Regence Blue Cross Blue Shield October 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 October 2017 Medical Policy Updates »

 

Regence Medical Policy Update, October 1, 2017
Changes to Regence Medical Policies Announced
The Regence Group and its affiliated Plans use medical policies as guidelines for coverage decisions within the member’s written benefits. Below are summaries of recent changes to The Regence Group’s medical policies. The detailed policies and complete Medical Policy Manual are available online at www.regence.com. We have included the section and policy number for your convenience.
Policy Name Summary of Policy or Change Section and
Policy #
Coding / Implementation Change PreAuthorization Change
Genetic Testing for Li-Fraumeni Syndrome New policy which considers genetic testing for TP53 medically necessary when policy criteria are met.

Effective Date: January 1, 2018

Genetic Testing, Policy No. 82 Continue preath on code 81405, and continue to review unlisted code 81479. Add this new medical policy with code 81405 on the preauth website.
Genetic Testing for Hereditary Breast and/or Ovarian Cancer Genetic testing for TP53 associated with Li-Fraumeni syndrome will now be addressed in a new policy, GT82.

Effective Date: January 1, 2018

Genetic Testing, Policy No. 02 N/A N/A
Cosmetic and Reconstructive Surgery Revised blepharoplasty criteria to include eyelid taping measurements.

Effective Date: January 1, 2018

Surgery, Policy No. 12 N/A N/A
BRAF Genetic Testing To Select Melanoma or Glioma Patients for Targeted Therapy Revised policy title. Added BRAF testing for glioma patients and treatment with MEK inhibitors.

Effective Date: October 1, 2017

Genetic Testing, Policy No. 41 N/A Update the medical policy title on the preauth website.
Molecular Analysis for Targeted Therapy of Non-Small Cell Lung Cancer (NSCLC) Added companion diagnostic test for targeted treatment to policy.

Effective Date: October 1, 2017

Genetic Testing, Policy No. 56 Add new CPT code 0022U with preauth for this medical policy. Add new CPT code 0022U to the preauth website for this policy.
Evaluating the Utility of Genetic Panels Added one new investigational panel.

Effective Date: October 1, 2017

Genetic Testing, Policy No. 64 Add new CPT code 0019U with investigational denial for this medical policy. N/A
Hyperbaric Oxygen Pressurization (HBOT) Added idiopathic sudden sensironeural hearing loss which may be considered medically necessary when criteria are met.

Effective Date: October 1, 2017

Medicine, Policy No. 14 N/A N/A
New and Emerging Medical Technologies and Procedures Added new CPT code 0021U.

Effective Date: October 1, 2017

Medicine, Policy No. 149 Add new CPT code 0021U with investigational denial for this medical policy. N/A
Sphenopalatine Ganglion Block for Headache and Pain New medical policy that will consider sphenopalatine ganglion block investigational for all indications.

Effective Date: October 1, 2017

Medicine, Policy No. 160 Adding investigational denial on code 64505.

Continue to review unlisted code 64999.

N/A
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Changed prostate cancer from investigational to medically necessary when policy criteria are met. Removed the requirement for no high-grade compression. Added SRS for spinal tumors as medically necessary.

Effective Date: October 1, 2017

Surgery, Policy No. 16 N/A N/A
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions Liberalized to include Matrix-induced Autologous Chondrocyte Implantation therapies with FDA approved devices following published criteria.

Effective Date: October 1, 2017

Surgery, Policy No. 87 N/A N/A
Cryosurgical Ablation of Miscellaneous Solid Organ, Pulmonary, and Breast Tumors Moved liver tumors into new policy, Ablation of Primary and Metastatic Liver Tumors, Surgery, Policy No. 204.

Effective Date: October 1, 2017

Surgery, Policy No. 132 Moving codes 47371, 47381, and 47383 to new medical policy SUR204. N/A
Ablation of Primary and Metastatic Liver Tumors Adding percutaneous ethanol injection and cryoablation to ablative techniques.

Effective Date: October 1, 2017

Surgery, Policy No. 204 Adding preauth to codes 47371, 47381, and 47383. Adding codes 47371, 47381, and 47383 to the preauth website.
Hematopoietic Cell Transplantation for Solid Tumors of Childhood Added metastatic retinoblastoma to potentially medically necessary criterion. Clarified nonmetastatic retinoblastoma is considered investigational.

Effective Date: October 1, 2017

Transplant, Policy No. 45.37 N/A N/A

 

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!

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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