Regence Blue Cross Blue Shield November 2017 Medical Policy Updates

Regence Blue Cross Blue Shield Medical Policy Updates
Regence Blue Cross Blue Shield Medical Policy Updates

Click here to view the Regence Blue Cross Blue Shield November 2017 Medical Policy Updates »

Policy Name Summary of Policy or Change Section and
Policy #
Coding / Implementation Change PreAuthorization Change
Wearable Cardioverter-Defibrillators Revised “low ejection” in criteria I.B. to state “left ventricular ejection fraction (LVEF) less than or equal to 35 percent” and expanded criteria I.C. to state: “As a bridge to definitive therapy (e.g., cardiac transplant), when criteria I.B. is met.”

Effective Date: February 1, 2018

Durable Medical Equipment, Policy No. 61 N/A N/A
Carrier Screening for Genetic Diseases New policy with medically necessary and investigational criteria.

Effective Date: November 1, 2017

Genetic Testing, Policy No. 81 Continue the preauth requirement on CPT codes 81250, 81252, 81253, 81254, 81257, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81412, 81434 and HCPCS codes S3844, S3845, S3846, S3849, S3850, S3853, and continue to review unlisted code 81479. Add this new policy to the preauth list with CPT codes 81250, 81252, 81253, 81254, 81257, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81412, 81434, 81479, and HCPCS codes S3844, S3845, S3846, S3849, S3850, S3853.
Charged Particle (Proton or Helium Ion) Radiotherapy Changed criteria II to specify that charged-particle irradiation has been shown to have comparable, but not superior, clinical outcomes compared to other irradiation approaches and to clar­ify when it will be considered medically necessary.

Effective Date: November 1, 2017

Medicine, Policy No. 49 N/A N/A
Extracranial Carotid Angioplasty/Stenting Added carotid angioplasty without stenting to criteria.

Effective Date: November 1, 2017

Surgery, Policy No. 93 N/A N/A
Percutaneous Angioplasty and Stenting of Veins Added several medically necessary indications.

Effective Date: November 1, 2017

Surgery, Policy No. 109 N/A N/A
Hematopoietic Cell Transplantation for Non-Hodgkin’s Lymphomas Clarified that myeloablative allogeneic HCT is considered investigational as an initial treatment for NHL.

Effective Date: November 1, 2017

Transplant, Policy No. 45.23 N/A N/A
Genetic Testing for FMR1 Mutation (Including Fragile X Syndrome) Change ovarian failure to ovarian insufficiency. Removed requirement for in vitro fertilization work-up.

Effective Date: October 1, 2017

Genetic Testing, Policy No. 43 N/A N/A

 

The following is a list of recently archived policies:
Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease Archive Effective Date: November 1, 2017 Medicine, Policy No. 145
Mechanical Embolectomy for Treatment of Acute Stroke Archive Effective Date: November 1, 2017 Surgery, Policy No. 158


Click here to view the Regence Blue Cross Blue Shield October 2017 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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