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News & Announcements04/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products4/1/202404/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
NotificationsTracheostomy Care SuppliesMA05.034a4/6/2024 11:00 AM5/6/20244/6/2024Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational UpdateTracheostomy Care Supplies
NotificationsBiofeedback TherapyMA07.010b3/22/2024 10:00 AM12/10/20234/23/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateBiofeedback Therapy
NotificationsEvinacumab-dgnb (Evkeeza®) MA08.133c4/24/2024 10:00 AM5/27/20244/24/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateEvinacumab-dgnb (Evkeeza®)
New PoliciesTalquetamab-tgvs (Talvey™)MA08.1664/1/20244/1/2024This is a New Policy.Talquetamab-tgvs (Talvey™)
New PoliciesPozelimab-bbfg (Veopoz TM)MA08.1674/1/20244/1/2024This is a New Policy.Pozelimab-bbfg (Veopoz TM)
New PoliciesElranatamab-bcmm (Elrexfio™)MA08.1684/22/20244/22/2024This is a New Policy.Elranatamab-bcmm (Elrexfio™)
Updated PoliciesLeadless PacemakersMA05.067e4/1/20244/1/2024Coverage and/or Reimbursement PositionLeadless Pacemakers
Updated PoliciesNatalizumab (Tysabri®) and Related BiosimilarsMA08.029c4/1/20244/1/2024Medical Necessity CriteriaNatalizumab (Tysabri®) and Related Biosimilars
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) InhibitorsMA08.073p4/1/20244/1/2024Medical Necessity CriteriaIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Updated PolicieseviCore Lab ManagementMA06.034l12/2/2023 10:00 AM1/2/20244/1/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update4/1/2024eviCore Lab Management
Updated PoliciesRadiation Therapy ServicesMA09.020r4/8/20244/8/2024Medical Necessity CriteriaRadiation Therapy Services
Updated PoliciesAnkle-Foot/Knee-Ankle-Foot OrthosesMA05.010j4/8/20244/8/2024General Description, Guidelines, or Informational UpdateAnkle-Foot/Knee-Ankle-Foot Orthoses
Updated PoliciesKnee OrthosesMA05.013g3/8/2024 10:00 AM4/8/20244/8/2024General Description, Guidelines, or Informational UpdateKnee Orthoses
Updated PoliciesMosunetuzumab-axgb (Lunsumio™)MA08.158b4/8/20244/8/2024Medical Necessity CriteriaMosunetuzumab-axgb (Lunsumio™)
Updated PoliciesTisotumab vedotin-tftv (Tivdak®)MA08.141c4/8/20244/8/2024Medical Necessity CriteriaTisotumab vedotin-tftv (Tivdak®)
Updated PoliciesPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass SurgeryMA11.056h4/8/20244/8/2024Medical Necessity CriteriaPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Updated PoliciesMedicare Part B vs. Part D Crossover DrugsMA08.007ak3/17/20244/8/2024Medical Necessity Criteria;Medical CodingMedicare Part B vs. Part D Crossover Drugs
Updated PoliciesExternal Infusion PumpsMA05.060b4/8/20244/8/2024Medical Necessity CriteriaExternal Infusion Pumps
Updated PoliciesNivolumab and relatlimab-rmbw (Opdualag™)MA08.152c4/8/20244/8/2024Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateNivolumab and relatlimab-rmbw (Opdualag™)
Updated PoliciesEfbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related BiosimilarsMA08.082l4/8/20244/8/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateEfbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
Updated PoliciesTeclistamab-cqyv (Tecvayli®)MA08.156c4/8/20244/8/2024Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateTeclistamab-cqyv (Tecvayli®)
Updated PoliciesPertuzumab (Perjeta®)MA08.063g4/8/20244/8/2024Medical Necessity Criteria;Medical CodingPertuzumab (Perjeta®)
Updated PoliciesPemetrexed (Pemfexy™)MA08.047k4/8/20244/8/2024Medical Necessity Criteria;Medical CodingPemetrexed (Pemfexy™)
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)MA08.113f4/8/20244/8/2024Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateEnfortumab vedotin-ejfv (Padcev®)
Updated PoliciesHigh-Technology Radiology ServicesMA09.002ab4/14/20244/15/2024General Description, Guidelines, or Informational UpdateHigh-Technology Radiology Services
Updated PoliciesMusculoskeletal ServicesMA00.047l4/14/20244/15/2024Medical Necessity CriteriaMusculoskeletal Services
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ao4/1/20244/1/20244/19/2024Medical Necessity CriteriaPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Updated PoliciesIntraoperative Neurophysiological Monitoring (INM)MA07.051i3/22/2024 11:00 AM12/10/20233/20/20244/22/2024Medical Coding4/22/2024Intraoperative Neurophysiological Monitoring (INM)
Updated PoliciesElectromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic StudiesMA07.050l3/22/2024 10:00 AM12/10/20234/22/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateElectromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Updated PoliciesBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsMA11.049g4/22/20244/22/2024General Description, Guidelines, or Informational UpdateBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Updated PoliciesErythropoiesis Stimulating Agents (ESAs)MA08.011g4/22/20244/22/2024Medical Necessity Criteria;Medical CodingErythropoiesis Stimulating Agents (ESAs)
