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.
The following changes will be made to our pre-authorization lists effective September 1, 2019:
Commercial and Uniform Medical Plan Pre-authorization Lists
Ventral Hernia Repair (Surgery #12.03)
- Adding CPT 15734, 49652
Cosmetic and Reconstructive Procedures (Medicare Surgery #12)
- Adding CPT 15734
Please review our pre-authorization lists for all updates and pre-authorize services accordingly.
Reimbursement policy updates
We review our reimbursement policies on an annual basis. Included below are updates to existing policies and new policies that will be added to our Reimbursement Policy Manual.
To see how a claim will pay, access the Clear Claim Connection tool on the Availity Provider Portal.
Revised policies effective September 1, 2019:
- Bundling Edits (Administrative #105)
- Global Days (Administrative #101)
- Virtual Care (Administrative #132)
Read the August 2019 issue of our newsletter for details.
Medical policy update
We publish updates to medical policies, dental policies and Clinical Position Statements in our monthly publication The Bulletin.
We provided 90-day notice in the June 2019 issue of The Bulletin about the following medical policies:
- Ventral Hernia Repair (Surgery #12.03), effective September 1, 2019
- Cosmetic and Reconstructive Procedures (Medicare Surgery #12), effective September 1, 2019
You can read issues of The Bulletin or subscribe to receive an email notification when issues are published. The Medical Policy Manual includes a list of recent updates and archived policies.
eviCore guidelines to be revised
Effective September 1, 2019, eviCore will revise its guidelines for several components of our Physical Medicine program.
Joint surgery guideline revisions
- Knee Surgery-Arthroscopic and Open Procedures: Indications and Non-Indications (#312.3)
- Hip Replace/Arthroplasty: Indications and Non-Indications (#313.3)
- Anesthesia Services for Interventional Pain Procedures: Indications (#400.3)
Spine surgery guideline revisions
- Anterior Cervical Discectomy and Fusion: Adjacent Segment Disease (#601.4)
- Cervical Total Disc Arthroplasty: Primary Cervical Total Disc Arthroplasty (#602.2), Adjacent Segment Disease Secondary to Cervical Total Disc Arthroplasty (#602.4) and Non-Indications (#602.5)
- Posterior Cervical Decompression (Laminectory/Hemilaminectory/Laminoplasty) with or without Fusion: Non-Indications (#604.6)
- Lumbar Microdiscectomy (Laminotomy, Laminectomy or Hemilaminectomy): Initial Primary Lumbar Microdiscectomy (#606.2)
- Sacroiliac Joint Fusion or Stabilization: Minimally Invasive Sacroiliac Joint Fusion or Stabilization (#611.2)
- Grafts: Bone Graft Substitutes (#612.4)
Redlined versions of these revisions are available on eviCore's website.
AIM guidelines to be revised
Effective September 1, 2019, AIM Specialty Health (AIM) will revise its guidelines for our radiology and Sleep Medicine programs.
The advanced imaging of the heart, transthoracic echocardiography (TTE), guideline will be revised to address the frequency of surveillance echocardiography following transcatheter mitral
valve repair. The ecochardiogram clinical guidelines will also be revised.
Redlined versions of all the revised guidelines are available on AIM's website.
E&M codes not payable to therapy providers
Effective September 1, 2019, physical, occupational, speech and massage therapists will no longer be reimbursed for evaluation and management (E&M) codes: CPT 99201-99205 and 99211-99215.
These providers should use the existing, non-E&M CPT codes that are specific to their specialty; providers should bill only for services within their specialty's scope of practice. All claims submitted, including those prior to September 1, 2019, are subject to audit.
This announcement is supported by statements in the Therapy Guidelines and Alternative Care sections of our Regence BlueShield Administrative Manual.
New electronic authorization features
Effective September 1, 2019, you will see additional information as part of the electronic authorization process in the Availity Portal. Code-specific messages will help you select the correct medical policy and will clearly indicate when pre-authorization is not required. Expanded messaging will also be available on the Commercial and UMP Pre-authorization Lists to help streamline your pre-authorization experience.
Livongo Diabetes Management
This program is for members with type 1 or type 2 diabetes who do not have a current cancer diagnosis and includes free strips and lancets—plus a new free blood glucose meter, better diabetes monitoring and answers to questions 24/7. Effective September 1, 2019, it will be available to Liberty Safe and Security Products Inc. (group #10013222) members.