MHK authorization update
Effective 1 de outubro, 2024, prior authorization criteria for Water Vapor Thermal Therapy (CPT code 53854) for Medicare members will move to InterQual under the Prostatectomy, Transurethral Ablation subset.
Intensity-Modulated Radiotherapy
Effective 1 de outubro, 2024, for both Medicare Advantage Plans and Commercial Products, the Intensity-Modulated Radiotherapy (IMRT) policy will have a change in criteria for the section involving IMRT of the Breast only. The change in the “Breast" section of the IMRT policy will now have medically necessary criteria for partial breast irradiation/APBI and post-mastectomy/chest wall irradiation. There is no change to coding. For additional details related to this policy, please click here.
Novel Biomarkers in Risk Assessment and Management of Cardiovascular Disease
Effective 1 de abril, 2024, the list of covered ICD-10-CM codes was updated with additional covered diagnoses applicable to both Medicare Advantage plans and commercial products for CPT codes 83700, 83701 and 83704. For additional details related to this policy, please click here.
Mastectomy Treatment, Breast Reconstruction and Hospital Stays Mandate
Effective retroactively to 1 de janeiro, 2024, new HCPCS codes are effective for Compression Garments (A6520-A6523, A6528-A6529, A6565, A6568-A6569, A6574-A6582, A6588-A6589, A6593) have been added to this policy for commercial products, and will be provided at no cost share for members.
Also, effective 1 de outubro, 2024, occupational therapy services will be added to the policy and will be provided at no cost share for commercial products.
For additional details related to this policy, please click here.
Measurement of Ocular Blood Flow for Glaucoma
Effective 1 de outubro, 2024, for both Medicare Advantage plans and commercial products, the policy coding section will change from requiring an ICD-10-CM diagnosis edit for CPT 0198T to not covered for Medicare Advantage plans and not medically necessary for commercial products with all diagnosis codes. For additional details related to this policy, please click here.