Paramount Healthcare October 2017 Medical Policy Updates

Paramount Healthcare Medical Policy Updates
Paramount Healthcare Medical Policy Updates

Click here to view the Paramount Healthcare Medical Policy Updates »

POLICY   STATUS   REVISION
PG0347 Bioimpedance Devices for Detection of Lymphedema Revision
PENDING
Effective 2/23/18
10/27/17: Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0228 Neuromuscular, Functional, & Therapeutic Electrical Stimulation Therapy Revision
PENDING
Effective 2/23/18
10/27/17: Changed title from “Electrical Stimulation Therapy” to “Neuromuscular, Functional, & Therapeutic Electrical Stimulation Therapy.” Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0351 The Implantable Miniature Telescope (IMT) Revision
PENDING
Effective 2/23/18
10/27/17: The Implantable Miniature Telescope (0308T) is now covered with prior authorization for HMO, PPO, & Individual Marketplace. Added ICD-10 codes H35.3114 & H35.3124 per CMS guidelines. Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0379 Peroral Endoscopic Myotomy (POEM) for Treatment of Esophageal Achalasia Revision
PENDING
Effective 2/23/18
10/27/17: Added ICD-10 code K22.0. Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0414 Peripheral Artery Disease (PAD) Rehabilitation New
PENDING
Effective 2/23/18
10/27/17: Peripheral Artery Disease (PAD) Rehabilitation (93668) is non-covered for HMO, PPO, Individual Marketplace, & Advantage. Peripheral Artery Disease (PAD) Rehabilitation (93668) is covered with prior authorization for Elite. Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0404 Laser Vitreolysis Revision
PENDING
Effective 2/23/18
10/27/17: ICD-10 diagnosis codes H43.391-H43.399, H43.811-H43.819 added to policy. Laser vitreolysis (67031) is non-covered for treatment of vitreous degeneration and vitreous floaters (H43.391-H43.399, H43.811-H43.819). Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0302 Genetic Testing for Colorectal Cancer Revision
PENDING
Effective 2/23/18
10/27/17: Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0403 Therapeutic Contact Lenses Revision
PENDING
Effective 2/23/18
10/27/17: Added criteria per OAC 5160-6-01. Codes S0515, V2531 are non-covered for Advantage per ODM guidelines. Code S0515 is Non-Medicare and therefore non-covered for Elite. Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0415 Pancreatic Islet Cell Transplantation New
PENDING
Effective 2/23/18
10/27/17: Autologous pancreatic islet cell transplantation (48160) for an individual undergoing total or near total pancreatectomy is covered with prior authorization for all product lines. Allogeneic pancreatic islet cell transplantation (S2102) is non-covered for HMO, PPO, Individual Marketplace, & Advantage. Allogeneic pancreatic islet cell transplantation (S2102) is covered with prior authorization for Elite. Codes G0341, G0342, & G0343 are non-covered for all product lines. Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0190 Chondrocyte Implantation of the Knee Revision
PENDING
Effective 2/23/18
10/27/17: Added information on MACI (autologous cultured chondrocytes on porcine collagen membrane). Paramount considers FDA-approved matrix-induced chondrocyte implantation (e.g., MACI (Vericel) autologous cultured chondrocytes on porcine collagen membrane) an equally acceptable alternative to autologous cultured chondrocytes (e.g., Carticel) for the medically necessary indications for autologous chondrocyte implants listed above. Policy revised to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0227 Airway Clearance Devices Revision
PENDING
Effective 2/23/18
10/27/17: Changed title from PG0227 Chest Wall Oscillation Vest to Airway Clearance Devices. Added codes E0480, E0482, E0484 as covered without prior authorization for all product lines. Added unlisted code E1399. Added code E0481 as covered without prior authorization for Advantage and non-covered for HMO, PPO, Individual Marketplace, & Elite. Added code S8185 as non-covered for all product lines. Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0238 Podiatry Shoes and Inserts (Orthotic Foot Inserts)

 

Revision
PENDING
Effective 12/29/17
10/10/17: Removed ICD-9 codes. Code A5507 is non-covered for Advantage per ODM guidelines. Updated policy per ODM 5160-10-12 & CMS L33641 guidelines. Policy reviewed and updated to reflect most current clinical evidence per Medical Policy Steering Committee
PG0304 Breast Tomosynthesis (Digital)        Revision
PENDING
Effective 12/29/17
09/11/17: HCPCS codes G0202, G0204 & G0206 are covered for Advantage. Advantage product line allows both CPT codes 77065, 77066 & 77067 or HCPCS codes G0202, G0204 & G0206 for Mammograms.

10/10/17: Removed ICD-9 codes. Policy reviewed and updated to reflect most current clinical evidence per Medical Policy Steering Committee.

PG0381 Hospital Readmissions Revision
PENDING
Effective 12/29/17
10/10/17: Removed #197 skin and subcutaneous tissue infections from Excluded Clinical Classification Software Codes (CCS). Policy reviewed and updated to reflect most current clinical evidence per Medical Policy Steering Committee.
PG0158 Physical Therapy (PT) and Occupational Therapy (OT) Revision
PENDING
Effective 12/29/17
10/10/17: Code 97012 added as covered for all product lines with limit of 1 unit per date of service. Kinesio taping added as non-covered for all product lines. Policy reviewed and updated to reflect most current clinical evidence per Medical Policy Steering Committee.
PG0177 Continuous Glucose Monitoring Systems and Insulin Pumps Revised
Effective 12/29/17
10/10/17: Added Dexcom G4 PLATINUM, iPro2 Professional with Enlite Sensor, & FreeStyle Libre Flash Glucose Monitoring System to examples of FDA approved long-term CGMS. Policy reviewed and updated to reflect most current clinical evidence per Medical Policy Steering Committee.

 

Click here to view the Paramount Healthcare 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.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!

Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.

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.

subscribe

Receive these updates by email

error: Content is protected !!