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News & Announcements01/01/2022 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 7, 2022)1/7/202201/01/2022 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 7, 2022)
News & AnnouncementsPharmaceutical Prophylaxis and Treatments of COVID-19 for Independence Medicare Advantage Members (Updated January 11, 2022)1/11/2022Pharmaceutical Prophylaxis and Treatments of COVID-19 for Independence Medicare Advantage Members (Updated January 11, 2022)
News & AnnouncementsCoverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated January 28, 2022)1/28/2022Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated January 28, 2022)
NotificationsIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)MA08.1371/4/2022 3:00 PM4/4/20221/4/2022This is a New Policy.Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
Updated PoliciesTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in AdultsMA05.047g12/3/2021 5:00 AM1/3/20221/3/20221/3/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update1/3/2022Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Updated PoliciesLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsMA00.030v1/1/20221/3/2022Coverage and/or Reimbursement PositionLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Updated PoliciesPreventive Care ServicesMA00.003r1/1/20221/3/2022Medical Necessity CriteriaPreventive Care Services
Updated PoliciesAvelumab (Bavencio®)MA08.122a1/3/20221/3/2022Medical Necessity CriteriaAvelumab (Bavencio®)
Updated PoliciesDurvalumab (Imfinzi®)MA08.123a1/3/20221/3/2022Medical Necessity CriteriaDurvalumab (Imfinzi®)
Updated PoliciesCemiplimab-rwlc (Libtayo®)MA08.124a1/3/20221/3/2022Medical Necessity CriteriaCemiplimab-rwlc (Libtayo®)
Updated PoliciesModifier 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 ServiceMA03.003j1/1/20221/4/2022General Description, Guidelines, or Informational UpdateModifier 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 Service
Updated PoliciesExperimental/Investigational ServicesMA00.005ab10/12/2021 7:00 AM1/10/20221/10/2022Medical Coding1/10/2022Experimental/Investigational Services
Updated PoliciesHyperbaric Oxygen TherapyMA07.001b1/31/20221/31/2022Medical Necessity CriteriaHyperbaric Oxygen Therapy
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)MA08.009o1/31/20221/31/2022Medical Necessity Criteria;Medical CodingImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Updated PoliciesModifiers XE, XS, XP, XU, and 59MA03.005c1/31/20221/31/2022General Description, Guidelines, or Informational UpdateModifiers XE, XS, XP, XU, and 59
Coding UpdateAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )MA08.036e1/1/20221/4/2022Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )
Coding UpdateAsparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)MA08.085e1/1/20221/4/2022Asparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)
Coding UpdateDostarlimab-gxly (Jemperli)MA08.136b1/1/20221/4/2022Dostarlimab-gxly (Jemperli)
Coding UpdateOstomy SuppliesMA05.014c1/1/20221/4/2022Ostomy Supplies
Coding UpdateAnifrolumab-fnia (Saphnelo™)MA08.140a1/1/20221/4/2022Anifrolumab-fnia (Saphnelo™)
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsMA11.015o1/1/20221/4/20221/4/2022Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Coding UpdateBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility CampusMA00.037k1/1/20221/5/2022Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Coding UpdateAlways Bundled Procedure CodesMA00.026m1/1/20221/10/2022Always Bundled Procedure Codes
Coding UpdateCare Management and Care Planning ServicesMA00.006i1/1/20221/11/2022Care Management and Care Planning Services
Coding UpdateGender Affirming InterventionsMA11.106g1/1/20221/12/2022Gender Affirming Interventions
Coding UpdateBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsMA11.049d1/1/20221/12/2022Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Coding UpdateHematopoietic Stem Cell TransplantationMA11.002i1/1/20221/12/2022Hematopoietic Stem Cell Transplantation
Coding UpdateServices Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care ProvidersMA00.033j1/1/20221/14/2022Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ag1/1/20221/14/2022PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Coding UpdateDirect Access to Obstetrics/Gynecology (OB/GYN) ServicesMA00.032d1/1/20221/18/2022Direct Access to Obstetrics/Gynecology (OB/GYN) Services
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional ProvidersMA09.009o1/1/20221/19/2022Reimbursement for Radiopharmaceutical Agents for Professional Providers
Coding UpdateRadiologic Guidance and/or Supervision and Interpretation of a ProcedureMA00.019i1/1/20221/25/2022Radiologic Guidance and/or Supervision and Interpretation of a Procedure
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsMA00.030w1/1/20221/31/2022Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products