Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions 

Effective 1 de outubro, 2022, additional CPT codes and ICD-10 diagnosis codes will be added to the medically necessary coding section. Please refer to the medical policy for details here.

Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis 

Effective 1 de setembro, 2022, the policy formerly known as Laparoscopic and Percutaneous Techniques for the Myolosis of Uterine Fibroids will now address criteria for transcervical radiofrequency ablation, and its title will be updated to Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis. Please refer to the medical policy for details here.

Aduhelm (Aducanumab)                                                                   

Effective 1 de outubro, 2022, HCPCS code J0172 for aducanumab, brand name Aduhelm, will require prior authorization for Medicare Advantage plans and commercial products through BCBSRI’s drug management vendor. As a result, Aduhelm will be referenced in the Prior Authorization for Drugs policy, and the specific Aduhelm policy will be archived. Please refer to the medical policy for details here.

Genetic Testing Services                                                                     

Effective 1 de outubro, 2022, for Medicare Advantage Plans and/or Commercial Products, the clinical criteria source for several CPT codes in the Genetic Testing Services policy will be changing from BCBSRI Genetic Testing Services policy criteria to InterQual criteria found in the online authorization tool. Additionally, the following codes will need authorization and will no longer be not medically necessary for Commercial: 81175, 81176, 81238, 81247, 81248, 81248, 81287, 81334, 81335. There is no change to Medicare Advantage Plans coverage for these codes, Finally, code 83080 will be a covered service and will no longer require authorization for Medicare Advantage Plans and Commercial Products. Please refer to the medical policy for details here.

Retinal Telescreening for Diabetic Retinopathy                              

Effective 1 de setembro, 2022, digital retinal imaging with image interpretation by artificial intelligence software may be considered medically necessary for screening for diabetic retinopathy. Please refer to the medical policy for details here.

Sensory Integration Therapy and Auditory Integration Therapy  

This policy's coding section has been updated to ensure proper claims processing. Please refer to the medical policy for details here.

Acupuncture and Dry Needling Services for BlueCHiP for Medicare Advantage Plans 

The policy for Acupuncture and Dry Needling Services for BlueCHiP for Medicare was updated to include coverage for the following lower back pain diagnoses (M54.50, M54.51, M54.59). Please refer to the payment policy for details here.

Preventive Services for Commercial Members  

The policy for Preventive Services for commercial members was updated to include coverage for CPT code 96040 (Genetic Counseling) for the diagnosis Z31.5 (Procreative Genetic Counseling). Please refer to the payment policy for details here.

Out-of-Network Services Requests 

This policy includes criteria that must be met for plans with tiered networks requesting coverage of higher-tier provider services at the lower-tier benefit level. Please refer to the medical policy for details here.