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News & AnnouncementsConsumer Grade Pulse Oximetry Devices For Use In The Home Setting (Updated October 01, 2021)10/1/2021Consumer Grade Pulse Oximetry Devices For Use In The Home Setting (Updated October 01, 2021)
News & Announcements10/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products10/1/202110/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
News & AnnouncementsCoverage of COVID-19 Vaccination for Medicare Advantage Members (updated October 15, 2021)10/15/2021Coverage of COVID-19 Vaccination for Medicare Advantage Members (updated October 15, 2021)
NotificationsExperimental/Investigational ServicesMA00.005ab10/11/2021 12:00 PM1/10/202210/11/2021Medical CodingExperimental/Investigational Services
New PoliciesLoncastuximab tesirine-lpyl (Zynlonta™)MA08.13910/1/202110/1/2021This is a New Policy.Loncastuximab tesirine-lpyl (Zynlonta™)
New PoliciesAnifrolumab-fnia (Saphnelo™)MA08.14010/11/202110/11/2021This is a New Policy.Anifrolumab-fnia (Saphnelo™)
New PoliciesTafasitamab-cxix (Monjuvi®)MA08.13810/11/202110/11/2021This is a New Policy.Tafasitamab-cxix (Monjuvi®)
Updated PoliciesRadiation Therapy ServicesMA09.020m8/31/2021 10:00 AM10/1/202110/1/2021Medical Necessity CriteriaRadiation Therapy Services
Updated PoliciesRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MA08.022m10/1/202110/1/2021Medical Necessity Criteria;Medical CodingRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Updated PoliciesInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)MA08.024i7/6/2021 1:00 PM10/4/202110/4/2021Coverage and/or Reimbursement Position;Medical Necessity CriteriaInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
Updated PoliciesFROM: Alglucosidase alfa (e.g., Lumizyme®) TO: Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )MA08.036d10/11/202110/11/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateFROM: Alglucosidase alfa (e.g., Lumizyme®) TO: Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )
Updated PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)MA07.004g10/11/202110/11/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical CodingScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Updated PoliciesExperimental/Investigational ServicesMA00.005aa10/1/202110/11/2021Medical CodingExperimental/Investigational Services
Updated PoliciesAlways Bundled Procedure CodesMA00.026l10/11/202110/11/2021Medical CodingAlways Bundled Procedure Codes
Updated PoliciesCoagulation Factors MA08.004s10/25/202110/25/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateCoagulation Factors
Updated PoliciesGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)MA08.083f10/25/202110/25/2021Medical Necessity CriteriaGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)
Updated PoliciesOctreotide Acetate (Sandostatin® LAR Depot)MA08.065g10/25/202110/25/2021Medical Necessity CriteriaOctreotide Acetate (Sandostatin® LAR Depot)
Updated PoliciesModifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)MA03.017c10/25/202110/25/2021Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational UpdateModifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
Reissue PoliciesCoverage of Medical DevicesMA05.040b11/4/201910/6/202110/6/2021Coverage of Medical Devices
Reissue PoliciesBiofeedback TherapyMA07.010a10/6/201710/6/202110/6/2021Biofeedback Therapy
Reissue PoliciesArtificial Intervertebral Lumbar Disc InsertionMA11.1141/10/202110/6/202110/6/2021Artificial Intervertebral Lumbar Disc Insertion
Reissue PoliciesOsteogenic Stimulators (Electrical and Ultrasonic)MA05.018b1/10/202110/6/202110/6/2021Osteogenic Stimulators (Electrical and Ultrasonic)
Reissue PoliciesWheelchair Cushions and SeatingMA05.023a12/29/201710/6/202110/7/2021Wheelchair Cushions and Seating
Reissue PoliciesCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsMA10.002b10/1/201710/6/202110/7/2021Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
Reissue PoliciesLumbar Interspinous Process Decompression SystemMA11.048c5/21/201810/20/202110/20/2021Lumbar Interspinous Process Decompression System
Reissue PoliciesDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic MalignanciesMA07.041b12/16/201910/20/202110/21/2021Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Reissue PoliciesPhotodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)MA07.030b12/17/201810/20/202110/21/2021Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Coding UpdateTrigger Point InjectionsMA11.017h10/1/202110/1/2021Trigger Point Injections
Coding UpdateBevacizumab (Avastin®) and Related Biosimilars For Oncologic UseMA08.072h10/1/202110/1/2021Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Coding UpdateGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)MA08.083e10/1/202110/1/2021Gonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)
