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.
Commercial and Uniform Medical Plan
Effective March 1, 2022, the following codes were added:
- Evaluating the Utility of Genetic Panels (#GT64)
- 81440, 81460, 81465
Genetic Testing; Primary Mitochondrial Disorders (#GT54)
- 81401, 81403 80415, 81440, 81460, 81465
Effective March 13, 2022, the following codes were added:
Radiology: Carelon Medical Benefits Management (Carelon)
- 0042T, 0648T, 0649T
Medicare Advantage
Effective March 13, 2022, the following codes were added:
Radiology: Carelon Specialty Health
- 0042T, 0648T, 0649T
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.
Effective March 1, 2022, the HCPCS J1453 will be added to the specialty medication pre-authorization lists for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members.
View all specialty medication information.
The Consolidated Appropriations Act (CAA), 2021, effective January 1, 2022, requires health plans to establish a process to verify and update provider directory information no less frequently than every 90 days. Accurate provider directories are also a requirement for compliance with CMS, the Affordable Care Act (ACA) and your agreement as a network provider with Regence.
View our Provider Directory Attestation Requirements policy, effective March 1, 2022.
Read more in the December, 2021 issue of our newsletter.
Carelon is revising the following advanced imaging clinical guidelines for our radiology program effective March 13, 2022:
- Cardiology guidelines
- Advanced imaging of the heart
- Abdominal/pelvic
- Brain
- Chest
- Head and neck
- Oncologic
Effective for dates of service on or after March 1, 2022, drug administration codes billed without an accompanying HCPCS drug code will be denied.
Effective March 1, 2022, concurrent clinical review for urgent behavioral health admissions for in-network percentage-of-billed-charge or per diem facilities, including critical access hospitals and free-standing psychiatric hospitals, will begin two midnights or three days after admission.
Currently, concurrent clinical review for urgent behavioral health admissions at these facilities begins four midnights or five days after admission.
No other aspect of the concurrent clinical review is changing except the day review will begin.
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 December 2021 issue of The Bulletin about changes to the following medical policy, which is effective March 1, 2022:
Extracorporeal Membrane Oxygenation (ECMO) for the Treatment of Cardiac and Respiratory Failure in Adults (Medicine #152)
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 December 2021 issue of The Bulletin about changes to the following reimbursement policy, which is effective March 1, 2022:
Associated Claims (Administrative #119)
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 website.
Revised medication policies effective March 1, 2022
- Keytruda, pembrolizumab, dru367
High cost medications for dry eye disease, dru472
Read the December 2021 and April 2022 issues of our newsletter for details.
Revised medication policies effective March 13, 2022
- Drugs for chronic inflammatory diseases, dru444
Provider administered drugs for chronic inflammatory diseases (for UMP plans), dru900
Read the April 2022 issue of our newsletter for details.