

The Regence Group and its affiliated Plans use medical policies as guidelines for coverage decisions within the member’s written benefits. Below are summaries of recent changes to The Regence Group’s medical policies. The detailed policies and complete Medical Policy Manual are available online at regence.com. We have included the section and policy number for your convenience.
Policy name | Summary of policy or change | Effective date | Section and policy number | Coding or implementation change | Pre-authorization change | |
---|---|---|---|---|---|---|
New policy addressing patient lifts and seat lifts will apply only to Individual members. | September 1, 2025 | Durable Medical Equipment #23 | Adding HCPCS codes E0625, E0627, E0629, E0630, E0635, E0636, E0639, E0640, E1035, E1036 with preauth requirement for this policy for Individual Line of Business only. | Adding codes E0625, E0627, E0629, E0630, E0635, E0636, E0639, E0640, E1035, E1036 to the preauth website for Individual Line of Business only. | ||
Updating criteria for large respiratory panel tests (>12 targets) to be considered not medically necessary. | September 1, 2025 | Genetic Testing #85 | Changing edit on CPT codes 0115U, 0202U, 0223U, 0225U 0373U, 87633 from investigational to not medically necessary for this medical policy. | N/A | ||
Removed two codes that have been moved into new medical policy SUR237 - Travoprost Drug-eluting Ocular Implants for the Treatment of Glaucoma. | September 1, 2025 | Medicine #149 | Removing CPT codes 0660T, 0661T from this medical policy, effective 9/1/2025 and moving to new policy SUR237. | N/A | ||
New policy addressing Travoprost Drug-eluting Ocular Implants for the Treatment of Glaucoma. | September 1, 2025 | Surgery #237 |
| N/A | ||
| August 1, 2025 | Durable Medical Equipment #37 | Adding HCPCS codes K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843 with preauth requirement for this policy for Individual Line of Business only. | Adding codes K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843 to the preauth website for Individual Line of Business only. | ||
New medical policy with medical necessity criteria will apply only to Individual members. | August 1, 2025 | Durable Medical Equipment #52 |
| Adding codes E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512 to the preauth website for Individual Line of Business only. | ||
New medical policy with medical necessity criteria will apply only to Individual members. | August 1, 2025 | Durable Medical Equipment #97 | Adding HCPCS codes L0452, L0454, L0456, L0460, L0466, L0468, L0480, L0482, L0484, L0486, L0626, L0627, L0629, L0630, L0631, L0632, L0633, L0634, L0636, L0637, L0638, L0639, L0640 with preauth requirement for this policy for Individual Line of Business only. | Adding codes L0452, L0454, L0456, L0460, L0466, L0468, L0480, L0482, L0484, L0486, L0626, L0627, L0629, L0630, L0631, L0632, L0633, L0634, L0636, L0637, L0638, L0639, L0640 to the preauth website for Individual Line of Business only. | ||
New lab policy for testosterone testing. | August 1, 2025 | Laboratory #81 |
| N/A | ||
| July 1, 2025 | Durable Medical Equipment #42 | N/A | N/A | ||
New policy created to address electromagnetic navigation bronchoscopy. | July 1, 2025 | Surgery #179 |
| Adding CPT codes 31626, 31627 and HCPCS codes C7509, C7510, C7511, C9751 to the preauth website for this medical policy. | ||
Clarifying criteria for soft tissue and bony procedures. | July 1, 2025 | Surgery #229 | Delete CPT code 27427 from this medical policy. | N/A | ||
Expanding post-service review of rotary air ambulance. | July 1, 2025 | Utilization Management #13 | N/A | N/A | ||
| June 1, 2025 | Medicine #149 |
| N/A | ||
New policy addressing Histotripsy for Hepatic or Renal Tumor Treatment. | June 1, 2025 | Medicine #178 | Moved CPT codes 0686T, 0888T to this medical policy from MED149 and continue investigational denial. | N/A | ||
