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 policies, 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.
The following updates were made to our Administrative Manual on December 1, 2022:
- Facility Guidelines
- Added information about claims that span calendar years
- Medical Management
- Updated information about diabetes prevention and maintenance programs
Provider Appeals
- Added requirement to submit provider appeals via Availity Essentials effective March 1, 2023
Effective December 1, 2022, the following codes were added to our pre-authorization lists:
Commercial and Uniform Medical Plan
Definitive Lower Limb Prostheses (#DME18)
- L5610, L5611, L5613, L5614, L5616, L5700-L5703, L5710-L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5810-L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5848, L5856-L5858, L5930, L5970, L5972, L5974, L5976, L5978-L5982, L5984-L5987
Medicare Advantage
- Definitive Lower Limb Prostheses (#M-DME18)
- L5610, L5611, L5613, L5614, L5616, L5700-L5703, L5710-L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5810-L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5848, L5856-L5858, L5930, L5970, L5972, L5974, L5976, L5978-L5982, L5984-L5987
Genetic and Molecular Diagnostics – Next Generation Sequencing and Genetic Panel Testing (Genetic Testing #64)
- 0288U
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.
Medical policy updates
We provided 90-day notice in the September 2022 issue of The Bulletin about the following medical policies, which are effective December 1, 2022:
- Definitive Lower Limb Prostheses (#DME18 and #M-DME18)
Pectus Excavatum and Carinatum Surgery (#SUR12.02)
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 December 1, 2022
- Rearranged During Transection (RET) Inhibitors, dru726
- Tyrosine Kinase Inhibitors (TKIs) for Gastrointestinal Stromal Tumors (GIST), dru725
- Vijoice, alpelisib, dru730
Ztalmy, ganaxolone, dru732
Revised medication policies effective December 1, 2022
- BRAF Inhibitors, dru728
- Dupixent, dupilumab, dru493
- Growth Hormone, dru015
- Lynparza, olaparib, dru389
- Mitogen-activate dextracellular signal-regulated kinase (MEK) Inhibitors, dru727
- Non-preferred Testosterone Replacement Therapy Products, dru548
- Opzelura, ruxolitinib cream, dru679
- Pituitary Disorder Therapies, dru488
- Tagrisso, osimertinib, dru441
- Tibsovo, ivosidenib, dru558
- Trientine-containing Products, dru417
- Tropomyosin receptor tyrosine kinase (TRK) inhibitors, dru724
Xalkori, crizotinib, dru265
Archived medication policy effective December 1, 2022
Vizimpro, dacomitinib, dru581
Read the October and December 2022 issues of our newsletter for details.