Florida Blue Cross Blue Shield October 2017 Medical Policy Revisions

Florida Blue Cross Blue Shield Medical Policy Updates
Florida Blue Cross Blue Shield Medical Policy Updates

Click here to view the Florida Blue Cross Blue Shield October 2017 Medical Policy Revisions »

 

WHAT’S NEW

10/15/17

Revised MCGs:

  1. Abatacept (Orencia®) – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
  2. Adalimumab (Humira®) – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
  3. Afatinib (Gilotrif TM) Tablets – Review and revision to guideline, consisting of updating position statement, coding, references.
  4. Alectinib (Alecensa®) – Review and revision to guideline, consisting of updating position statement, coding, references.
  5. Alemtuzumab (Lemtrada TM) IV – Review and revision to guideline; consisting of updating position statement and references.
  6. Anakinra (Kineret®) – Review and revision to guideline consisting of updating description, position statement, coding/billing, definitions, related guidelines, and references
  7. Apremilast (Otezla®) Tablet – Review and revision to guideline consisting of updating description, position statement, dosage/administration, definitions, related guidelines, and references.
  8. Brachytherapy – Oncologic Applications – Revision; revised position statement. Updated references.
  9. Buprenorphine HCl (Probuphine ®) Subdermal Implant – Review and revision to guideline, consisting of updating position statement, coding, references.
  10. Ceritinib (Zykadia™) Capsules – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
  11. Certolizumab Pegol (Cimzia®) – Review and revision to guideline, consisting of updating position statement, coding, references.
  12. Computer Assisted Surgical Navigation – Review; no change in position statement. Updated references.
  13. Continuous Monitoring of Glucose in the Interstitial Fluid – Unscheduled review. Revised description section, position statement section, HCPCS coding section, reimbursement information section, and program exceptions section. Updated references.
  14. Crizotinib (Xalkori®) Capsules – Review and revision to guideline, consisting of updating position statement, coding, references.
  15. Dimethyl Fumarate (Tecfidera®) Capsule – Review and revision to guideline; consisting of updating position statement and references.
  16. Erlotinib (Tarceva®) Tablets – Review and revision to guideline, consisting of updating position statement, coding, references.
  17. Etanercept (Enbrel®) – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
  18. Fingolimod (Gilenya™) Capsule – Review and revision to guideline; consisting of updating the position statement and references.
  19. Fractionation and Radiation Therapy – Revision; revised position statement. Updated references.
  20. Gefitinib (Iressa) – Review and revision to guideline, consisting of updating position statement and references.
  21. Genetic Testing – Revision; CMA investigational position statement added for the evaluation of all other conditions of delayed development; Diagnosis Table, coding, and references updated.
  22. Golimumab (Simponi®, Simponi® Aria™) – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
  23. Granisetron (Sustol®) injection – Revision to guideline; consisting of updating position statement, description, and references.
  24. Ibrutinib (Imbruvica™) – Revision to guideline consisting of updating the description section, position statement, dosage/administration section, billing/coding information, and references based on a new FDA approved indication for chronic Graft versus Host Disease (cGVHD).
  25. Image-Guided Radiation Therapy for Treatment Planning and Delivery – Revision; revised position statement. Updated references.
  26. Immune Globulin Therapy – Review and revision to guideline; consisting of updating position statement, coding and references.
  27. In Utero (Intrauterine) Fetal Surgery for Correction of Malformations – Review; added position statement for myelomeningocele. Updated references.
  28. Infliximab Products [infliximab (Remicade®), infliximab-dyyb (Inflectra®), and infliximab-abda (Renflexis®)] – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
  29. Intensity-Modulated Radiation Therapy (IMRT) – Revision; revised position statement. Added Hodgkin and Non-Hodgkin lymphoma, thyoma and thymic carcinoma. Revised other malignancies. Updated references.
  30. Ipilimumab (Yervoy™) Injection – Revision to guideline; consisting of updating position statement and references.
