May 1, 2023

Policies recently reviewed for annual update

The following policies were recently reviewed for annual update. The full texts of these policies are available in the Provider section of bcbsri.com:

  • Acute Inpatient Rehabilitation Level of Care
  • Amniotic Membrane and Amniotic Fluid
  • Arthrotomy for Temporomandibular Joint (TMJ) Disorder
  • Auditory Brainstem Implant
  • Cardiointegram
  • Chelation Therapy for Off-Label Uses
  • Chronic Intermittent Intravenous Insulin Therapy
  • Constraint-Induced Movement Therapy
  • Corneal Collagen Cross-Linking
  • Corneal Topography, Computer Assisted Corneal Topography, Photokeratoscopy
  • Dynamic Posturography
  • Envisia for Idiopathic Pulmonary Fibrosis
  • Gastric Electrical Stimulation – Insertion
  • Intravitreal and Punctum Corticosteroid Implants
  • Laparoscopic, Percutaneous, and Transcervical Techniques for the Myolysis of Uterine Fibroids & Hysterectomies
  • Measurement of Ocular Blood Flow for Glaucoma
  • Microprocessor-Controlled Prostheses for the Lower Limb
  • Microvolt T-Wave Alternans Testing
  • Myoelectric Controlled Upper-Limb Orthoses
  • Outpatient Pulmonary Rehabilitation
  • Phototherapy in the Home for the Treatment of Dermatological Conditions
  • Powered Exoskeleton for Ambulation in Patients with Lower-Limb Disabilities
  • Prior Authorization Cardiology and Radiology Services
  • Proprietary Laboratory Analyses (PLA)
  • Reflectance Confocal Microscopy for Evaluating Skin Lesions for Suspected Malignancy. 96931-96936
  • Retinal Telescreening for Diabetic Retinopathy
  • Scanning Computerized Ophthalmic Diagnostic Imaging
  • Sensory Integration and Auditory Integration Therapy
  • Skin Contact Monochromatic Infrared Energy (MIRE)
  • Steroid Eluting Sinus Stents and Implants
  • Surgery for Groin Pain in Athletes
  • Surgical Deactivation of Migraine Headache Trigger Sites
  • Surgical Ventricular Restoration
  • Sympathetic Therapy for Pain Treatment
  • Thoracic Lumbosacral Orthosis with Pneumatics
  • Transanal Radiofrequency Treatment of Fecal Incontinence
  • Transpupillary Thermotherapy for Treatment of Choroidal Neovascularization
  • Vestibular Function Testing

We also post monthly drafts of medical policies being created or reassessed for your review. As a reminder, you can provide comments on draft policies for up to 30 days. Draft policies are located on the Provider homepage, under the Medical Policies section, under the drop-down “Draft Medical Policies.”