Loading...Loading...In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and reimbursement policies, Clinical Position Statements and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies. Monthly change summaries are added to our website within 10 business days of our newsletter publication.
Review other monthly changes for 2022.
Effective April 1, 2022, the following codes were added to our pre-authorization lists.
Commercial
- Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products (#MED170)
- A4100
- Digital Health Products (#MED175)
- A9291
- Digital Health Products for Attention Deficit Hyperactivity Disorder (#MED175.01)
- A9291
- Digital Health Products for Substance Use Disorders (#MED175.02)
- A9291
Negative Pressure Wound Therapy in the Outpatient Setting (Durable Medical Equipment #42)
- CPT 97605-97608; HCPCS E2402
Uniform Medical Plan
- Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products (#MED170)
- A4100
- Digital Health Products (#MED175)
- A9291
- Digital Health Products for Attention Deficit Hyperactivity Disorder (#MED175.01)
- A9291
- Digital Health Products for Substance Use Disorders (#MED175.02)
- A9291
- Genomic Microarray Testing
- 0318U
Negative Pressure Wound Therapy in the Outpatient Setting (Durable Medical Equipment #42)
- CPT 97605-97608; HCPCS E2402
Medicare Advantage
- External Insulin Infusion Pumps (#M-DME86)
- A4238
- Genetic and Molecular Diagnostics—Next Generation Sequencing and Genetic Panel Testing (#M-GT64)
- 0306U, 0307U, 0311U
- Orthopedic Applications of Stem Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow (#M-MED142)
- C9782
- Transplants—Stem Cell and Bone Marrow (#M-TRA45)
- C9782
Negative Pressure Wound Therapy in the Outpatient Setting (#M-DME42)
- CPT 97605-97608; HCPCS A6550, A7000, E2402, K0743
Please review our pre-authorization lists for all updates and pre-authorize services accordingly. You can submit standard medical pre-authorizations through Availity Essentials. Learn more about electric authorizations.
Pre-authorization will no longer be required for most chiropractic, acupuncture and massage services delivered April 1, 2022, or later. Currently, providers submit pre-authorization requests for these services to eviCore healthcare (eviCore).
Pre-authorization will still be required for:
- Services occurring through March 31, 2022
Services provided to members of administrative services only (ASO) groups that have purchased our Physical Medicine program with the chiropractic/acupuncture/massage (CAM) component
We publish updates to medical policies in our monthly publication, The Bulletin. You can read issues of The Bulletin or subscribe to receive an email notification when issues are published.
We provided 90 day notice in the January 2022 issue of The Bulletin about the following medical policy, which is effective April 1, 2022:
- Bariatric Surgery (Surgery #58)
- Negative Pressure Wound Therapy in the Outpatient Setting (Durable Medical Equipment #42)
Negative Pressure Wound Therapy Pumps (Medicare Advantage—Durable Medical Equipment #42)
We publish updates to reimbursement policies in our monthly publication, The Bulletin. You can read issues of The Bulletin or subscribe to receive an email notification when issues are published.
We provided 90 day notice in the January 2022 issue of The Bulletin about the following reimbursement policies, which are effective April 1, 2022:
- Cellular and Gene Therapy Products (Medicine #112)
Modifier 90; Reference (Outside) Laboratory (Modifiers #118)
Listed below is a summary of medication policy additions and changes. Links to all medication policies, medication lists and pre-authorization information for our members, including real-time deletions from our pre-authorization lists, are available on our provider website.
New medication policies effective April 15, 2022
- Betibeglogene autotemcel, dru698
- Tivdak, tisotumab vedotin, dru690
- Vyvgart, efgartigimod alfa, dru696
Xipere, triamcinolone, dru702
Revised medication policies effective April 15, 2022
- Complement Inhibitors, dru385
- Keytruda, pembrolizumab, dru367
- Opdivo, nivolumab, dru390
Tecentriq, atezolizumab, dru463
Read the April 2022 issue of our newsletter for details.
The following updates were made to our manual sections April 1, 2022:
BlueCard Program
Added information that home infusion therapy (HIT) claims should be filed to the Blue Plan in whose service area the member’s home, or equivalent setting, is located because this is where services were rendered
Facility Guidelines
- Clarified that if a member under observation meets the inpatient level of care standard, the provider will be reimbursed for inpatient care for the entire length of stay
- Revised the treatment requirements for the chemical dependency intensive outpatient program (CDIOP) level of care
Regence BlueCross BlueShield of Oregon only: Clarified that providers should keep waivers for deluxe products and submit HCPCS S1001 on a separate claim line
Hospice VBID Model (Regence BCBSO and Regence BCBSU only)
Updated the transitional concurrent care information
Medicare Advantage Compliance Requirements
- Updated regulatory references
Risk Adjustment Added information about provider education
See our Administrative Manual for details.