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News & Announcements7/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products7/2/20217/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
NotificationsRadiation Therapy ServicesMA09.020l7/1/2021 10:00 AM8/1/20217/1/2021Medical Necessity CriteriaRadiation Therapy Services
NotificationsSpinal OrthosesMA05.030d7/2/2021 7:00 AM8/2/20217/2/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateSpinal Orthoses
NotificationsAnkle-Foot/Knee-Ankle-Foot OrthosesMA05.010g7/2/2021 7:00 AM8/2/20217/2/2021Coverage and/or Reimbursement PositionAnkle-Foot/Knee-Ankle-Foot Orthoses
NotificationsKnee OrthosesMA05.013e7/2/2021 7:00 AM8/2/20217/2/2021Coverage and/or Reimbursement PositionKnee Orthoses
NotificationsOmalizumab (Xolair®)MA08.025d7/6/2021 1:00 PM10/4/20217/6/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateOmalizumab (Xolair®)
NotificationsInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)MA08.024i7/6/2021 1:00 PM10/4/20217/6/2021Coverage and/or Reimbursement Position;Medical Necessity CriteriaInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
New PoliciesDostarlimab-gxly (Jemperli)MA08.1367/12/20217/12/2021This is a New Policy.Dostarlimab-gxly (Jemperli)
Updated PoliciesPreventive Care ServicesMA00.003q7/1/20217/1/2021Medical Necessity CriteriaPreventive Care Services
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ae7/1/20217/1/2021Coverage 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 PolicieseviCore Lab ManagementMA06.034b6/2/2021 3:00 PM7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateeviCore Lab Management
Updated PoliciesTocilizumab (Actemra®) for Intravenous Infusion and Subcutaneous InjectionMA08.045h7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateTocilizumab (Actemra®) for Intravenous Infusion and Subcutaneous Injection
Updated PoliciesGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)MA08.083d7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical CodingGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)
Updated PoliciesVedolizumab (Entyvio®)MA08.001e7/12/20217/12/2021Medical Necessity Criteria;Medical CodingVedolizumab (Entyvio®)
Updated PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMA05.006f6/10/2021 2:00 PM7/12/20217/12/2021Medical Necessity CriteriaTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Updated PoliciesExperimental/Investigational ServicesMA00.005z4/12/2021 12:00 PM7/12/20217/12/2021Coverage and/or Reimbursement Position;Medical Coding7/12/2021Experimental/Investigational Services
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)MA08.113b6/4/2021 1:00 PM7/12/20217/12/2021Medical Necessity CriteriaEnfortumab vedotin-ejfv (Padcev®)
Updated PoliciesModifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative PeriodMA03.009e7/12/20217/12/2021General Description, Guidelines, or Informational UpdateModifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Updated PoliciesMarijuana for Medical UseMA00.038b7/12/20217/12/2021General Description, Guidelines, or Informational UpdateMarijuana for Medical Use
Updated PoliciesPhysical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)MA10.003g7/19/20217/19/2021Medical Necessity Criteria;Medical CodingPhysical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)
Updated PoliciesX-rays Associated with Fractures in the Office SettingMA00.031e7/19/20217/19/2021Medical Coding;General Description, Guidelines, or Informational UpdateX-rays Associated with Fractures in the Office Setting
Updated PoliciesReimbursement for the Administration of Drugs, Substances, and/or Biologic AgentsMA00.051a7/19/20217/19/2021General Description, Guidelines, or Informational UpdateReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents
Updated PoliciesPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass SurgeryMA11.056f7/19/20217/19/2021Coverage and/or Reimbursement Position;Medical CodingPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Updated PoliciesRadiation Therapy ServicesMA09.020l7/1/2021 10:00 AM8/1/20217/30/2021Medical Necessity CriteriaRadiation Therapy Services
Reissue PoliciesAlemtuzumab (Lemtrada®)MA08.015d5/4/20206/30/20217/1/2021Alemtuzumab (Lemtrada®)
Reissue PoliciesDay RehabilitationMA10.005b1/13/20206/30/20217/1/2021Day Rehabilitation
Reissue PoliciesPulmonary Rehabilitation ServicesMA10.001a12/30/20196/30/20217/1/2021Pulmonary Rehabilitation Services
Reissue PoliciesTopical OxygenationMA07.011a4/8/20156/30/20217/1/2021Topical Oxygenation
Reissue PoliciesHospital Beds and AccessoriesMA05.002d10/12/20206/30/20217/1/2021Hospital Beds and Accessories
Reissue PoliciesPressure-Reducing Support SurfacesMA05.025d11/9/20206/30/20217/1/2021Pressure-Reducing Support Surfaces
Reissue PoliciesObsolete or Unreliable Diagnostic Tests and Medical ServicesMA00.001a1/14/20196/30/20217/2/2021Obsolete or Unreliable Diagnostic Tests and Medical Services
Reissue PoliciesRoutine Foot Care for Certain Medical ConditionsMA07.009h10/1/20207/28/20217/28/2021Routine Foot Care for Certain Medical Conditions
Reissue PoliciesAprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)MA08.091c3/11/20197/29/2021Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Reissue PoliciesCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)MA08.12811/30/20207/28/20217/30/2021Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)
Reissue PoliciesHyaluronan Acid Therapies for Osteoarthritis of the KneeMA11.023k4/1/20217/28/20217/30/2021Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Reissue PoliciesEptinezumab-jjmr (VYEPTI™)MA08.116b10/1/20207/28/20217/30/2021Eptinezumab-jjmr (VYEPTI™)
Coding UpdateMargetuximab-cmkb (Margenza)MA08.132a7/1/20217/1/2021Margetuximab-cmkb (Margenza)
Coding UpdateTrilaciclib (Cosela™)MA08.134a7/1/20217/1/2021Trilaciclib (Cosela™)
Coding UpdateMedicare Part B vs. Part D Crossover DrugsMA08.007x7/1/20217/1/2021Medicare Part B vs. Part D Crossover Drugs
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringMA07.026g7/1/20217/1/2021Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver DiseaseMA06.024d7/1/20217/1/2021Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
Coding UpdateChimeric Antigen Receptor (CAR) TherapyMA08.093h7/1/20217/1/2021Chimeric Antigen Receptor (CAR) Therapy
Coding UpdateModifiers 26 (Professional Component) and TC (Technical Component)MA03.011h7/1/20217/1/2021Modifiers 26 (Professional Component) and TC (Technical Component)
Coding UpdateModifier 50: Bilateral ProcedureMA03.002j7/1/20217/1/2021Modifier 50: Bilateral Procedure
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional ProvidersMA09.009m7/1/20217/1/2021Reimbursement for Radiopharmaceutical Agents for Professional Providers
Coding UpdateMelphalan flufenamide (Pepaxto®)MA08.135a7/1/20217/1/2021Melphalan flufenamide (Pepaxto®)
Coding Updateevinacumab-dgnb (Evkeeza)MA08.133a7/1/20217/1/2021evinacumab-dgnb (Evkeeza)
Coding UpdateRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MA08.022l7/1/20217/1/2021Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASMA00.015i7/1/20217/1/2021Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Coding UpdateModifier 62: Two SurgeonsMA00.011j7/1/20217/1/2021Modifier 62: Two Surgeons
Coding 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 ServiceMA03.003i7/1/20217/1/2021Modifier 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
Coding UpdateAlways Bundled Procedure CodesMA00.026k7/1/20217/6/2021Always Bundled Procedure Codes
Coding UpdateVitamin D Assay TestingMA06.031d10/1/20207/14/20217/14/2021Vitamin D Assay Testing