Laboratory Testing Investigational Services

Effective 1 de agosto, 2025, CPT codes 0371U, 0372U, 0373U, 0374U, 0376U, 0377U, 0384U, 0385U, and 0390U will be added to this policy and will be considered not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here. 

Local or Whole Body Hyperthermia            

Effective 1 de agosto, 2025, CPT codes for local hyperthermia, 77600, 77610, and 77615, will change from being covered to requiring prior authorization for Medicare Advantage plans and prior authorization will be recommended for commercial products. CPT codes for local hyperthermia, 77605 and 77620, will change from not covered for Medicare Advantage plans and not medically necessary for commercial products to requiring prior authorization for Medicare Advantage plans and prior authorization will be recommended for commercial products. All codes for local hyperthermia will be approved when the medical criteria in this policy are met. There are no changes related to whole body hyperthermia, which will remain not covered for Medicare Advantage plans and not medically necessary for commercial products (no specific CPT code). For additional details related to this policy, please click here.

Microvolt T-Wave Alternans Testing          

Effective 1 de agosto, 2025, services will change from not medically necessary to a recommendation of prior authorization for commercial products and will be approved when the medical criteria in this policy are met. There is no change for Medicare Advantage plans. For additional details related to this policy, please click here.

Behavioral Health Integration Services including the Collaborative Care Mode

Effective 1 de junho, 2025, clarifications were made under the Psychiatric Collaborative Care Model for Medicare Advantage plans and commercial products. Clarification of cost share waiver for OHIC (Office of the Health Insurance Commissioner) in Rhode Island was designated integrated behavioral health primary care practice for commercial products only. For additional details related to this policy, please click here.

Removal of Implantable Devices      

Effective 1 de agosto, 2025, for Medicare Advantage plans and commercial products, the following CPT codes will change from “review using medical criteria in medical policy, medical necessity" to “using medical criteria" in the medical policies indicated below: 

• 0269T, 0270T, and 0271T: Baroreflex Stimulation Devices 

*Refer to new policies above for details

• 0511T: Subtalar Arthroereisis
• 64595: When this CPT code represents peripheral or sacral neurostimulator, the medical criteria will be found in the online tool.
• 0588T and 0818T: Percutaneous and Subcutaneous Tibial Nerve Stimulation

For additional details related to this policy, please click here.

Intravitreal and Punctum Corticosteroid Implants          

Effective 1 de agosto, 2025, for Medicare Advantage plans and commercial products, there will be a revision to the policy statement regarding Dextenza. There will be no other changes to this policy. For additional details related to this policy, please click here.