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Regence Blue Cross Blue Shield November 2017 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.
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!
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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.
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