Emergency Department Services/Waiver of Copayment
This policy was edited to clarify the definition of emergency services. For additional information related to this policy, please click here.
Intravitreal and Punctum Corticosteroid Implants
Effective November 1, 2023, for both Medicare Advantage plans and commercial products, CPT code J1096 will be added to the coding section and will be subject to the medically necessary ICD-10 Diagnosis Code requirements. Additionally, the medically necessary ICD-10 Diagnosis Code list has been updated to mirror the policy's statements. For additional information related to this policy, please click here.
Minimal Residual Disease Testing for Cancer
Effective November 1, 2023, this policy will be updated to include the Guardant REVEAL test for which prior authorization will be required for Medicare Advantage plans and recommended for commercial products. For additional information related to this policy, please click here.
Genetic Testing Services
Effective November 1, 2023, CPT code 81308 will change from being reviewed against criteria in the web-based authorization tool to being reviewed against criteria in this policy for Medicare Advantage plans and commercial products. For additional information related to this policy, please click here.
Preventive Services for Commercial Members
Effective January 1, 2024, updates have been made regarding coverage of screening for anxiety disorders for adults and clarified coverage of codes 82947 and 83036 for diabetes screening that each code is covered one time per year. For additional information related to this policy, please click here.
Non-Reimbursable Health Service Codes
Effective October 1, 2023, CPT codes 99446, 99447, 99448, 99449, and 99451 will be removed from the Non-Reimbursable Health Service Codes list for professional providers.
Also, effective November 1, 2023, G0176 will be added to the list for professional and facility providers.
For additional information related to this policy, please click here.