Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
Effective June 1, 2024, CPT codes 81457-81459 and 81462-81464 (new codes effective January 1, 2024) will be added to this policy, will continue to require prior authorization, and will be approved when the medical criteria in this policy is met for both Medicare Advantage plans and commercial products. For full details related to this policy, please click here.
Glucose Monitoring – Continuous
Effective June 1, 2024, CPT code 0446T will change from being not medically necessary for commercial products to prior authorization using the medical criteria in this policy. For full details related to this policy, please click here.
Lyme Disease Diagnosis and Treatment Mandate
Effective June 1, 2024, CPT code 86619 will be added to the policy and will continue to be covered for Medicare Advantage plans and commercial products. For full details related to this policy, please click here.
Molecular Testing in the Management of Pulmonary Nodules
Effective June 1, 2024, CPT code 0080U will change from being not covered for Medicare Advantage plans and not medically necessary for commercial products to requiring prior authorization using the medical necessity criteria in this policy. For full details related to this policy, please click here.
Remote Intraoperative Neurophysiologic (IONP) Monitoring
Effective June 1, 2024, this new policy will include guidelines for the coverage of remote intraoperative IONP monitoring services for Medicare Advantage plans and commercial coverage. For full details related to this policy, please click here.
Surgical Deactivation of Migraine Headache Trigger
Effective June 1, 2024, for CPT codes 30140, 30520, 64716, and 67900, the list of non-covered ICD-10-CM codes, G43.001-G43.919, will be expanded to include G43.E01-G43.E19 (new codes effective October 1, 2023) for both Medicare Advantage plans and commercial products. For full details related to this policy, please click here.
Autism Spectrum Disorders Mandate
This policy was updated to reflect CMS MUE Limits will not apply to the following codes; 0362T, 0373T, 97151 – 97158. For full details related to this policy, please click here.