Digital Health Technologies for Attention Deficit/Hyperactivity Disorder (REVISED POLICY TITLE 

The above reference policy was formerly known as Digital Health Therapies for Attention Deficit/Hyperactivity Disorder. We updated the policy statement from “Prescription digital therapy is considered not covered/not medically necessary for the treatment of ADHD” to “The use of EndeavorRx is considered not covered/not medically necessary for all indications including attention-deficit/hyperactivity disorder.” This will go into effect December 1, 2023. For additional information related to this policy, please click here.   

Lyme Disease Diagnosis and Treatment Mandate            

Effective December 1, 2023, CPT codes 0043U and 0044U are being added to the above referenced policy and will change from not covered for Medicare Advantage plans and not medically necessary for commercial products to covered for both Medicare Advantage plans and commercial products. CPT codes 0301U and 0302U are also being added to the policy and will continue to be covered for Medicare Advantage plans and commercial products. For additional information related to this policy, please click here. 

Non-Reimbursable Health Service Codes                                           

Effective October 1, 2023, codes 99446, 99447, 99448, 99449, and 99451 (interprofessional consultative codes) have been removed from list for professional providers.

Effective November 1, 2023, code G0176 (activity therapy partial hospitalization program) has been added to list for professional and facility providers. For additional information related to this policy, please click here.

Mammogram and Pap Smears Mandate                                               

Effective January 1, 2024, Rhode Island state mandate §27-20-17 requires coverage of medically necessary screenings in accordance with American College of Radiology for members who have received notice of dense breast tissue according to §23-12-9.2. For additional information related to this policy, please click here.

Prolonged Physician Services                                                             

The above referenced policy was edited to clarify the coding and reimbursement for codes 99417 and 99418. For additional information related to this policy, please click here.