  31. Ixekizumab (Taltz®) Injection – Review and revision to guideline consisting of updating description, position statement, dosage/administration, definitions, related guidelines, and references.
  32. Lumbar Spine Surgery – Revision: updated position statement section regarding intra-operative/surgically induced segmental instability.
  33. Magnetic Resonance Imaging (MRI) Abdomen and Pelvis – Revised position statement (musculoskeletal pelvic and fetal MRI). Updated references.
  34. Multigene Expression Assay for Predicting Recurrence in Colon Cancer – Review; investigational position maintained, description, program exception, and references updated.
  35. Multiple Sclerosis Self Injectable Therapy – Review and revision to guideline; consisting of updating position statement and references.
  36. Natalizumab (Tysabri®) IV – Review and revision to guideline; consisting of updating position statement and references.
  37. Necitumumab (PortrazzaTM) – Review and revision to guideline, consisting of updating position statement, coding, references.
  38. Neurolysis/Ablation – Revision: Revised MCG title and description section. Added clarifying language to Position Statement regarding when neurolysis is considered E/I. Revised ICD10 coding section, Reimbursement Information section, and definitions. Updated references.
  39. Nivolumab (Opdivo®) – Revision to guideline; consisting of updating position statement, description, coding, and references.
  40. Non-Covered Services – Added codes S1030, S1031, S1034, S1035, S1036, S1037. Deleted codes A4244, A4245, A4246, A4247, A4248, A4927, D1330, D9310, E0189, E1639, G0182, L3030, S0201, S0620, S0621, S8415, S9453, V2750.
  41. Olaparib (Lynparza TM) – Review and revision to guideline; consisting of updating position statement, description, dosing and references.
  42. Osimertinib (TagrissoTM) – Review and revision to guideline, consisting of updating position statement, coding, references.
  43. Pembrolizumab (Keytruda®) Injection – Revision to guideline; consisting of updating position statement, description, coding and references.
  44. Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty – Revision: revised description section. Added coverage statement for percutaneous radiofrequency kyphoplasty. Updated references.
  45. Radiofrequency Ablation of Liver Tumors – Scheduled review. Revised description section and position statement section. Updated references.
  46. Rituximab (Rituxan) and Rituximab hyaluronidase (Rituxan Hycela) – Revision to guideline; consisting of updating position statement and references.
  47. Secukinumab (Cosentyx) – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
  48. Special Treatment Procedure and Special Physics Consult – Revision; revised position statement. Updated references.
  49. Stereotactic Body Radiotherapy – Revision; revised position statement. Added Hodgkin and Non-Hodgkin lymphoma. Updated references.
  50. Stereotactic Radiosurgery (Intracranial) – Revision; revised position statement. Added Hodgkin and Non-Hodgkin lymphoma, thyoma and thymic carcinoma. Revised other malignancies. Updated references.
  51. Subtalar Arthroereisis – Review; investigational position maintained; guideline description, coding, and references updated.
  52. Teriflunomide (Aubagio®) Tablets – Review and revision to guideline; consisting of updating position statement and references.
  53. Teriparatide (Forteo®) – Revision to guideline; consisting of updating position statement and references.
  54. Tetrabenazine (Xenazine) and Deutetrabenazine (Austedo) – Review and revision to guideline; consisting of updating position statement and references.
  55. Tocilizumab (Actemra®) Injection – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
  56. Tofacitinib (Xeljanz, Xeljanz XR) Tablets – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
  57. Ultrasound Osteogenesis Stimulators, Non-invasive – Review; no change in position statement. Updated references.
  58. Ustekinumab (Stelara™) – Review and revision to guideline consisting of updating description, position statement, coding/billing, definitions, related guidelines, and references.
  59. Vedolizumab (Entyvio™) Injection – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.

 

 

Click here to view the Florida Blue Cross Blue Shield October 2017 Medical Policy Revisions »

 

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