Updated PoliciesPressure-Reducing Support SurfacesMA05.025f4/22/20244/22/2024Medical Necessity Criteria;General Description, Guidelines, or Informational UpdatePressure-Reducing Support Surfaces
Updated PoliciesAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )MA08.036g4/22/20244/22/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )
Updated PoliciesBiofeedback TherapyMA07.010b3/22/2024 10:00 AM12/10/20234/23/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateBiofeedback Therapy
Reissue PoliciesPulse Oximetry Device in the Home SettingMA05.042d1/1/20244/3/20244/3/2024Pulse Oximetry Device in the Home Setting
Reissue PoliciesTebentafusp-tebn (Kimmtrak®)MA08.143b1/1/20244/3/20244/3/2024Tebentafusp-tebn (Kimmtrak®)
Reissue PoliciesCochlear ImplantationMA11.039e1/1/20244/3/20244/3/2024Cochlear Implantation
Reissue PoliciesHospital Beds and AccessoriesMA05.002f1/1/20244/3/20244/3/2024Hospital Beds and Accessories
Reissue PoliciesComposite Tissue Allotransplantation of the Hand(s) and FaceMA11.1121/1/20244/3/20244/3/2024Composite Tissue Allotransplantation of the Hand(s) and Face
Reissue PoliciesPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)MA08.129a1/1/20244/3/20244/3/2024Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
Reissue PoliciesChiropractic ServicesMA10.004i10/23/20234/17/20244/17/2024Chiropractic Services
Reissue PoliciesTranscranial Magnetic Stimulation (TMS)MA07.035d1/1/20234/17/20244/17/2024Transcranial Magnetic Stimulation (TMS)
Reissue PoliciesLabiaplastyMA11.067d5/14/20184/17/20244/17/2024Labiaplasty
Reissue PoliciesSpeech TherapyMA10.007c1/1/20204/17/20244/17/2024Speech Therapy
Reissue PoliciesOcrelizumab (Ocrevus®)MA08.088c9/17/20194/17/20244/17/2024Ocrelizumab (Ocrevus®)
Reissue PoliciesAcute Care Facility Inpatient TransfersMA12.003b1/1/20234/17/20244/17/2024Acute Care Facility Inpatient Transfers
Reissue PoliciesAutonomic Nervous System TestingMA07.027f10/1/20224/17/20244/17/2024Autonomic Nervous System Testing
Reissue PoliciesManual WheelchairsMA05.026d1/1/20244/17/20244/17/2024Manual Wheelchairs
Reissue PoliciesPharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) TherapyMA06.014e1/1/20244/17/20244/17/2024Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy
Reissue PoliciesFull-Body Computerized Tomography (CT) Scan ScreeningMA09.012a3/25/20154/17/20244/17/2024Full-Body Computerized Tomography (CT) Scan Screening
Reissue PoliciesPercutaneous Image-Guided Lumbar Decompression (PILD) for Spinal StenosisMA11.097e1/1/20244/17/20244/17/2024Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue PoliciesMigraine Deactivation SurgeryMA11.0981/1/20244/17/20244/17/2024Migraine Deactivation Surgery
Reissue PoliciesAlemtuzumab (Lemtrada®)MA08.015d5/4/20204/17/20244/17/2024Alemtuzumab (Lemtrada®)
Coding UpdateTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in AdultsMA05.047n4/1/20244/1/2024Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Coding UpdateTrigger Point InjectionsMA11.017i4/1/20244/1/2024Trigger Point Injections
Coding UpdateReimbursement for the Administration of Drugs, Substances, and/or Biologic AgentsMA00.051f4/1/20244/1/2024Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents
Coding UpdateWheelchair Options and AccessoriesMA05.046i4/1/20244/1/2024Wheelchair Options and Accessories
Coding UpdateVedolizumab (Entyvio®) for Injection for Intravenous UseMA08.001g4/1/20244/1/2024Vedolizumab (Entyvio®) for Injection for Intravenous Use
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsMA11.015y4/1/20244/1/2024Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Coding UpdateTreatments for Complex Regional Pain Syndrome (CRPS)MA08.026j4/1/20244/1/2024Treatments for Complex Regional Pain Syndrome (CRPS)
Coding UpdateAbortionMA11.010c4/1/20244/1/2024Abortion
Coding UpdateTocilizumab (Actemra®) for Intravenous Infusion and Subcutaneous Injection MA08.045k4/1/20244/1/2024Tocilizumab (Actemra®) for Intravenous Infusion and Subcutaneous Injection
Coding UpdateSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of IncontinenceMA11.028j4/1/20244/2/2024Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Coding UpdateModifier 50: Bilateral ProcedureMA03.002q4/1/20244/5/2024Modifier 50: Bilateral Procedure
Coding UpdateModifier 62: Two SurgeonsMA00.011r4/1/20244/5/2024Modifier 62: Two Surgeons
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASMA00.015p4/1/20244/5/2024Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Coding UpdateComplementary and Integrative Health ServicesMA12.001e4/1/20244/8/2024Complementary and Integrative Health Services
Coding UpdateLower Limb ProsthesesMA05.024f4/1/20244/12/2024Lower Limb Prostheses
Coding UpdatePrescription Digital Therapeutics and Mobile-Based Health Management ApplicationsMA12.011b4/1/20244/12/2024Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Coding UpdateDurable Medical Equipment (DME)MA05.044q4/1/20244/12/2024Durable Medical Equipment (DME)