Medicare Advantage
  
  
  
  
  
  
  
  
  
  
  
  
News & Announcements4/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products4/1/20214/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
News & AnnouncementsTesting for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated April 20, 2021)4/20/2021Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated April 20, 2021)
NotificationsContrast Agents Used in Conjunction with EchocardiographyMA09.004c4/2/2021 2:00 PM5/3/20214/2/2021General Description, Guidelines, or Informational UpdateContrast Agents Used in Conjunction with Echocardiography
NotificationsExperimental/Investigational ServicesMA00.005z4/12/2021 12:00 PM7/12/20214/12/2021Coverage and/or Reimbursement Position;Medical CodingExperimental/Investigational Services
NotificationsTeprotumumab (Tepezza™)MA08.1154/23/2021 10:00 AM5/24/20214/23/2021This is a New Policy.Teprotumumab (Tepezza™)
New PoliciesFilgrastim  (Neupogen ®) and related biosimilars, and Tbo-filgrastim (Granix ®)MA08.13012/31/2020 10:00 AM4/1/20214/1/2021This is a New Policy.Filgrastim  (Neupogen ®) and related biosimilars, and Tbo-filgrastim (Granix ®)
New PoliciesTrilaciclib (Cosela™)MA08.1344/26/20214/26/2021This is a New Policy.Trilaciclib (Cosela™)
Updated Policiespegfilgrastim (Neulasta®) and related biosimilarsMA08.082e12/31/2020 11:00 AM4/1/20214/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Updatepegfilgrastim (Neulasta®) and related biosimilars
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ac4/1/20214/1/2021Coverage and/or Reimbursement PositionPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related BiosimilarsMA08.073h4/12/20214/12/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars
Updated PoliciesWheelchair Options and AccessoriesMA05.046f3/12/2021 2:00 PM4/12/20214/12/2021Medical Necessity CriteriaWheelchair Options and Accessories
Updated PoliciesPower Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist DevicesMA05.032a3/12/2021 2:00 PM4/12/20214/12/2021Medical Necessity CriteriaPower Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
Updated PoliciesRoutine Costs of Clinical Trials and Coverage of Investigational Devices A and BMA00.004b4/12/20214/12/2021General Description, Guidelines, or Informational UpdateRoutine Costs of Clinical Trials and Coverage of Investigational Devices A and B
Updated PoliciesMagnetic Resonance Imaging (MRI) Contrast AgentsMA09.010c4/12/20214/12/2021General Description, Guidelines, or Informational UpdateMagnetic Resonance Imaging (MRI) Contrast Agents
Updated PoliciesTrastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)MA08.018f4/12/20214/15/2021Medical Necessity Criteria;Medical CodingTrastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Updated PoliciesBortezomib (Bortezomib for Injection, Velcade®)MA08.037g4/12/20214/19/2021Medical Necessity CriteriaBortezomib (Bortezomib for Injection, Velcade®)
Updated PoliciesExperimental/Investigational ServicesMA00.005y4/1/20214/26/2021Coverage and/or Reimbursement Position;Medical CodingExperimental/Investigational Services
Updated PoliciesHeating Pads and Heat LampsMA05.029c4/26/20214/26/2021General Description, Guidelines, or Informational UpdateHeating Pads and Heat Lamps
Updated PoliciesMedicare Part B vs. Part D Crossover DrugsMA08.007v1/2/20214/26/2021Medical Coding;General Description, Guidelines, or Informational UpdateMedicare Part B vs. Part D Crossover Drugs
Updated PoliciesPulmonary Function TestsMA07.007j1/2/20214/26/2021Coverage and/or Reimbursement Position;Medical CodingPulmonary Function Tests
Reissue PoliciesSpeech TherapyMA10.007c1/1/20204/7/20214/7/2021Speech Therapy
Reissue PoliciesOrthopedic FootwearMA05.012a11/6/20154/7/20214/7/2021Orthopedic Footwear
Reissue PoliciesImmune Cell Function AssayMA06.018a11/6/20153/24/20214/9/2021Immune Cell Function Assay
Reissue PoliciesUpper Limb ProsthesesMA05.057c4/15/20194/7/20214/22/2021Upper Limb Prostheses
Reissue PoliciesIn Vitro Allergy TestingMA06.002b3/25/20194/21/20214/23/2021In Vitro Allergy Testing
Reissue PoliciesIn Vivo Allergy Sensitivity TestingMA06.004b1/1/20214/21/20214/23/2021In Vivo Allergy Sensitivity Testing
Reissue PoliciesAllergy ImmunotherapyMA07.055d1/1/20214/21/20214/23/2021Allergy Immunotherapy
Reissue PoliciesNerve Fiber Density TestingMA06.023c1/1/20194/21/20214/30/2021Nerve Fiber Density Testing
Coding UpdateVagus Nerve Stimulation (VNS)MA11.019f4/1/20214/1/2021Vagus Nerve Stimulation (VNS)
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)MA08.009n4/1/20214/1/2021Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Coding UpdateAnkle-Foot/Knee-Ankle-Foot OrthosesMA05.010f4/1/20214/1/2021Ankle-Foot/Knee-Ankle-Foot Orthoses
Coding UpdateImplantable Steroid-Eluting Sinus StentsMA11.107e4/1/20214/1/2021Implantable Steroid-Eluting Sinus Stents
Coding UpdateUrological SuppliesMA05.054g4/1/20214/1/2021Urological Supplies
Coding UpdateChimeric Antigen Receptor (CAR) TherapyMA08.093g4/1/20214/1/2021Chimeric Antigen Receptor (CAR) Therapy
Coding UpdateExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso))MA08.084a4/1/20214/1/2021Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso))
Coding UpdateeviCore Lab ManagementMA06.034a4/1/20214/2/2021eviCore Lab Management
Coding Updatebelantamab mafodotin-blmf (Blenrep) MA08.119b4/1/20214/5/2021belantamab mafodotin-blmf (Blenrep)
Coding UpdateAlways Bundled Procedure CodesMA00.026j4/1/20214/5/2021Always Bundled Procedure Codes
Coding UpdateModifier 50: Bilateral ProcedureMA03.002i4/1/20214/5/2021Modifier 50: Bilateral Procedure
Coding UpdateModifier 62: Two SurgeonsMA00.011i4/1/20214/5/2021Modifier 62: Two Surgeons
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional ProvidersMA09.009l4/1/20214/5/2021Reimbursement for Radiopharmaceutical Agents for Professional Providers
Coding UpdateHyaluronan Acid Therapies for Osteoarthritis of the KneeMA11.023k4/1/20214/5/2021Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASMA00.015h4/1/20214/8/2021Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Coding UpdateRepair and Replacement of Durable Medical Equipment (DME) and Prosthetic DevicesMA05.062g4/1/20214/8/2021Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices
Coding UpdateDurable Medical Equipment (DME)MA05.044j4/1/20214/8/2021Durable Medical Equipment (DME)
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ad4/2/20214/14/2021PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsMA00.030t4/1/20214/14/2021Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Archived PoliciesCold Therapy DevicesMA05.035b4/9/2021 7:00 AM5/10/20214/9/2021Cold Therapy Devices
Archived PoliciesRepository Corticotropin (H.P. Acthar® Gel Injection)MA08.067a4/23/2021 9:00 AM5/24/20214/23/2021Repository Corticotropin (H.P. Acthar® Gel Injection)