Corneal Topography, Computer Assisted Corneal Topography, Photokeratoscopy

Effective April 1, 2025, CPT code 92025 will change from not covered for Medicare Advantage plans and not medically necessary for commercial products to covered when filed with a covered ICD-10 code listed in this policy. All other ICD-10 codes will be considered not covered for Medicare Advantage plans and not medically necessary for commercial products. As a result, the policy statements will also be revised. For additional details related to this policy, please click here.

Prior Authorization via Web Based Tool for Durable Medical Equipment (DME)

Effective April 1, 2025, HCPCS code E1802 will no longer require prior authorization for commercial products. No change for Medicare Advantage plans. 

Effective April 1, 2025, HCPCS code E0676 will change from being not covered using the Medicare Noridian LCD to requiring prior authorization using the Medicare Compliant InterQual NCD Module called Pneumatic Compression Devices NCD for Medicare Advantage plans. The Noridian LCD for Pneumatic and other Powered Compression Devices was retired by CMS in November 2024.

For additional details related to this policy, please click here.

Vitamin D Testing

Effective April 1, 2025, CPT code 0038U will be added to this policy and will be covered only when filed with a covered ICD-10 code for Medicare Advantage plans and commercial products. All other ICD-10 codes will be considered not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.

New Technology and Miscellaneous Services 

Prior Authorization of Cardiology and Radiology Services                                    

Effective April 1, 2025, CPT codes 0862T, 0863T and 0865T will change from covered to prior authorization for Medicare Advantage Plans and Commercial Products using the clinical guidelines found on the Cardiology and Radiology Management Program vendor's website which can be accessed at evicore.com or calling 1-888-233-8158 or faxing to 1-888-693-3210. For additional details related to this policy, please click here. 

Genetic Testing Services                                                                           

Effective April 1, 2025, the following changes will take place: 

• For CPT codes 81275, 81276, 81308, coverage will change to Covered for Medicare Advantage Plans and Commercial Products. 
• For CPT codes 81272, 81287, 81310, 81311, 81314, 81334, 81335 and 81540, for Medicare Advantage Plans and Commercial Products, coverage will change to medically necessary with specific diagnosis codes, all other diagnosis codes will be Not Covered for Medicare Advantage Plans and Not Medically Necessary for Commercial Products. See policy for specific diagnosis codes.
• For CPT codes 81273 and 81301 for Medicare Advantage Plans and Commercial Products, prior authorization will no longer be needed for specific diagnosis codes identified in the policy. All other diagnosis codes will continue to need prior authorization, using InterQual content.
• For CPT codes 81227 and 81355, coverage will change to Covered for Commercial Products. 

For additional details related to this policy, please click here.

Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA)                                                                                                                           

Effective April 1, 2025, the following changes will take place: 

• For CPT code 0030U, coverage will change to Covered for Commercial Products.
• For CPT code 0038U, for Medicare Advantage Plans and Commercial Products, coverage will change to medically necessary with specific diagnosis codes, all other diagnosis codes will be Not Covered for Medicare Advantage Plans and Not Medically Necessary for Commercial Products. Code will also be found in the Vitamin-D Testing policy. 
• For CPT code 0039U, coverage will change to Not Covered for Medicare Advantage Plans.
• For CPT code 0040U, for Medicare Advantage Plans, medical necessity review will change to using InterQual content. 
• For CPT codes 0070U – 0076U, for Medicare Advantage Plans and Commercial Products, coverage will change to prior authorization using InterQual content, with the following exceptions: 
• Services will deny as Not Covered for Medicare and Not Medically Necessary for Commercial for specific diagnosis codes identified in the policy.
• Prior authorization will not be needed for specific diagnosis codes identified in the policy.
• All other diagnosis codes will need prior authorization using InterQual content.
• For CPT codes 0180U – 0201U, 0221U and 0222U, for Medicare Advantage Plans and Commercial Products, coverage will change to Not Covered for Medicare Advantage Plans and Not Medically Necessary for Commercial Products. 

For additional details related to this policy, please click here.

Biofeedback

Effective April 1, 2025, CPT codes 90875, 90876 and E0746 will change from not covered to requiring Prior Authorization utilizing the medical criteria in the web-based tool InterQual for Medicare Advantage plans only.

Additionally, effective April 1, 2025, CPT codes 90901, 90912 and 90913 will change from being reviewed utilizing the medical criteria in the Biofeedback Medical Policy to being reviewed utilizing the web-based tool InterQual for Medicare Advantage Plans. 

There will be no other changes to this policy. For additional details related to this policy, please click here.