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News & Announcements10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products10/1/202410/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
News & Announcements10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated October 8, 2024)10/10/202410/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated October 8, 2024)
News & AnnouncementsPreventive Coverage of Pre-exposure Prophylaxis for the Prevention of HIV Infection (Retroactively Effective September 30, 2024)10/14/2024Preventive Coverage of Pre-exposure Prophylaxis for the Prevention of HIV Infection (Retroactively Effective September 30, 2024)
NotificationsIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) InhibitorsMA08.073q10/8/2024 9:00 AM1/1/202510/8/2024Medical Necessity CriteriaIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
NotificationsLuspatercept–aamt (Reblozyl®)MA08.110d10/22/2024 11:00 AM1/17/202510/22/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateLuspatercept–aamt (Reblozyl®)
New PoliciesLifileucel (Amtagvi™)MA08.17210/21/202410/21/2024This is a New Policy.Lifileucel (Amtagvi™)
Updated PoliciesSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of IncontinenceMA11.028k10/1/202410/1/2024Medical Necessity Criteria;Medical CodingSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Updated PoliciesTocilizumab (Actemra®) and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection MA08.045l10/1/202410/7/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateTocilizumab (Actemra®) and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
Updated PoliciesRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MA08.022r10/7/202410/7/2024Medical Necessity Criteria;Medical CodingRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Updated PoliciesEfgartigimod alfa - fcab (Vyvgart) and efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)MA08.142d10/7/202410/7/2024Medical Necessity Criteria;Medical CodingEfgartigimod alfa - fcab (Vyvgart) and efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
Updated PoliciesSacituzumab govitecan-hziy (Trodelvy™)MA08.118f10/7/202410/7/2024Medical Necessity CriteriaSacituzumab govitecan-hziy (Trodelvy™)
Updated PoliciesRisankizumab-rzaa (Skyrizi®) for intravenous useMA08.153c10/21/202410/21/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateRisankizumab-rzaa (Skyrizi®) for intravenous use
Updated PoliciesTrilaciclib (Cosela™)MA08.134e10/21/202410/21/2024Medical Necessity CriteriaTrilaciclib (Cosela™)
Updated PoliciesPercutaneous Coronary Intervention, Coronary Angiography, and Arterial UltrasoundMA11.113i10/20/202410/21/2024Medical Coding;General Description, Guidelines, or Informational UpdatePercutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound
Updated PoliciesHigh-Technology Radiology ServicesMA09.002ac10/20/202410/21/2024General Description, Guidelines, or Informational UpdateHigh-Technology Radiology Services
Updated PoliciesSleep Disorder Testing and Positive Airway Pressure Therapy Services and SuppliesMA07.058l10/20/202410/21/2024Coverage and/or Reimbursement Position;Medical Necessity CriteriaSleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Updated PoliciesMusculoskeletal ServicesMA00.047m10/20/202410/21/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical CodingMusculoskeletal Services
Updated PoliciesBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis MA11.100f10/21/202410/21/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis
Updated PoliciesInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)MA08.024l10/21/202410/21/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
Updated Policiespatisiran (Onpattro®) and vutrisiran (Amvuttra®)MA08.100d10/21/202410/21/2024Medical Necessity Criteriapatisiran (Onpattro®) and vutrisiran (Amvuttra®)
Reissue PoliciesProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)MA11.055f1/2/202310/2/202410/2/2024Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Reissue PoliciesLoncastuximab tesirine-lpyl (Zynlonta®)MA08.139c1/1/202410/2/202410/2/2024Loncastuximab tesirine-lpyl (Zynlonta®)
Reissue PoliciesChemical PeelsMA11.103b12/26/202210/2/202410/2/2024Chemical Peels
Reissue PoliciesProcedures for the Treatment of AcneMA11.109a10/1/201610/2/202410/2/2024Procedures for the Treatment of Acne
Reissue PoliciesSelective Photothermolysis Using Pulsed-Dye Lasers (PDL)MA11.071b7/11/202210/2/202410/2/2024Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
Reissue PoliciesNeuropsychological Testing for Neurologically Based ConditionsMA07.038k10/1/202310/16/202410/16/2024Neuropsychological Testing for Neurologically Based Conditions
Reissue PoliciesSTAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point-of-Service (POS) ProductsMA00.021b1/1/202110/16/202410/16/2024STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point-of-Service (POS) Products
Reissue PoliciesDay RehabilitationMA10.005b1/1/202410/16/202410/16/2024Day Rehabilitation
