Medicare Advantage

Medical Policy

	MPDocType	Title	MPPolicyNumber	MPNotificationIssuedDate	MPEffectiveDate	MPReissuedDate	MPArchiveNotifEffDate	MPSALogCreatedOn	MPPolicyChangeTypeslt	MPRevisionDate	MPPolicyTitle	MPSiteActivityRemovedDate
	News & Announcements	Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated on September 22, 2023)						9/22/2023			Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated on September 22, 2023)
	News & Announcements	10/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products						9/28/2023			10/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
	Notifications	Abatacept (Orencia®) for Injection for Intravenous Use	MA08.028h	9/12/2023 10:00 AM	12/11/2023			9/12/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update		Abatacept (Orencia®) for Injection for Intravenous Use
	Notifications	Wheelchair Options and Accessories	MA05.046h	9/21/2023 11:00 AM	5/16/2023			9/21/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding		Wheelchair Options and Accessories
	Notifications	Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices	MA05.032c	9/21/2023 11:00 AM	5/16/2023			9/21/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding		Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices
	Notifications	Nebulizers and Inhalation Solutions	MA05.007f	9/11/2023 11:00 AM	10/16/2023			9/22/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding		Nebulizers and Inhalation Solutions	9/22/2023
	Updated Policies	Durvalumab (Imfinzi®) and tremelimumab-act (Imjudo®)	MA08.123c		9/4/2023			9/1/2023	Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update		Durvalumab (Imfinzi®) and tremelimumab-act (Imjudo®)
	Updated Policies	High-Technology Radiology Services	MA09.002z		9/10/2023			9/11/2023	General Description, Guidelines, or Informational Update		High-Technology Radiology Services
	Updated Policies	Musculoskeletal Services	MA00.047i		9/10/2023	9/10/2023		9/11/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update		Musculoskeletal Services
	Updated Policies	Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies	MA07.058k		9/10/2023	9/10/2023		9/11/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update		Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
	Updated Policies	Pressure-Reducing Support Surfaces	MA05.025e		9/11/2023			9/11/2023	Medical Necessity Criteria;General Description, Guidelines, or Informational Update		Pressure-Reducing Support Surfaces
	Updated Policies	Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors	MA08.073l	6/20/2023 9:00 AM	9/18/2023			9/18/2023	Medical Necessity Criteria		Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors
	Updated Policies	PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services	MA00.010al		9/25/2023			9/25/2023	Coverage and/or Reimbursement Position		PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
	Updated Policies	Catheter Ablation of Cardiac Arrhythmias	MA11.060f		9/25/2023			9/25/2023	Medical Necessity Criteria;Medical Coding		Catheter Ablation of Cardiac Arrhythmias
	Updated Policies	Percutaneous Left Atrial Appendage (LAA) Closure for Non-Valvular Atrial Fibrillation (NVAF)	MA11.013c		9/25/2023			9/25/2023	Medical Coding		Percutaneous Left Atrial Appendage (LAA) Closure for Non-Valvular Atrial Fibrillation (NVAF)
	Updated Policies	Medicare Part B vs. Part D Crossover Drugs	MA08.007ag		9/3/2023			9/25/2023	Medical Coding		Medicare Part B vs. Part D Crossover Drugs
	Updated Policies	External Infusion Pumps	MA05.060a		7/1/2023			9/25/2023	Medical Coding		External Infusion Pumps
	Updated Policies	Knee Orthoses	MA05.013f		9/25/2023			9/25/2023	Coverage and/or Reimbursement Position;Medical Necessity Criteria		Knee Orthoses
	Updated Policies	Reduction Mammoplasty	MA11.069e		9/25/2023			9/25/2023	Medical Necessity Criteria		Reduction Mammoplasty
	Updated Policies	Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty	MA11.099d		9/25/2023			9/25/2023	Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update		Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
	Reissue Policies	Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids	MA11.049e		1/1/2023	9/6/2023		9/6/2023			Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
	Reissue Policies	Cranial Electrotherapy Stimulation	MA05.066c		1/1/2023	9/6/2023		9/6/2023			Cranial Electrotherapy Stimulation
	Reissue Policies	Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)	MA08.024k		10/1/2022	9/6/2023		9/6/2023			Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
	Reissue Policies	Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)	MA03.017c		10/25/2021	9/6/2023		9/6/2023			Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
	Reissue Policies	National Correct Coding Initiative (NCCI) Code Pair Edits	MA00.041a		1/3/2022	9/6/2023		9/6/2023			National Correct Coding Initiative (NCCI) Code Pair Edits
	Reissue Policies	Modifier 52: Reduced Services	MA03.014b		12/6/2021	9/6/2023		9/6/2023			Modifier 52: Reduced Services
	Reissue Policies	Modifier 53: Discontinued Procedure	MA03.018b		12/6/2021	9/6/2023		9/6/2023			Modifier 53: Discontinued Procedure
	Reissue Policies	Enteral Nutritional Therapy	MA08.003f		12/6/2021	9/6/2023		9/6/2023			Enteral Nutritional Therapy
	Reissue Policies	Transcatheter Closure of Cardiac Septal Defects	MA11.040c		10/1/2022	9/6/2023		9/6/2023			Transcatheter Closure of Cardiac Septal Defects