Added criterion for revision of sleeve gastrectomy due to medication resistant gastroesophageal reflux disease. | June 1, 2025 | Surgery #58 | N/A | N/A | ||
Clarified criteria. Updated minimum age for Osia system. | June 1, 2025 | Surgery #121 | N/A | N/A | ||
Combined investigational criteria in the policy. | May 1, 2025 | Genetic Testing #44 | N/A | N/A | ||
New policy for mechanical residual limb volume management systems (e.g., RevoFit) for upper extremity prostheses. | April 1, 2025 | Durable Medical Equipment #98 | Added new Q2 HCPCS code L7406 as always not medically necessary for this policy. | N/A | ||
| April 1, 2025 | Genetic Testing #64 | Added new Q2 CPT 0533U with investigational denial for this policy. | N/A | ||
| April 1, 2025 | Laboratory #77 | Added new Q2 CPT 0542U with investigational denial for this policy. | N/A | ||
Clarified criteria regarding pancreatic cancer and prostate cancer. | April 1, 2025 | Medicine #165 | N/A | N/A | ||
Clarified policy criteria for functional impairments and documentation of orthodontic treatment. | April 1, 2025 | Surgery #137 | N/A | N/A | ||
Added NRG1 fusion testing to policy. | March 1, 2025 | Genetic Testing #56 | N/A | N/A | ||
New policy addressing screening laboratory testing in asymptomatic individuals. | March 1, 2025 | Laboratory #80 | Adding CPT codes: 82310, 82330, 82340, 82670, 82681, 82728, 82977, 83540, 83550, 83735, 83970, 83993, 84100, 84105, 84402, 84403, 84410, 84443, 84466, 85651, 85652, 86038, 86039, 86140, 86225, 86235 to the policy with no edit. This will be implemented as an automatic denial for the CPT codes listed when billed with the diagnosis code Z00.00 as a sole diagnosis code. | N/A | ||
Extracorporeal Membrane Oxygenation (ECMO) for the Treatment of Cardiac and Respiratory Failure in Adults | Updated policy to address continuation of ECMO.
| March 1, 2025 | Medicine #152 | N/A | N/A | |
Updated policy to address the GERDX-System for transoral incisionless fundoplication for treatment of GERD. | March 1, 2025 | Surgery #110 | N/A | N/A | ||
Added medical necessity criteria for cryoablation of certain desmoid tumors. | March 1, 2025 | Surgery #132 | N/A | N/A | ||
Clarified criteria without change to policy intent. | March 1, 2025 | Surgery #134 | Added HCPCS codes C1778, C1883 with no clinical edit. | N/A | ||
Added joint procedure codes that were formerly reviewed by eviCore. | March 1, 2025 | Utilization Management #19 | Adding CPT codes: 20520, 20525, 20670, 20680, 20693, 20694, 23415, 23450, 23460, 23465, 23515, 23550, 23615, 23630, 23655, 23665, 24105, 24305, 24340, 24341, 24342, 24343, 24345, 24346, 24357, 24358, 24359, 24505, 24516, 24530, 24538, 24545, 24546, 24575, 24579, 24586, 24605, 24620, 24635, 24655, 24665, 24666, 24685, 25000, 25107, 25111, 25112, 25118, 25210, 25215, 25240, 25260, 25270, 25280, 25290, 25295, 25310, 25320, 25360, 25390, 25447, 25505, 25515, 25545, 25565, 25574, 25575, 25600, 25605, 25606, 25607, 25608, 25609, 25628, 25645, 25652, 25825, 26011, 26020, 26055, 26080, 26121, 26123, 26145, 26160, 26236, 26320, 26340, 26350, 26356, 26370, 26410, 26418, 26426, 26440, 26445, 26480, 26516, 26520, 26525, 26540, 26541, 26608, 26615, 26650, 26665, 26676, 26725, 26727, 26735, 26746, 26756, 26765, 26785, 26850, 26860, 26951, 26952, 27335, 27424, 27605, 27606, 27612, 27620, 27625, 27626, 27650, 27652, 27654, 27659, 27675, 27676, 27680, 27685, 27687, 27690, 27691, 27695, 27696, 27698, 27705, 27752, 27762, 27766, 27769, 27781, 27784, 27786, 27788, 27792, 27810, 27814, 27818, 27822, 27823, 27840, 28002, 28005, 28008, 28010, 28022, 28035, 28060, 28062, 28080, 28086, 28090, 28092, 28110, 28112, 28113, 28116, 28118, 28119, 28120, 28122, 28124, 28160, 28190, 28192, 28200, 28208, 28230, 28232, 28234, 28238, 28250, 28270, 28272, 28285, 28288, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 28300, 28304, 28306, 28308, 28310, 28313, 28315, 28322, 28415, 28445, 28465, 28475, 28476, 28485, 28505, 28515, 28525, 28555, 