Reissue PoliciesTumor Treating FieldsMA07.0329/1/201910/16/202410/16/2024Tumor Treating Fields
Reissue PoliciesHyaluronan Acid Therapies for Osteoarthritis of the KneeMA11.023k1/1/202410/16/202410/16/2024Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Reissue PoliciesCatheter Ablation of Cardiac ArrhythmiasMA11.060g1/1/202410/16/202410/16/2024Catheter Ablation of Cardiac Arrhythmias
Reissue PoliciesUpper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)MA07.023k1/2/202410/16/202410/16/2024Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Reissue PoliciesDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic MalignanciesMA07.041c10/1/202410/30/202410/30/2024Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Reissue PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)MA07.004h10/1/202410/30/202410/30/2024Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Reissue PoliciesCoverage of Medical DevicesMA05.040b11/4/201910/30/202410/30/2024Coverage of Medical Devices
Reissue PoliciesDurable Medical Equipment (DME) Not Subject to a Rental to Purchase MaximumMA05.028e1/18/202110/30/202410/30/2024Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
Reissue PoliciesInsertion of Implantable Infusion PumpsMA05.053n10/1/202410/30/202410/30/2024Insertion of Implantable Infusion Pumps
Reissue PoliciesPulmonary RehabilitationMA10.001c1/1/202410/30/202410/30/2024Pulmonary Rehabilitation
Reissue PoliciesEptinezumab-jjmr (VYEPTI™)MA08.116d1/1/202410/30/202410/30/2024Eptinezumab-jjmr (VYEPTI™)
Reissue PoliciesScar RevisionMA11.078c12/19/202210/30/202410/30/2024Scar Revision
Reissue PoliciesIn Vitro Allergy TestingMA06.002c1/1/202410/30/202410/30/2024In Vitro Allergy Testing
Reissue PoliciesNebulizers and Inhalation SolutionsMA05.007f1/1/202410/30/202410/30/2024Nebulizers and Inhalation Solutions
Reissue PoliciesLurbinectedin (Zepzelca®)MA08.125c5/8/202310/30/202410/30/2024Lurbinectedin (Zepzelca®)
Reissue PoliciesSutimlimab-jome (Enjaymo)MA08.145a1/1/202410/30/202410/30/2024Sutimlimab-jome (Enjaymo)
Reissue PoliciesTreatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic AgentsMA08.016g1/1/202410/30/202410/30/2024Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Reissue PoliciesPolatuzumab vedotin-piiq (Polivy®)MA08.108e1/1/202410/30/202410/30/2024Polatuzumab vedotin-piiq (Polivy®)
Reissue PoliciesIn Vivo Allergy Sensitivity TestingMA06.004c1/1/202410/30/202410/30/2024In Vivo Allergy Sensitivity Testing
Reissue PoliciesUltraviolet Light Therapy for the Treatment of Dermatological ConditionsMA07.002i10/1/202410/30/202410/30/2024Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Reissue PoliciesPain Management of Peripheral Nerves by InjectionMA07.047h12/27/202110/30/202410/30/2024Pain Management of Peripheral Nerves by Injection
Reissue PoliciesPower Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices Policy #MA05.032cMA05.032c1/1/202410/30/202410/30/2024Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices Policy #MA05.032c
Coding UpdateUltraviolet Light Therapy for the Treatment of Dermatological ConditionsMA07.002i10/1/202410/1/2024Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Coding UpdateTreatment of Medical and Surgical ComplicationsMA11.050c10/1/202410/1/2024Treatment of Medical and Surgical Complications
Coding UpdateVagus Nerve Stimulation (VNS)MA11.019l10/1/202410/1/2024Vagus Nerve Stimulation (VNS)
Coding UpdateBrentuximab Vedotin (Adcetris®)MA08.068j10/1/202410/1/2024Brentuximab Vedotin (Adcetris®)
Coding UpdateEpcoritamab-bysp (EPKINLY™)MA08.165a10/1/202410/1/2024Epcoritamab-bysp (EPKINLY™)
Coding UpdatePrescription Digital Therapeutics and Mobile-Based Health Management ApplicationsMA12.011c10/1/202410/1/2024Prescription Digital Therapeutics and Mobile-Based Health Management Applications
Coding UpdateHair Transplants and Cranial Prostheses (Wigs)MA11.046c10/1/202410/1/202410/1/2024Hair Transplants and Cranial Prostheses (Wigs)
Coding UpdateHome Prothrombin Time MonitoringMA05.016i10/1/202410/1/202410/1/2024Home Prothrombin Time Monitoring
Coding UpdateKnee OrthosesMA05.013i10/1/202410/1/202410/1/2024Knee Orthoses
Coding UpdateTranscutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMA05.006j10/1/202410/1/202410/1/2024Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Coding UpdateCarfilzomib (Kyprolis)MA08.062i10/1/202410/1/2024Carfilzomib (Kyprolis)
Coding UpdateExternal Infusion PumpsMA05.060c10/1/202410/1/2024External Infusion Pumps
Coding UpdatePulmonary Function TestsMA07.007o10/1/202410/1/2024Pulmonary Function Tests
Coding UpdateContinuous Glucose Monitors and Home Blood Glucose Monitors and SuppliesMA00.002p10/1/202410/1/2024Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
Coding UpdateAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint ManagementMA01.008c10/1/202410/1/2024Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
