization utilizing the medical criteria found in the online authorization tool, based on policy, prior authorization via web-based tool for procedures and will continue. For additional information related this this policy, please click here.
Viscocanalostomy and Canaloplasty
Effective July 1, 2024, CPT codes 66174 and 66175, canaloplasty, will change from covered for Medicare Advantage plans and commercial products to covered when filed with a covered diagnosis listed in the policy. A viscocanalostomy will remain not covered for Medicare Advantage plans and not medically necessary for commercial products and will need to be filed with Unlisted CPT code 66999 instead of CPT codes 66174 and/or 66175. For additional information related this this policy, please click here.
Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement
Effective July 1, 2024, CPT codes 0479T and 0480T will be added to this new policy and will change from covered to not medically necessary for commercial products and not covered for Medicare Advantage plans. For additional information related this this policy, please click here.
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA)
Effective July 1, 2024, the medical criteria used to determine medical necessity of Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA) tests and codes that do not have specific criteria found in another BCBSRI policy will change from medical necessity criteria to general genetic testing criteria. For additional information related this this policy, please click here.