| 4/1/2025 | 04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products | 0.1 | | The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 04/01/2025, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable. | 04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products | c35cc635-9666-4887-aef5-62310408c5ed |
| 2/14/2025 | Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management (Retroactively Effective to 01/13/2025) | 0.1 | | The purpose of this document is to communicate the Company’s coverage criteria for implantation of a pulmonary artery pressure sensor (PAPS) for heart failure management for our Medicare Advantage members in accordance with the Centers for Medicare & Medicaid Services final decision memo (CAG-0046N) 01/13/2025.
| Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management (Retroactively Effective to 01/13/2025) | aa8f867c-3c27-40ea-a9d8-ebf4b2d6dd7e |
| 12/23/2024 | Coverage of Tofersen (Qalsody®) for the Treatment of Amyotrophic Lateral Sclerosis (ALS) for Independence Medicare Advantage Members (Retroactively Effective to April 25, 2023) | 0.1 | | The purpose of this document is to communicate the Company's coverage position for tofersen (Qalsody®) for Independence Medicare Advantage members. Coverage for tofersen (Qalsody) for Medicare Advantage members is retroactively effective to April 25, 2023.
| Coverage of Tofersen (Qalsody®) for the Treatment of Amyotrophic Lateral Sclerosis (ALS) for Independence Medicare Advantage Members (Retroactively Effective to April 25, 2023) | b1b55eb7-77d3-46f4-b622-e3dadf1239ab |
| 12/23/2024 | Coverage of Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45) (Retroactively Effective) | 0.1 | | The purpose of this document is to communicate the Company's coverage position for Exon Skipping Drugs for  Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45) for Independence Medicare Advantage members. Coverage for Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)) for Medicare Advantage members is retroactively effective for each of these exon skipping drugs for DMD as of the specific FDA approval dates. | Coverage of Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45) (Retroactively Effective) | e1e053e8-1496-4bd5-b339-3c984545d44d |
| 10/14/2024 | Preventive Coverage of Pre-exposure Prophylaxis for the Prevention of HIV Infection (Retroactively Effective September 30, 2024) | 0.1 | | Retroactively effective September 30, 2024, the purpose of this communication is to provide notice of the preventive coverage of pre-exposure prophylaxis for the prevention of HIV infection under the Company's medical benefit (Part B) for Medicare Advantage members.
| Preventive Coverage of Pre-exposure Prophylaxis for the Prevention of HIV Infection (Retroactively Effective September 30, 2024) | 56af6779-7574-4985-8270-c4c180a3c1df |
| 10/8/2024 | 10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated October 8, 2024) | 0.1 | | The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 10/01/2024.
For more information related to these services, please refer to specific policies when applicable. | 10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated October 8, 2024) | f55fc64e-6d67-4059-b5f5-ed09268baca8 |
| 8/28/2024 | New Preventive Coverage of 21-valent Pneumococcal Vaccine for Medicare Advantage Members (Retroactively effective to June 17, 2024) | 0.1 | | The purpose
of this communication is to provide notice regarding the new preventive
coverage criteria for 21-valent pneumococcal vaccine for Medicare
Advantage members. Services covered are retroactively effective to June 17, 2024.
| New Preventive Coverage of 21-valent Pneumococcal Vaccine for Medicare Advantage Members (Retroactively effective to June 17, 2024) | 6fac7323-5bfe-46c6-b61b-5bb43acd89e3 |
| 8/12/2024 | Pemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Medicare Advantage Members (Retroactively Effective to 03/22/2024) | 0.1 | | The purpose of this document is to communicate the Company's coverage position for pemivibart (Pemgarda) for pre-exposure prophylaxis for Coronavirus disease 2019 (COVID-19) for Medicare Advantage members. Coverage for pre-exposure prophylaxis for Coronavirus disease 2019 (COVID-19) for Medicare Advantage members is retroactively effective to March 22, 2024.
| Pemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Medicare Advantage Members (Retroactively Effective to 03/22/2024) | 4d3c45aa-723b-4145-a537-3d1907ca6ab7 |
| 8/5/2024 | Coverage of Cantharidin (Ycanth) Topical Solution Medicare Advantage Products (Retroactively Effective to 04/01/2024) | 0.1 | |
The purpose of this document is to communicate that the Company has revised its coverage position for cantharidin (Ycanth) topical solution.
