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 October 1, 2023, the following codes will be added to our pre-authorization lists.
Commercial and Uniform Medical Plan
Expanded Molecular Testing of Cancers to Select Targeted Therapies (#GT83)
- 0334U
Medicare Advantage
- Genetic and Molecular Diagnostics— Single Gene or Variant (#M-GT20)
- 0338U
- Genetic and Molecular Diagnostics— Next Generation Sequencing and Genetic Panel Testing (#M-GT64)
- 0334U, 0340U, 0343U, 0345U, 0352U, 0118U, 0131U, 0133U, 0134U, 0171U
Charged-Particle (Proton) Radiotherapy (#M-MED49)
- 77301, 77338
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.
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.
Revised medication policies effective October 1, 2022
- Drugs for chronic inflammatory diseases, dru444
Provider-administered drugs for chronic inflammatory diseases (for UMP plans), dru900
Revised medication policies effective October 15, 2022
- Chimeric Antigen Receptor (CAR) T-cell Therapies, dru523
- Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors, dru621
- Opdivo, nivolumab, dru390
- Prolia, denosumab, dru223
Yervoy, ipilimumab, dru238
New medication policy effective October 15, 2022
Pluvicto, lutetium Lu 177 vipivotide tetraxetan, dru722
Read the October and December 2022 issues of our newsletter for details.
We publish updates to medical and reimbursement policies in our monthly publication, The Bulletin. Read issues of The Bulletin or subscribe to receive an email notification when issues are published.
Medical policy updates
We provided 90-day notice in the July 2022 issue of The Bulletin about the following medical policies, which are effective October 1, 2022:
- Leadless Cardiac Pacemakers (#SUR217)
Ventral (Including Incisional) Hernia Repair (#SUR12.03)
We will make the following reimbursement changes on October 1, 2022 for providers on standard agreements:
- We will adjust rates for psychiatrists, psychologists and master’s-level clinicians billing CPT 90837.
We are standardizing the alcohol and drug treatment services (ADTS) we allow and will adjust reimbursement rates.
For more details, read the June, 2022 issue of our newsletter.
The updated rates and codes will be available on Availity Essentials.