Paramount Healthcare September 2017 Medical Policy Updates

Paramount Healthcare Medical Policy Updates
Paramount Healthcare Medical Policy Updates

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Updates for September 2017

POLICY

 

STATUS

 

REVISION

 

PG0308 Pulsed Dye Laser Therapy for Cutaneous Vascular Lesions Revision
PENDING
Effective 12/29/17
09/22/17: Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0281 Cochlear and Auditory Brainstem Implants Revision
PENDING
Effective 12/29/17
09/22/17: Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0339 Gait Analysis Revision
PENDING
Effective 12/29/17
09/22/17: Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0407 Frenectomy or Frenotomy for Ankyloglossia New
PENDING
Effective 12/29/17
09/22/17: Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0410 Deep Brain, Cortical, and Cerebellar Stimulation New
PENDING
Effective 12/29/17
09/22/17: Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0409 Ketamine for Treatment of Psychiatric Disorders and Pain Management New
PENDING
Effective 12/29/17
09/22/17: Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0411 Genetic Testing for Duchenne and Becker Muscular Dystrophy New
PENDING
Effective 12/29/17
09/22/17: Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0327 Glaucoma Treatment with Aqueous Drainage Device Revision
PENDING
Effective 12/29/17
09/22/17: Added effective 07/01/2017 new code 0474T as covered without prior authorization for HMO, PPO, Individual Marketplace, & Elite per CMS guidelines. Procedure 0474T is non-covered per ODM guidelines. Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0043 New Experimental Services Revision
PENDING
Effective 12/29/17
09/22/17: Added new codes 0469T-0473T, 0475T-0478T effective 7-1-17 as non-covered for all product lines. PG0327 Glaucoma Treatment with Aqueous Drainage Device effective 7-1-17 added new code 0474T. Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0412 Genetic Testing for Macular Degeneration New
PENDING
Effective 12/29/17
09/22/17: Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0413 Peristeen Anal Irrigation System New
PENDING
Effective 12/29/17
09/22/17: Policy created to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).
PG0358 Genetic Counseling  Revision
PENDING
Effective 12/29/17
09/22/17: Coverage of genetic counseling changed from three (3) visits to two (2) visits. Policy reviewed and updated to reflect most current clinical evidence per The Technology Assessment Working Group (TAWG).

 

 

 

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.

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