Coding UpdateChiropractic ServicesMA10.004h10/1/202110/1/2021Chiropractic Services
Coding UpdateRoutine Foot Care for Certain Medical ConditionsMA07.009i10/1/202110/1/2021Routine Foot Care for Certain Medical Conditions
Coding UpdatePaclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)MA08.049h10/1/202110/1/2021Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)
Coding UpdateBrentuximab Vedotin (Adcetris®)MA08.068f10/1/202110/1/2021Brentuximab Vedotin (Adcetris®)
Coding UpdatePembrolizumab (Keytruda®)MA08.121b10/1/202110/1/2021Pembrolizumab (Keytruda®)
Coding UpdateTrilaciclib (Cosela™)MA08.134b10/1/202110/1/2021Trilaciclib (Cosela™)
Coding UpdateTranscutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMA05.006g10/1/202110/1/2021Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASMA00.015j10/1/202110/1/2021Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Coding UpdateModifier 62: Two SurgeonsMA00.011k10/1/202110/1/2021Modifier 62: Two Surgeons
Coding UpdateHyperthermic Intraperitoneal Chemotherapy for Select IntraAbdominal and Pelvic MalignanciesMA07.017d10/1/202110/1/2021Hyperthermic Intraperitoneal Chemotherapy for Select IntraAbdominal and Pelvic Malignancies
Coding UpdateHigh-Frequency Chest Wall Oscillation DevicesMA05.001f10/1/202110/1/2021High-Frequency Chest Wall Oscillation Devices
Coding UpdateElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)MA07.050h10/1/202110/1/2021Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Coding UpdateNerve Conduction Studies (NCS) and Related Electrodiagnostic StudiesMA07.033h10/1/202110/1/2021Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Coding UpdateNeuropsychological Testing for Neurologically Based ConditionsMA07.038g10/1/202110/1/2021Neuropsychological Testing for Neurologically Based Conditions
Coding UpdateDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsMA11.014g10/1/202110/1/2021Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Coding UpdateUltraviolet Light Therapy for the Treatment of Dermatological ConditionsMA07.002d10/1/202110/1/2021Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsMA11.015m10/1/202110/1/2021Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Coding Updateevinacumab-dgnb (Evkeeza)MA08.133b10/1/202110/1/2021evinacumab-dgnb (Evkeeza)
Coding UpdateAcupunctureMA12.004c10/1/202110/1/2021Acupuncture
Coding UpdatePulmonary Function TestsMA07.007k10/1/202110/1/2021Pulmonary Function Tests
Coding UpdateLower Limb ProsthesesMA05.024d10/1/202110/1/2021Lower Limb Prostheses
Coding UpdateRemoval of Breast ImplantsMA11.076f10/1/202110/1/2021Removal of Breast Implants
Coding UpdateDostarlimab-gxly (Jemperli)MA08.136a10/1/202110/1/2021Dostarlimab-gxly (Jemperli)
Coding UpdateMelphalan flufenamide (Pepaxto®)MA08.135b10/1/202110/1/2021Melphalan flufenamide (Pepaxto®)
Coding UpdateTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in AdultsMA05.047f10/1/202110/1/2021Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Coding UpdateMultiple Procedure Payment Reduction (MPPR) on Certain Diagnostic ServicesMA01.005f10/1/202110/1/2021Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
Coding UpdateModifier 50: Bilateral ProcedureMA03.002k10/1/202110/1/2021Modifier 50: Bilateral Procedure
Coding UpdateUpper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)MA07.023g10/1/202110/1/2021Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Coding UpdateChimeric Antigen Receptor (CAR) TherapyMA08.093i10/1/202110/1/2021Chimeric Antigen Receptor (CAR) Therapy
Coding UpdateExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)MA08.084c10/1/202110/1/2021Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)
Coding UpdatePresumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsMA06.025o10/1/202110/1/2021Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Coding UpdateeviCore Lab ManagementMA06.034c10/1/202110/4/2021eviCore Lab Management
Coding UpdateDurable Medical Equipment (DME)MA05.044k10/1/202110/6/2021Durable Medical Equipment (DME)
Coding UpdateRepair and Replacement of Durable Medical Equipment (DME) and Prosthetic DevicesMA05.062h10/1/202110/6/2021Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010af10/1/202110/25/2021PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Coding UpdateEnteral Nutritional TherapyMA08.003e10/1/202110/25/2021Enteral Nutritional Therapy
Archived PoliciesBronchial ThermoplastyMA11.006b11/29/2020 2:00 PM1/3/202210/7/2021Bronchial Thermoplasty
Archived PoliciesPhotography, including Documentation and Record-Keeping Photography, Whole Body Integumentary Photography, Dermoscopy, and DermatoscopyMA07.020a10/8/2021 10:00 AM11/8/202110/8/2021Photography, including Documentation and Record-Keeping Photography, Whole Body Integumentary Photography, Dermoscopy, and Dermatoscopy