Coding UpdateUpper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)MA07.023k10/1/202410/1/2024Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Coding UpdateNivolumab (Opdivo®)MA08.120d10/1/202410/1/2024Nivolumab (Opdivo®)
Coding UpdateDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyMA11.099e10/1/202410/1/2024Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Coding UpdateDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic MalignanciesMA07.041c10/1/202410/1/2024Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Coding UpdatePanniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant SkinMA11.073e10/1/202410/1/2024Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
Coding UpdateSpeech and Non-Speech Generating DevicesMA05.003g10/1/202410/1/2024Speech and Non-Speech Generating Devices
Coding UpdateTranscatheter Arterial Chemoembolization (TACE) of Hepatic MalignanciesMA07.040c10/1/202410/1/2024Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Coding UpdateOctreotide Acetate (Sandostatin® LAR Depot)MA08.065j10/1/202410/1/2024Octreotide Acetate (Sandostatin® LAR Depot)
Coding UpdateAutonomic Nervous System TestingMA07.027g10/1/202410/1/2024Autonomic Nervous System Testing
Coding UpdateTeplizumab-mzwv (Tzield)MA08.157a10/1/202410/1/2024Teplizumab-mzwv (Tzield)
Coding UpdateTreatments for Complex Regional Pain Syndrome (CRPS)MA08.026k10/1/202410/1/2024Treatments for Complex Regional Pain Syndrome (CRPS)
Coding UpdateOmalizumab (Xolair®)MA08.025f10/1/202410/1/2024Omalizumab (Xolair®)
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)MA08.009v10/1/202410/1/2024Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Coding UpdateTafasitamab-cxix (Monjuvi®)MA08.138d10/1/202410/1/2024Tafasitamab-cxix (Monjuvi®)
Coding UpdateAsparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)MA08.085h10/1/202410/1/2024Asparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)
Coding UpdateChimeric Antigen Receptor (CAR) TherapyMA08.093n10/1/202410/1/2024Chimeric Antigen Receptor (CAR) Therapy
Coding UpdateDenosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)MA08.052m10/1/202410/1/2024Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)
Coding UpdateGlofitamab-gxbm (Columvi)MA08.163c10/1/202410/1/2024Glofitamab-gxbm (Columvi)
Coding UpdateBevacizumab (Avastin®) and Related Biosimilars For Oncologic UseMA08.072n10/1/202410/1/2024Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Coding UpdateLanreotide (Somatuline® Depot)MA08.090g10/1/202410/1/2024Lanreotide (Somatuline® Depot)
Coding UpdatePaclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)MA08.049n10/1/202410/1/2024Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)
Coding UpdatePembrolizumab (Keytruda®)MA08.121e10/1/202410/1/2024Pembrolizumab (Keytruda®)
Coding UpdatePemetrexed (Pemfexy™)MA08.047l10/1/202410/1/2024Pemetrexed (Pemfexy™)
Coding UpdateScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)MA07.004h10/1/202410/1/2024Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Coding UpdateInsertion of Implantable Infusion PumpsMA05.053n10/1/202410/1/2024Insertion of Implantable Infusion Pumps
Coding UpdatePhotodynamic Therapy Using Verteporfin (Visudyne®)MA07.003e10/1/202410/1/2024Photodynamic Therapy Using Verteporfin (Visudyne®)
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsMA11.015aa10/1/202410/1/2024Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Coding UpdatePreventive Care ServicesMA00.003aa10/1/202410/2/2024Preventive Care Services
Coding UpdateModifier 62: Two SurgeonsMA00.011t10/1/202410/4/2024Modifier 62: Two Surgeons
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASMA00.015r10/1/202410/4/2024Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
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 ServiceMA03.003o10/1/202410/4/2024Modifier 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 UpdateMedicare Part B vs. Part D Crossover DrugsMA08.007ao10/1/202410/7/2024Medicare Part B vs. Part D Crossover Drugs10/7/2024
Coding UpdateMedicare Part B vs. Part D Crossover DrugsMA08.007ao10/1/202410/8/2024Medicare Part B vs. Part D Crossover Drugs
Coding UpdateMagnetic Resonance Imaging (MRI) Contrast AgentsMA09.010f10/1/202410/9/2024Magnetic Resonance Imaging (MRI) Contrast Agents
Coding UpdateDurable Medical Equipment (DME)MA05.044r10/1/202410/10/2024Durable Medical Equipment (DME)
Coding UpdateRepair and Replacement of Durable Medical Equipment (DME) and Prosthetic DevicesMA05.062k10/1/202410/10/2024Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices
Coding UpdateAlways Bundled Procedure CodesMA00.026v10/1/202410/15/2024Always Bundled Procedure Codes
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010aq10/1/202410/16/2024PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional ProvidersMA09.009u10/1/202410/28/2024Reimbursement for Radiopharmaceutical Agents for Professional Providers
Archived PoliciesTranscatheter Closure of Cardiac Septal DefectsMA11.040c10/18/2024 11:00 AM11/18/202410/18/2024Transcatheter Closure of Cardiac Septal Defects