28585, 28615, 28645, 28715, 28725, 28740, 28750, 28755, 28810, 28820, 28825, 29834, 29837, 29838, 29844, 29846, 29848 which are moving from eviCore joint Site of Care to this policy, (UM19) with preauth edit | Adding CPT codes: 20520, 20525, 20670, 20680, 20693, 20694, 23415, 23450, 23460, 23465, 23515, 23550, 23615, 23630, 23655, 23665, 24105, 24305, 24340, 24341, 24342, 24343, 24345, 24346, 24357, 24358, 24359, 24505, 24516, 24530, 24538, 24545, 24546, 24575, 24579, 24586, 24605, 24620, 24635, 24655, 24665, 24666, 24685, 25000, 25107, 25111, 25112, 25118, 25210, 25215, 25240, 25260, 25270, 25280, 25290, 25295, 25310, 25320, 25360, 25390, 25447, 25505, 25515, 25545, 25565, 25574, 25575, 25600, 25605, 25606, 25607, 25608, 25609, 25628, 25645, 25652, 25825, 26011, 26020, 26055, 26080, 26121, 26123, 26145, 26160, 26236, 26320, 26340, 26350, 26356, 26370, 26410, 26418, 26426, 26440, 26445, 26480, 26516, 26520, 26525, 26540, 26541, 26608, 26615, 26650, 26665, 26676, 26725, 26727, 26735, 26746, 26756, 26765, 26785, 26850, 26860, 26951, 26952, 27335, 27424, 27605, 27606, 27612, 27620, 27625, 27626, 27650, 27652, 27654, 27659, 27675, 27676, 27680, 27685, 27687, 27690, 27691, 27695, 27696, 27698, 27705, 27752, 27762, 27766, 27769, 27781, 27784, 27786, 27788, 27792, 27810, 27814, 27818, 27822, 27823, 27840, 28002, 28005, 28008, 28010, 28022, 28035, 28060, 28062, 28080, 28086, 28090, 28092, 28110, 28112, 28113, 28116, 28118, 28119, 28120, 28122, 28124, 28160, 28190, 28192, 28200, 28208, 28230, 28232, 28234, 28238, 28250, 28270, 28272, 28285, 28288, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 28300, 28304, 28306, 28308, 28310, 28313, 28315, 28322, 28415, 28445, 28465, 28475, 28476, 28485, 28505, 28515, 28525, 28555, 28585, 28615, 28645, 28715, 28725, 28740, 28750, 28755, 28810, 28820, 28825, 29834, 29837, 29838, 29844, 29846, 29848 to the preauth website for this policy. | ||
Removed neurofilament light chain tests from the policy. | February 1, 2025 | Laboratory #77 | Removed CPT codes 0361U, 0443U from this medical policy with removal of investigational denial. | N/A | ||
New investigational policy for the use of ablation of peripheral nerves to treat pain. | February 1, 2025 | Surgery #236 |
| N/A | ||
Clarifying documentation requirements for:
| February 1, 2025 | Surgery #187 | N/A | N/A | ||
Updated criteria to remove age limits and provide guidance for use of general anesthesia services. | January 1, 2025 | Allied Health #35 | N/A | N/A | ||
Updated policy to address concurrent optical and electromagnetic stimulation for wound healing. | January 1, 2025 | Durable Medical Equipment #83.13 |
| N/A | ||
| January 1, 2025 | Laboratory #51 | Added two new CPT code 0526U as always investigational. | N/A | ||
Added criteria for continuation of treatment. | January 1, 2025 | Medicine #14 | N/A | N/A | ||
Updated the policy in alignment with the 2025 Q1 annual code update. | January 1, 2025 | Medicine #149 |
| N/A | ||
| January 1, 2025 | Surgery #139 |
| Added new CPT code 61715 to the preauth website for this policy. | ||
Added criteria to address 3D Ablation confirmation software. | January 1, 2025 | Surgery #204 |
| N/A | ||
| January 1, 2025 | Surgery #217 |
| Removed codes 0823T, 0825T, 33274 from the preauth website for this policy. | ||
Added criteria to address prostatic urethral scaffold device. | January 1, 2025 | Surgery #230 |
| N/A | ||
| January 1, 2025 | Surgery #235 |
| N/A |
Policy name | Archive date | Policy number |
---|---|---|
Extracorporeal Membrane Oxygenation (ECMO) for the Treatment of Cardiac and Respiratory Failure in Adults | 06/01/2025 | Medicine #152 |
Radioembolization, Transarterial Embolization (TAE), and Transarterial Chemoembolization (TACE) | 05/01/2025 | Medicine #140 |
Ovarian, Internal Iliac, and Gonadal Vein Embolization, Ablation, and Sclerotherapy | 05/01/2025 | Surgery #147 |
Intensive In-Home Family Intervention | 04/01/2025 | Behavioral Health #34 |