Medicare Advantage
  
  
  
  
  
  
  
  
  
  
  
  
News & AnnouncementsExpiration of Coverage for Consumer Grade Pulse Oximeters Effective January 1, 2022 for Medicare Advantage Members12/2/2021Expiration of Coverage for Consumer Grade Pulse Oximeters Effective January 1, 2022 for Medicare Advantage Members
News & AnnouncementsChanges for COVID-19 Vaccination and Pharmaceutical Treatments for Medicare Advantage Members to Become Effective January 1, 202212/7/2021Changes for COVID-19 Vaccination and Pharmaceutical Treatments for Medicare Advantage Members to Become Effective January 1, 2022
News & AnnouncementsPharmaceutical Treatments of COVID-19 for Independence Medicare Advantage Members (Effective January 1, 2022)12/31/2021Pharmaceutical Treatments of COVID-19 for Independence Medicare Advantage Members (Effective January 1, 2022)
News & AnnouncementsTelehealth Services for Medicare Advantage Members12/31/2021Telehealth Services for Medicare Advantage Members
News & AnnouncementsCoverage of COVID-19 Vaccination for Medicare Advantage Members (Updated Effective January 1, 2022)12/31/2021Coverage of COVID-19 Vaccination for Medicare Advantage Members (Updated Effective January 1, 2022)
News & AnnouncementsAduhelm™ (aducanumab-avwa) injection for Medicare Advantage Members (Updated January 1, 2022)12/31/2021Aduhelm™ (aducanumab-avwa) injection for Medicare Advantage Members (Updated January 1, 2022)
News & Announcements01/01/2022 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products12/31/202101/01/2022 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
NotificationseviCore Lab ManagementMA06.034d12/1/2021 2:00 PM1/1/202212/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateeviCore Lab Management
NotificationsElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)MA07.050i12/20/2021 12:00 PM3/21/202212/20/2021Coverage and/or Reimbursement Position;Medical Necessity CriteriaElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
NotificationsNerve Conduction Studies (NCS) and Related Electrodiagnostic StudiesMA07.033i12/20/2021 12:00 PM3/21/202212/20/2021Coverage and/or Reimbursement Position;Medical Necessity CriteriaNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
NotificationsPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)MA08.129a12/21/2021 7:00 AM3/21/202212/21/2021Medical Necessity CriteriaPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
NotificationsPegfilgrastim (Neulasta®) and Related BiosimilarsMA08.082h12/31/2021 9:00 AM4/1/202212/31/2021Coverage and/or Reimbursement PositionPegfilgrastim (Neulasta®) and Related Biosimilars
NotificationsRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MA08.022n12/31/2021 9:00 AM4/1/202212/31/2021Coverage and/or Reimbursement PositionRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
New PoliciesTisotumab vedotin-tftv (Tivdak™) MA08.14112/20/202112/20/2021This is a New Policy.Tisotumab vedotin-tftv (Tivdak™)
Updated PoliciesModifier 52: Reduced ServicesMA03.014b12/6/202112/6/2021General Description, Guidelines, or Informational UpdateModifier 52: Reduced Services
Updated PoliciesModifier 53: Discontinued ProcedureMA03.018b12/6/202112/6/2021General Description, Guidelines, or Informational UpdateModifier 53: Discontinued Procedure
Updated PoliciesSurgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)MA11.004i12/27/202012/6/2021Coverage and/or Reimbursement Position;Medical Necessity CriteriaSurgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Updated PoliciesCarfilzomib (Kyprolis™)MA08.062f12/6/202112/6/2021Medical Necessity Criteria;Medical CodingCarfilzomib (Kyprolis™)
Updated PoliciesAdo-Trastuzumab Emtansine (Kadcyla®)MA08.066e12/6/202112/6/2021Medical Necessity Criteria;Medical CodingAdo-Trastuzumab Emtansine (Kadcyla®)
Updated PoliciesSacituzumab govitecan-hziy (TrodelvyTM)MA08.118c12/6/202112/6/2021Medical Necessity Criteria;Medical CodingSacituzumab govitecan-hziy (TrodelvyTM)
Updated PoliciesEnteral Nutritional TherapyMA08.003f12/6/202112/6/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateEnteral Nutritional Therapy
Updated PoliciesOutpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)MA10.003h12/20/202112/20/202112/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical CodingOutpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)
Updated PoliciesPaclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)MA08.049i12/20/202112/20/2021Medical Necessity CriteriaPaclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)
Updated PoliciesPertuzumab (Perjeta®)MA08.063e12/20/202112/20/2021Medical Necessity Criteria;Medical CodingPertuzumab (Perjeta®)
Updated PoliciesWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsMA11.015n12/20/202112/20/2021General Description, Guidelines, or Informational UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Updated PoliciesInfliximab and Related BiosimilarsMA08.019i12/20/202112/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateInfliximab and Related Biosimilars
Updated PoliciesPersonalized Vaccines (e.g., Provenge®)MA08.053b12/20/202112/20/2021Medical Necessity CriteriaPersonalized Vaccines (e.g., Provenge®)
