Active Notifications
The notifications listed below represent new policy versions that are scheduled to become active on the intended Policy Effective Date. These notifications allow you to become familiar with the new policy version in advance of its release. Please check back frequently as notifications are posted often.
 
   

Policy Effective Date
Notification Title
Notification Issue Date
Hide details for 04/20/202004/20/2020
Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)
03/20/2020
Hide details for 04/21/202004/21/2020
Anesthesia Services for a Cancelled or Discontinued Procedure
01/22/2020
Reporting and Documentation Requirements for Anesthesia Services
01/22/2020
Hide details for 05/15/202005/15/2020
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Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
02/13/2020
Attachment A (Dosing and Frequency Requirements) to MA08.072f Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
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Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
02/13/2020
Attachment A (Dosing and Frequency Requirements For Rituximab (Rituxan®) infusion and related biosimilars, and rituximab/hyaluronidase human for subcutaneous injection (Rituxan Hycela®)) to MA08.022i Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Attachment B (ICD-10 CODES AND NARRATIVES) to MA08.022i Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
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Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
02/13/2020
Attachment A (Dosing & Frequency Requirements for Trastuzumab (Herceptin®)) to MA08.018e Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Attachment B (ICD-10 CM Codes and Narratives) to MA08.018e Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Hide details for 05/17/202005/17/2020
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High-Technology Radiology Services
02/17/2020
Attachment A (High-Technology Radiology Services Code List) to MA09.002m High-Technology Radiology Services
Hide details for 05/18/202005/18/2020
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Chiropractic Services
02/18/2020
Attachment A (Medically neessary ICD-10 diagnosis codes) to MA10.004g Chiropractic Services
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PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
02/14/2020
Attachment A1 (DME Network Rules and Limited Circumstances) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment A2 (DME Network Rules and Limited Circumstances cont'd.) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment A3 (DME Network Rules and Limited Circumstances) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment B1 (Laboratory Network Rules and Limited Circumstances) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment B2 (Laboratory Network Rules and Limited Circumstances ) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment B3 (Laboratory Network Rules and Limited Circumstances cont'd.) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment C1 (Radiology Network Rules and Limited Circumstances) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment C2 to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Attachment D (Physical Medicine & Rehabilitation Network Rules and Limited Circumstances) to MA00.010y PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Hide details for 06/15/202006/15/2020
Artificial Intervertebral Disc Insertion
03/11/2020
Denervation of the Spinal Nerves for Chronic Pain
03/11/2020
Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
03/11/2020
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Meniscal Allograft Transplantation and Meniscal Implants
03/11/2020
Attachment A (ICD-10-CM codes) to MA11.081b Meniscal Allograft Transplantation and Meniscal Implants
Hide details for
Musculoskeletal Services
03/11/2020
Attachment A (Procedure Codes for Spine) to MA00.047c Musculoskeletal Services
Attachment B (Procedure Codes for Joints) to MA00.047c Musculoskeletal Services
Attachment C (Procedures Codes for Interventional Pain Management) to MA00.047c Musculoskeletal Services
Spinal Cord and Dorsal Root Ganglion Stimulation
03/11/2020
Spinal Discectomy
03/11/2020
Spinal Fusion
03/11/2020
Spinal Laminectomy
03/11/2020









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