Blue Cross Blue Shield Massachusetts January 2018 Medical Policy Updates

January 2018 Medical Policy Updates:

• None

REVISED MEDICAL POLICIES:

• Artificial Pancreas Device Systems
• Coronary CT Angiography (CCTA)
• Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
• Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
• Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome (BRCA1 or BRCA2)
• KRAS, NRAS, and BRAF Variant Analysis in Metastatic Colorectal Cancer

CLARIFICATIONS TO MEDICAL POLICIES:

• Adoptive Immunotherapy including CAR T-Cell Therapy
• Adoptive Immunotherapy including CAR T-Cell Therapy – Preauthorization Request Form added
• Aqueous Shunts and Stents for Glaucoma
• Coronary Computed Tomography Angiography with Selective Noninvasive Fractional Flow Reserve
• Neuropsychological Testing
• Outpatient Psychotherapy
• Phototherapy: PUVA and UV-B

RETIRED MEDICAL POLICIES:

• Coronary Computed Tomography Angiography with Selective Noninvasive Fractional Flow Reserve

New 2018 Category III CPT Codes
All category III CPT Codes, including new 2018 codes, are non-covered unless they are explicitly described as “medically necessary” in a BCBSMA medical policy. To search for a particular code, click the following link: https://www.bluecrossma.com/common/en_US/medical_policies/medcat.htm and type the code in the search box on the page. Consult the coverage statement of any associated medical policy. If there is no associated policy, the code is non-covered.

Click here to view the Blue Cross Blue Shield Massachusetts Medical Policy Updates »

Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.

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Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.