Orthognathic Surgery         

Effective 1 de maio, 2023, these services will now be medically necessary for Medicare Advantage plan members when the criteria in the policy have been met. Please refer to the policy for additional details here.

Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy

The policy formerly known as Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy will now only address transurethral water jet ablation (Aquablation). The policy will remain applicable to commercial products only. Effective 1 de maio, 2023, transurethral water jet ablation (CPT code 0421T) will be considered medically necessary when criteria in the policy have been met. For requests for water vapor thermal therapy (CPT code 53854) for commercial products, please refer to the article below regarding the Prior Authorization via Web Based Tool for Procedures policy. (As a reminder, requests for Medicare Advantage plans for transurethral water vapor thermal therapy and transurethral water jet ablation are reviewed via the web-based tool.) Please refer to the policy for additional details here.

Prior Authorization via Web Based Tool for Procedures               

Effective 1 de maio, 2023, water vapor thermal therapy (CPT code 53854) will be considered medically necessary for commercial products when the criteria in the web-based tool has been met.

Effective 1 de maio, 2023, HCPCS codes C7504, C7505, C7507 and C7508 will require prior authorization for both Medicare Advantage plans and commercial products. Please refer to the policy for additional details here.

Nutrient/Nutritional Panel Testing                                      

Effective 1 de maio, 2023, the coding section of the policy will be updated to provide further clarification of coding for nutrient/nutritional panels. While there may be specific CPT codes for some of the components of the panel testing, claims for the entire panel MUST be filed only with one unlisted CPT code: 81479 or 84999. Please refer to the policy for additional details here.

Provider Credentialing & Recredentialing                                                 

The credentialing policy has been updated to align with the OHIC definition of a completed application. BCBSRI will now require the OHIC defined requirements to make a credentialing determination, however additional administrative requirements will continue to be requested for a provider to be set up in our claims processing system. If upon the BCBSRI credentialing determination any administrative items are omitted, BCBSRI will outreach to the provider. Providers will have 60 days to submit any missing documentation. Please review the policy for the updated requirements here.

Breast Pump Hospital Grade 

Effective 1 de maio, 2023, a license provider’s order is required for the initial sixty (60) days and for every additional sixty (60) day rental for a hospital grade pump. Please refer to the policy for additional details here.

New Technology and Miscellaneous Services 

Effective 1 de maio, 2023, HCPCS codes C7504, C7505, C7507 and C7508 will be removed from this policy as these codes will now be addressed in the Prior Authorization via Web-Based Tool for Procedures policy. Please refer to the policy for additional details here.