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Monthly Changes

Our at-a-glance summary of monthly changes to our policies, pre-authorization requirements, Administrative Manual and other programs or initiatives that impact your office are published:

  • Monthly in our bulletin
  • Bi-monthly in our newsletter
  • On this page within two weeks of our newsletter publication

Subscribe to receive newsletters and bulletins via email. View the changes listed by effective date below:

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November, 2019

In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and dental policies, and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies.

AIM revising clinical guidelines

AIM Specialty Health (AIM) is revising its radiology clinical guidelines effective November 10, 2019, for head and neck, brain, spine, extremity, cardiac, vascular and oncology. Revised guidelines are available on AIM's website.

Clinical Practice Guidelines updates

We reviewed the Treatment for Attention Deficit Hyperactivity Disorder in Children and Adolescents Clinical Practice Guideline, effective July 1, 2019, with no changes.

Reimbursement change for medical drug administration

We do not reimburse for claims associated with denied services, in accordance with our Associated Claims (Administrative #119) reimbursement policy. Effective November 1, 2019, we will also apply this policy to medical drug claims for infusion and injection codes, which are two part: One code for the medication itself and one for the administration of these medications. If a medical drug is not payable, the administration of the drug will not be payable.

Read the August 2019 issue of our newsletter for details.

Pre-authorization updates

The following codes will be added to our pre-authorization lists effective November 1, 2019:

Commercial and Uniform Medical Plan

  • Insulin Infusion Pumps and Artificial Pancreas Device System (APDS) (Durable Medical Equipment #77)
    • HCPCS E0784
  • Noninvasive Ventilators in the Home Setting (Durable Medical Equipment #87)
    • HCPCS E0466
  • Power Wheelchairs: Group 3 (Durable Medical Equipment #37)
    • HCPCS K0848-K0864

Medicare

  • Continuous Glucose Monitors (CGMs) and External Insulin Infusion Pumps (Medicare Durable Medical Equipment #86)
    • HCPCS E0784
  • Noninvasive Ventilators in the Home Setting (Medicare Durable Medical Equipment #87)
    • HCPCS E0466
  • Power Wheelchairs (PWCs) (Medicare Durable Medical Equipment #37)
    • HCPCS K0848-K0855, K0857-K0860, K0862-K0864

Please review our pre-authorization lists for all updates and pre-authorize services accordingly.