	Reissue Policies	Home Health Care Services	MA02.003c		8/29/2022	9/6/2023		9/6/2023			Home Health Care Services
	Reissue Policies	Hyperbaric Oxygen Therapy	MA07.001b		1/31/2022	9/6/2023		9/6/2023			Hyperbaric Oxygen Therapy
	Reissue Policies	Surgery for Gynecomastia	MA11.110a		12/19/2022	9/6/2023		9/6/2023			Surgery for Gynecomastia
	Reissue Policies	Nusinersen (Spinraza®)	MA08.086d		12/17/2018	9/6/2023		9/11/2023			Nusinersen (Spinraza®)
	Reissue Policies	Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR)	MA11.027d		10/1/2022	9/20/2023		9/20/2023			Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR)
	Reissue Policies	Bioimpedance for the Detection of Lymphedema	MA07.052		12/28/2014	9/20/2023		9/20/2023			Bioimpedance for the Detection of Lymphedema
	Reissue Policies	Surgical Treatment of Nails	MA11.036d		7/25/2022	9/20/2023		9/20/2023			Surgical Treatment of Nails
	Reissue Policies	Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies	MA05.006h		12/5/2022	9/20/2023		9/20/2023			Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
	Reissue Policies	Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions	MA11.062b		10/1/2022	9/20/2023		9/20/2023			Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
	Coding Update	Molecular Diagnostics	MA06.017z		7/1/2023			9/18/2023			Molecular Diagnostics
	Coding Update	Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies	MA05.006i		10/1/2023			9/29/2023			Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
	Coding Update	Electroconvulsive Therapy (ECT)	MA14.001a		10/1/2023			9/29/2023			Electroconvulsive Therapy (ECT)
	Coding Update	Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management	MA01.008b		10/1/2023			9/29/2023			Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
	Coding Update	Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)	MA08.022p		10/1/2023			9/29/2023			Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
	Coding Update	Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)	MA05.005g		10/1/2023			9/29/2023			Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
	Coding Update	Pulmonary Function Tests	MA07.007n		10/1/2023			9/29/2023			Pulmonary Function Tests
	Coding Update	Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia	MA05.027c		10/1/2023			9/29/2023			Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia
	Coding Update	Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults	MA05.047k		10/1/2023			9/29/2023			Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
	Coding Update	Urological Supplies	MA05.054h		10/1/2023			9/29/2023			Urological Supplies
	Coding Update	Ventricular Assist Devices (VADs)	MA11.011g		10/1/2023			9/29/2023			Ventricular Assist Devices (VADs)
	Coding Update	Catheter Ablation of Cardiac Arrhythmias	MA11.060g		10/1/2023			9/29/2023			Catheter Ablation of Cardiac Arrhythmias
	Coding Update	Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs	MA10.002d		10/1/2023			9/29/2023			Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
	Coding Update	Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)	MA07.050k		10/1/2023			9/29/2023			Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
	Coding Update	Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies	MA07.033k		10/1/2023			9/29/2023			Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
	Coding Update	Trilaciclib (Cosela™)	MA08.134d		10/1/2023			9/29/2023			Trilaciclib (Cosela™)
	Coding Update	Deep Brain Stimulation (DBS)	MA11.005g		10/1/2023			9/29/2023			Deep Brain Stimulation (DBS)
	Coding Update	Mentoplasty or Genioplasty	MA11.080b		10/1/2023			9/29/2023			Mentoplasty or Genioplasty
	Coding Update	Neuropsychological Testing for Neurologically Based Conditions	MA07.038j		10/1/2023			9/29/2023			Neuropsychological Testing for Neurologically Based Conditions
	Coding Update	Vagus Nerve Stimulation (VNS)	MA11.019j		10/1/2023			9/29/2023			Vagus Nerve Stimulation (VNS)
	Coding Update	crizanlizumab-tmca (Adakveo®)	MA08.109b		10/1/2023			9/29/2023			crizanlizumab-tmca (Adakveo®)
	Coding Update	Intravenous Chelation Therapy	MA07.016c		10/1/2023			9/29/2023			Intravenous Chelation Therapy
	Coding Update	Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds	MA11.015v		10/1/2023			9/29/2023			Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
	Coding Update	Bortezomib (Bortezomib for Injection, Velcade®)	MA08.037j		10/1/2023			9/29/2023			Bortezomib (Bortezomib for Injection, Velcade®)
	Coding Update	Retifanlimab-dlwr (Zynyz TM)	MA08.161a		10/1/2023			9/29/2023			Retifanlimab-dlwr (Zynyz TM)
	Coding Update	Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)	MA08.052k		10/1/2023			9/29/2023			Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)
	Coding Update	Botulinum Toxin Agents	MA08.017j		10/1/2023			9/29/2023			Botulinum Toxin Agents
	Coding Update	Eptinezumab-jjmr (VYEPTI™)	MA08.116d		10/1/2023			9/29/2023			Eptinezumab-jjmr (VYEPTI™)
	Coding Update	Abatacept (Orencia®) for Injection for Intravenous Use	MA08.028h		10/1/2023			9/29/2023			Abatacept (Orencia®) for Injection for Intravenous Use
	Coding Update	Refractive Lenses	MA07.029e		10/1/2023			9/29/2023			Refractive Lenses
	Coding Update	Treatment of Medical and Surgical Complications	MA11.050b		10/1/2023			9/29/2023			Treatment of Medical and Surgical Complications
	Coding Update	Mohs Micrographic Surgery (MMS)	MA11.018d		10/1/2023			9/29/2023			Mohs Micrographic Surgery (MMS)