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)MA08.113c12/20/202112/20/2021Medical Necessity CriteriaEnfortumab vedotin-ejfv (Padcev®)
Updated PoliciesPain Management of Peripheral Nerves by InjectionMA07.047h9/27/2021 12:00 PM12/27/202112/27/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdatePain Management of Peripheral Nerves by Injection
Updated PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyMA11.099b1/3/202212/31/2021Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational UpdateDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Updated PoliciesIntraoperative Neurophysiological TestingMA07.051h1/3/202212/31/2021Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational UpdateIntraoperative Neurophysiological Testing
Updated PolicieseviCore Lab ManagementMA06.034d12/1/2021 2:00 PM1/1/202212/31/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateeviCore Lab Management
Updated PoliciesNational Correct Coding Initiative (NCCI) Code Pair EditsMA00.041a1/3/202212/31/2021Medical Coding;General Description, Guidelines, or Informational UpdateNational Correct Coding Initiative (NCCI) Code Pair Edits
Updated PoliciesReporting and Documentation Requirements for Anesthesia ServicesMA00.009h1/1/202212/31/2021General Description, Guidelines, or Informational UpdateReporting and Documentation Requirements for Anesthesia Services
Reissue PoliciesCobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingMA06.0325/28/201911/17/202112/15/2021Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
Reissue PoliciesUpper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)MA07.023g10/1/202111/17/202112/15/2021Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Reissue PoliciesPatisiran (Onpattro™)MA08.100b10/1/201911/17/202112/15/2021Patisiran (Onpattro™)
Reissue PoliciesNusinersen (Spinraza®)MA08.086d12/17/201811/17/202112/15/2021Nusinersen (Spinraza®)
Reissue PoliciesMeasurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory DisordersMA07.044b3/26/201811/17/202112/15/2021Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders
Coding UpdatePulmonary Rehabilitation ServicesMA10.001b1/1/20221/1/202212/31/2021Pulmonary Rehabilitation Services
Coding UpdateMusculoskeletal ServicesMA00.047e1/1/20221/1/202212/31/2021Musculoskeletal Services
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringMA07.026h1/1/20221/1/202212/31/2021Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Coding UpdateCatheter Ablation of Cardiac ArrhythmiasMA11.060d1/1/20221/1/202212/31/2021Catheter Ablation of Cardiac Arrhythmias
Coding UpdateEndovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal LesionsMA11.062a1/1/20221/1/202212/31/2021Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Coding UpdateMedicare Part B vs. Part D Crossover DrugsMA08.007z1/1/20221/1/202212/31/2021Medicare Part B vs. Part D Crossover Drugs
Coding UpdateCapsule EndoscopyMA07.022d1/1/20221/1/202212/31/2021Capsule Endoscopy
Coding UpdateHigh-Technology Radiology ServicesMA09.002t1/1/202212/31/2021High-Technology Radiology Services
Coding Updatepegfilgrastim (Neulasta®) and related biosimilarsMA08.082f1/1/202212/31/2021pegfilgrastim (Neulasta®) and related biosimilars
Coding UpdateChimeric Antigen Receptor (CAR) TherapyMA08.093j1/1/202212/31/2021Chimeric Antigen Receptor (CAR) Therapy
Coding UpdateAutonomic Nervous System TestingMA07.027e1/1/202212/31/2021Autonomic Nervous System Testing
Coding UpdateCataract SurgeryMA11.054d1/1/202212/31/2021Cataract Surgery
Coding UpdateSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of IncontinenceMA11.028g1/1/202212/31/2021Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Coding UpdateEndovascular Grafts for Abdominal Aortic Aneurysms, Aortic-Iliac Aneurysms, and Infrarenal Aortic AneurysmsMA11.012f1/1/202212/31/2021Endovascular Grafts for Abdominal Aortic Aneurysms, Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Coding UpdateVagus Nerve Stimulation (VNS)MA11.019g1/1/202212/31/2021Vagus Nerve Stimulation (VNS)
Coding UpdateAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaMA11.105h1/1/202212/31/2021Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Coding UpdateExtracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal ConditionsMA11.087c1/1/202212/31/2021Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Coding UpdatePlatelet-Rich Plasma (PRPs) for Chronic Non-Healing Wounds and Stem-Cell Therapy for Orthopedic ApplicationsMA07.008c1/1/202212/31/2021Platelet-Rich Plasma (PRPs) for Chronic Non-Healing Wounds and Stem-Cell Therapy for Orthopedic Applications
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver DiseaseMA06.024e1/1/202212/31/2021Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
Archived PoliciesMelphalan flufenamide (Pepaxto®)MA08.135b12/1/2021 3:00 PM1/1/202212/1/2021Melphalan flufenamide (Pepaxto®)
Archived PoliciesIbalizumab-uiyk (Trogarzo™)MA08.096a12/3/2021 1:00 PM1/3/202212/3/2021Ibalizumab-uiyk (Trogarzo™)
Archived PoliciesTagraxofusp-erzs (Elzonris®)MA08.105c12/3/2021 2:00 PM1/3/202212/3/2021Tagraxofusp-erzs (Elzonris®)