Aqueous Shunts and Stents for Glaucoma
Effective March 1, 2024, CPT Codes 66179, 66180, 66184, and 66185 will be added to this policy and will be subject to the medically necessary ICD-10 diagnosis codes. This policy will be applicable to both Medicare Advantage plans and commercial products. For additional information related to this policy, please click here.
Remote Electrical Neuromodulation for Migraines
Effective March 1, 2024, Remote electrical neuromodulation will now also be not covered for Medicare Advantage plans and not medically necessary for commercial products for prevention of migraines. For additional information related to this policy, please click here.
Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia and Gastroparesis
Effective March 1, 2024, gastric peroral endoscopic myotomy as a treatment for gastroparesis will not be covered for Medicare Advantage plans and is not medically necessary for commercial products. For additional information related to this policy, please click here.
Vitamin D Testing
Effective October 1, 2023, the list of covered ICD-10-CM codes for CPT code 82306 was updated with new ICD-10-CM codes that became valid on October 1, 2023 for both Medicare Advantage plans and commercial products. Please refer to the medical policy for details. For additional information related to this policy, please click here.
Dermatologic Applications of Photodynamic Therapy
Effective March 1, 2024, we will be adding HCPCS code J7345 to this policy, which will be considered medically necessary for commercial products only when filed with a covered ICD-10-CM code. For additional information related to this policy, please click here.
Spinal Cord Stimulation
Effective March 1, 2024, this policy will be archived; however, prior authorization will continue to be required for both Medicare Advantage plans and commercial products utilizing the medical criteria found in the online authorization tool. For additional information related to this policy, please click here.
Epidural Injections for Pain Management
Effective March 1, 2024, CPT codes 62324, 62325, 62326, and 62327 will no longer require prior authorization for Medicare Advantage plans and commercial products. For additional information related to this policy, please click here.
Prior Authorization via Web-Based Tool for Procedures
Effective March 1, 2024, CPT codes 62324, 62325, 62326, and 62327 will no longer require prior authorization for Medicare Advantage plans and commercial products. For additional information related to this policy, please click here.
Mobile Cardiac Outpatient Telemetry (MCOT)
Effective March 1, 2024, prior authorization will be recommended for commercial products only for CPT codes 93228 and 93229 utilizing the medical criteria found in the online authorization tool, and will no longer be considered not medically necessary. As a result, this policy will be archived effective March 1, 2024. For additional information related to this policy, please click here.