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News & Announcements4/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products3/31/2023
NotificationsAtezolizumab (Tecentriq®)08.01.69c3/3/2023 9:00 AM4/3/20233/3/2023Medical Necessity Criteria
NotificationsInsertion of Implantable Infusion Pumps11.15.03m3/10/2023 9:00 AM4/10/20233/10/2023Medical Necessity Criteria
NotificationsModifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service03.00.06x3/10/2023 2:00 PM6/12/20233/10/2023Coverage and/or Reimbursement Position;Medical Coding
NotificationsAnkle-Foot/Knee-Ankle-Foot Orthoses05.00.39s3/14/2023 9:00 AM4/13/20233/14/2023Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational Update
Notificationspatisiran (Onpattro®) and vutrisiran (Amvuttra™)08.01.50c3/14/2023 10:00 AM6/12/20233/14/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsCosmetic Procedures12.01.03b3/31/2023 11:00 AM7/1/20233/31/2023Coverage and/or Reimbursement Position
NotificationsInjectable Dermal Fillers for Cosmetic Procedures05.00.62i3/31/2023 1:00 PM7/1/20233/31/2023General Description, Guidelines, or Informational Update
New PoliciesUblituximab-xiiy (Briumvi TM) for intravenous use08.02.023/13/20233/13/2023This is a New Policy.
New PoliciesMosunetuzumab-axgb (Lunsumio™)08.02.003/27/20233/27/2023This is a New Policy.
Updated PoliciesTrastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)08.00.33q3/13/20233/13/2023Medical Necessity Criteria
Updated Policiesnivolumab and relatlimab-rmbw (Opdualag™) 08.01.94b3/13/20233/13/2023Medical Necessity Criteria
Updated PoliciesTotal Artificial Hearts (TAHs)11.02.19g3/13/20233/13/2023Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesRamucirumab (Cyramza®)08.01.25g3/13/20233/13/2023Medical Necessity Criteria
Updated PoliciesDostarlimab-gxly (Jemperli)08.01.79d3/13/20233/13/2023Medical Necessity Criteria
Updated PoliciesPegloticase (Krystexxa®)08.01.02h2/24/2023 10:00 AM3/27/20233/27/2023Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Reissue PoliciesEvaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)07.03.15d6/28/20173/8/20233/8/2023
Reissue PoliciesBiofeedback Therapy07.00.01j10/1/20203/8/20233/8/2023
Reissue PoliciesOtoplasty or Non-Surgical External Ear Molding11.01.01j9/8/20183/8/20233/8/2023
Reissue PoliciesDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17k10/1/20213/8/20233/8/2023
Reissue PoliciesMedical Necessity12.01.02a7/20/20203/8/20233/8/2023
Reissue PoliciesTrigger Point Injections11.14.02q10/1/20213/8/20233/8/2023
Reissue PoliciesSpinal Decompression with Interspinous and Interlaminar Devices11.14.22d1/1/20173/8/20233/8/2023
Reissue PoliciesMohs Micrographic Surgery11.08.23j10/1/20183/8/20233/8/2023
Reissue PoliciesLow Osmolar Contrast Agents09.00.31d12/30/20153/8/20233/8/2023
Reissue PoliciesMagnetic Resonance Imaging (MRI) Contrast Agents09.00.45i4/12/20213/8/20233/8/2023
Reissue PoliciesContrast Agents Used in Conjunction with Echocardiography09.00.11e5/3/20213/8/20233/8/2023
Reissue PoliciesModifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period03.00.15p7/12/20213/8/20233/8/2023
Reissue PoliciesContact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects07.13.11k10/1/20213/8/20233/8/2023
Reissue PoliciesPartial Coherence Interferometry07.13.08e4/23/20183/8/20233/8/2023
Reissue PoliciesCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)08.01.7111/30/20203/8/20233/8/2023
Reissue PoliciesEnzyme Replacement for the Treatment of Gaucher's Disease08.00.51k6/7/20213/8/20233/8/2023
Reissue PoliciesEnzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase®, Vimizim®, Naglazyme®, Mepsevii™, etc.)08.00.70e6/3/20193/22/20233/22/2023
