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News & AnnouncementsCoverage for Low Frequency Ultrasound Treatment for Wound Management for Commercial Members7/1/2024
News & Announcements7/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products7/1/2024
News & AnnouncementsPemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Commercial Members7/3/2024
NotificationsElectromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies07.03.09v7/2/2024 10:00 AM9/30/20247/9/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsIntraoperative Neurophysiological Monitoring (INM)07.03.14r7/2/2024 8:00 AM9/30/20247/9/2024Medical Coding
NotificationsLower Limb Prostheses05.00.59o7/12/2024 5:00 PM8/12/20247/12/2024Coverage and/or Reimbursement Position
NotificationsImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13ai7/16/2024 10:00 AM10/14/20247/16/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
New PoliciesADAMTS13, recombinant-krhn (Adzynma)08.02.217/15/20247/15/2024This is a New Policy.
New PoliciesToripalimab-tpzi (LOQTORZI™)08.02.207/15/20247/15/2024This is a New Policy.
Updated PoliciesPreventive Care Services00.06.02ar6/1/2024 10:00 AM7/1/20247/1/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesSelf-Administered Drugs and Biologics08.00.78ar7/1/20247/1/2024Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesSpeech Therapy10.06.01m7/1/20247/1/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesChiropractic Spinal and Extraspinal Manipulation Therapy10.02.02k7/1/20247/1/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PolicieseviCore Lab Management (Independence)06.02.52ag5/31/2024 11:00 AM7/1/20247/1/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update7/1/2024
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bo7/1/20247/1/2024Coverage and/or Reimbursement Position
Updated PoliciesBetibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]08.01.89a7/1/20247/1/2024General Description, Guidelines, or Informational Update
Updated PoliciesIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)08.01.80c7/1/20247/1/2024Medical Necessity Criteria
Updated PoliciesBiofeedback Therapy07.00.01n7/1/20247/15/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesBeremagene Geperpavec (Vyjuvek™)08.02.10b7/15/20247/15/2024Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesEtranacogene dezaparvovec-drlb (Hemgenix®)08.02.03a7/15/20247/15/2024Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesValoctocogene roxaparvovec-rvox (ROCTAVIAN™)08.02.09b7/15/20247/15/2024General Description, Guidelines, or Informational Update
Updated PoliciesOrthoptic/Pleoptic Training07.13.01k7/15/20247/15/2024Coverage and/or Reimbursement Position
Updated PoliciesRamucirumab (Cyramza®)08.01.25h7/15/20247/15/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesAssisted Reproductive Technology for Infertility and Oocyte Cryopreservation07.10.06j7/15/20247/15/2024Medical Necessity Criteria
Reissue PoliciesWheelchair Cushions and Seating05.00.55k8/14/20236/26/20247/8/2024
Reissue PoliciesGolimumab (Simponi Aria®) Intravenous (IV) Injection08.01.15g10/30/20237/10/20247/10/2024
Reissue PoliciesCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54c10/1/20227/10/20247/10/2024
Reissue PoliciesImmune Cell Function Assay06.02.37a11/6/20157/10/20247/10/2024
Reissue PoliciesIn Vitro Chemosensitivity and Chemoresistance Assays06.02.14i1/1/20207/10/20247/10/2024
Reissue PoliciesNerve Fiber Density Testing06.02.38d1/1/20197/10/20247/10/2024
Reissue PoliciesTesting Serum Vitamin D Levels06.02.51d10/1/20207/10/20247/10/2024
Reissue PoliciesHome Oxygen Therapy05.00.58o7/17/20237/10/20247/10/2024
Reissue PoliciesPercutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation11.02.26c7/18/20227/10/20247/10/2024
Reissue PoliciesNonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home07.03.25a1/1/20207/10/20247/10/2024
Reissue PoliciesMedical Necessity12.01.02b1/1/20247/10/20247/10/2024
Reissue PoliciesFecal Microbiota Transplantation (FMT)07.05.08d7/1/20237/10/20247/10/2024
Reissue PoliciesTotal Artificial Hearts (TAHs)11.02.19g3/13/20237/10/20247/10/2024
Reissue PoliciesMentoplasty or Genioplasty11.14.01h10/1/20237/10/20247/10/2024
Reissue PoliciesOstomy Supplies05.00.50o6/30/20237/10/20247/10/2024
Reissue PoliciesCryosurgical Ablation of the Prostate Gland11.11.03d4/6/20156/26/20247/16/2024
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20al7/1/20247/1/2024
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08q7/1/20247/1/2024
Coding UpdateEfbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars08.01.32m7/1/20247/1/2024
Coding UpdateElective Abortion11.06.02n7/1/20247/1/2024
Coding UpdateChimeric Antigen Receptor (CAR) Therapy08.01.43m7/1/20247/1/2024
Coding UpdateTelemedicine Services00.10.41m7/1/20247/1/2024
Coding UpdateElectromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter07.03.21n7/2/2024 3:00 PM10/1/20237/3/20247/3/2024
Coding UpdateAlways Bundled Procedure Codes00.01.52v7/1/20247/8/2024
Coding UpdateModifiers 26 (Professional Component) and TC (Technical Component)03.00.20s7/1/20247/9/2024
Coding UpdateModifier 50: Bilateral Procedure03.00.05y7/1/20247/11/2024
Coding UpdateModifier 62: Two Surgeons00.10.11z7/1/20247/11/2024
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS00.10.18x7/1/20247/11/2024
Coding UpdateMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease08.01.93d7/2/20247/19/2024
Archived PoliciesNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18t7/2/2024 3:00 PM9/30/20247/2/2024