The coverage position for cantharidin (Ycanth), represented by HCPCS code J7354, has been revised from non-covered to medically necessary. This medically necessary coverage position is retroactively effective for dates of service beginning 04/01/2024. | Coverage of Cantharidin (Ycanth) Topical Solution Medicare Advantage Products (Retroactively Effective to 04/01/2024) | 5a238e5c-d006-4b81-8145-88b034242d1f |
| 5/28/2024 | Update to the Preventive Coverage of Medicare Diabetes Prevention Program | 0.1 | | Retroactively effective to January 1, 2024, in alignment with the CMS expanded model of the Medicare Diabetes Prevention Program (MDPP), this communication is intended to provide updates to the MA00.003z Preventive Care Services policy for MDPP recommendation.
| Update to the Preventive Coverage of Medicare Diabetes Prevention Program | c17077dc-76c7-46e0-8168-108644741397 |
| 3/4/2024 | Expansion of Preventive Coverage of Diabetes Screening Tests for Medicare Advantage Members (Retroactively Effective 01/01/2024) | 0.1 | | Retroactively
effective to January 1, 2024, the purpose of this document is to communicate
the addition of hemoglobin A1c blood test to the preventive coverage of
diabetes screening test and to update the frequency of the diabetes screening tests for Medicare Advantage members.
| Expansion of Preventive Coverage of Diabetes Screening Tests for Medicare Advantage Members (Retroactively Effective 01/01/2024) | 13c77466-2297-4b48-be8c-181004935261 |
| 2/26/2024 | Coverage of the Administration at Home for Pneumococcal, Influenza, Hepatitis B, and COVID-19 Vaccination for Medicare Advantage Members (Retroactively Effective to 1/1/2024) | 0.1 | | To communicate the expansion of the administration at home procedure code to include additional vaccines (i.e., pneumococcal, influenza, hepatitis B) that can be
administered in a home setting.
| Coverage of the Administration at Home for Pneumococcal, Influenza, Hepatitis B, and COVID-19 Vaccination for Medicare Advantage Members (Retroactively Effective to 1/1/2024) | 88d36544-a5d8-4968-9f88-b746f09f6e63 |
| 2/12/2024 | Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated February 12, 2024. Retroactively Effective to January 1, 2024.) | 0.1 | | This communication provides notice regarding information and procedure codes related to the coverage of SARS-CoV-2 (Coronavirus Disease 2019 [COVID-19]) vaccines and administration of the vaccines that have been granted US Food and Drug Administration (FDA) approval and/or have received an Emergency Use Authorization (EUA). Coverage of SARS-CoV-2 vaccines granted an EUA shall remain in effect during the applicable EUA declaration, unless the specific EUA for a SARS-CoV-2 vaccine has been terminated and/or revoked. | Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated February 12, 2024. Retroactively Effective to January 1, 2024.) | 69cbcca3-61f4-42cb-9982-4d6ec2bbcee4 |
| 1/26/2024 | 01/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 26, 2024; Retroactively Effective January 1, 2024) | 0.1 | | The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. Procedure codes that represent these services are retroactively effective to 01/01/2024, unless otherwise noted. | 01/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 26, 2024; Retroactively Effective January 1, 2024) | c16e8a95-1748-42d7-b3da-3fd09ead62a0 |
| 5/12/2023 | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated May 12, 2023) | 0.1 | | The purpose of this communication is to provide advance notice regarding information and procedure codes related to testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage members. Additionally, this Company document identifies when coverage is provided for clinical purposes, and the not covered instances such as public health surveillance and screening.
| Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated May 12, 2023) | bbb097d3-f300-4610-a41e-d4d86cbcc5e2 |