Reissue PoliciesAgalsidase beta (Fabrazyme®)08.00.69c8/30/20213/22/20233/22/2023
Reissue PoliciesLaboratory-Based Vestibular Function Testing07.03.24b1/1/20213/22/20233/22/2023
Reissue PoliciesPain Management of Peripheral Nerves by Injection07.03.2712/27/20213/22/20233/22/2023
Reissue PoliciesRepair of Cleft Lip, Cleft Nose, and/or Cleft Palate11.03.01f12/21/20203/22/20233/22/2023
Reissue PoliciesGastric Electrical Stimulation (Enterra™), Gastric Pacing11.03.15i11/30/20203/22/20233/22/2023
Reissue PoliciesIslet Cell Transplantation11.04.01d1/1/20203/22/20233/22/2023
Reissue PoliciesEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®)08.00.84i10/17/20223/22/20233/22/2023
Reissue PoliciesTriamcinolone Acetonide Extended-Release Injectable (Zilretta®)08.01.47a1/1/20193/22/20233/22/2023
Reissue PoliciesPulse Oximetry Devices in the Home Setting05.00.31e5/7/20183/22/20233/22/2023
Reissue PoliciesCranial Remolding Orthoses (Helmets)05.00.25i4/20/20203/22/20233/22/2023
Reissue PoliciesSmell and Taste Dysfunction Testing07.11.01c5/7/20183/22/20233/23/2023
Reissue PoliciesModifier 66: Surgical Team00.10.17m4/1/20223/22/20233/23/2023
Reissue PoliciesModifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional03.00.11c6/21/20213/22/20233/23/2023
Reissue PoliciesModifier 79:  Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period03.00.28n9/13/20213/22/20233/23/2023
Reissue PoliciesAllogeneic Processed Thymus Tissue-agdc (Rethymic®)08.01.885/16/20223/22/20233/23/2023
Reissue PoliciesModifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional03.00.02c6/21/20213/22/20233/23/2023
Reissue PoliciesModifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period03.00.12g9/13/20213/22/20233/23/2023
Reissue PoliciesIsatuximab-irfc (Sarclisa®)08.00.46c5/23/20223/22/20233/23/2023
Reissue PoliciesVoretigene Neparvovec-rzyl (Luxturna™)08.01.44c1/1/20193/22/20233/23/2023
Reissue PoliciesCervical Traction Devices for In-home Use05.00.61g11/9/20203/22/20233/23/2023
Reissue PoliciesOff-label Coverage for Prescription Drugs and/or Biologics08.00.15f5/4/20203/22/20233/23/2023
Reissue PoliciesNonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home07.03.25a1/1/20203/22/20233/23/2023
Reissue PoliciesSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77c10/1/20223/22/20233/23/2023
Reissue PoliciesPositron Emission Mammography (PEM)09.00.51a11/6/20133/22/20233/23/2023
Reissue PoliciesRefractive Keratoplasty11.05.01g7/1/20223/22/20233/24/2023
Reissue PoliciesVeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer06.02.49b5/6/20163/22/20233/24/2023
Coding UpdateTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring11.00.06p4/1/20233/31/2023
Coding UpdateVagus Nerve Stimulation (VNS)11.15.16s4/1/20233/31/2023
Coding UpdateSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence11.17.04v4/1/20233/31/2023
Coding UpdateGastric Electrical Stimulation (Enterra™), Gastric Pacing11.03.15j4/1/20233/31/2023
Coding UpdateDeep Brain Stimulation (DBS)11.15.20r4/1/20233/31/2023
Coding UpdateReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents00.10.43c4/1/20233/31/2023
Coding UpdateSpesolimab--sbzo (Spevigo®)08.01.97a4/1/20233/31/2023
Coding UpdateIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars08.00.74r4/1/20233/31/2023
Coding Updateolipudase alfa-rpcp (Xenpozyme™)08.01.96a4/1/20233/31/2023
Coding UpdateEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related biosimilars08.01.32j4/1/20233/31/2023
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20af4/1/20233/31/2023
Coding UpdateGenetic Testing (Independence Administrators)06.02.35aj4/1/20233/31/2023
Coding UpdatePreventive Care Services00.06.02al4/1/20233/31/2023