Provider News
January 2018 - In this issue:
 MCO
NHP Continues To Be One Of Fastest Growing Commercial Health Plans In Massachusetts!
  
As more and more members are choosing NHP, we are proud to continue to be one of the fastest growing commercial health plans in Massachusetts! With over 123,000 commercial members today, we have seen our commercial membership nearly double in 5 years!

One reason more members and employers are choosing NHP is because of our strong and growing provider network. Thank you to providers like you for being a trusted partner in delivering quality care.

Here is a look at some of the employer groups we have added in the past several months:
  • Plumbers Union Local 12
  • Mystic Valley Elder Services
  • T.L. Edwards
  • Solomon Schechter Day School
  • Captain Marden's Seafoods
  • ProEMS Solutions
  • Wayne Alarm Systems
  • Edgar P. Benjamin Healthcare Center
  • Manufacturing Resource Group
  • ACP Facilities Services
  • Payne Boucher
  • Fayerweather Street School
  • CJ Mabardy
  • North End Rehabilitation & Healthcare Center
  • Integrity Home Care Solutions
  • Neptune Garment Company
NHP's MassHealth Line of Business
As you may have heard, MassHealth's landscape will be changing in 2018. Beginning March 1, 2018, 17 Accountable Care Organizations (ACOs) will be available and serving select regions across the Commonwealth. ACOs are groups of doctors, hospitals, and other health care providers who come together to give coordinated, high-quality care. An ACO can partner with just one health plan that serves MassHealth members or with MassHealth directly. Members will be enrolled in the health plan affiliated with their primary care provider's ACO.

NHP is excited to partner with the Merrimack Valley ACO (Greater Lawrence Family Health Center and Lawrence General Hospital). This partnership will be known as My Care Family. My Care Family will offer care and coverage to nearly 36,000 MassHealth patients in the Greater Lawrence area, where many residents face financial and social challenges to accessing care and to maintaining their health. Read My Care Family's press release for more information.  

As part of MassHealth's restructuring, MassHealth has selected fewer health plans to participate through the Managed Care Organization (MCO) program beginning March 1, 2018. While NHP was not selected to participate in the MCO program, we remain committed to our MassHealth members through the ACO program. 

NHP is working with MassHealth to ensure a smooth transition for members switching to or from NHP coverage, especially those who are currently receiving or scheduled to receive care. Over the next several months, we will share more information on how we will support these efforts. 

Please note that these changes in MassHealth do not impact your participation as a commercial provider with NHP.
  Product
Reminder: 2018 Commercial Product and Benefit Updates
  
Care Complement
We are excited to introduce Care Complement, an innovative set of benefits for select large group members beginning January 1, 2018! Care Complement removes the financial barriers to care and introduces alternative methods for managing pain and chronic conditions, which encourages healthy behaviors and helps mitigate future complications. 

For example, Care Complement members pay $0 copay for:
  • Coverage for acupuncture, first 6 visits
  • Drug-free, pain treatments (first 6 chiro visits and first 6 visits for PT/OT)
  • 11 common Rx maintenance medications that treat common chronic conditions like high-cholesterol, diabetes, high-blood pressure, heart disease, and depression
  • Diabetic education and nutritional counseling 
  • Cardiac rehabilitative therapy
  • Treatments for certain substance use disorders
When verifying member eligibility, Care Complement members will have "Care Complement" in the plan name. Remember to always check benefits and copay information before the service by contacting NHP Provider Service at 855-444-4647 or providerservice@nhp.org. 

PPO Plus
Our new PPO product, PPO Plus, will be available to small and large employer groups as early as January 1, 2018. For in-network coverage, PPO Plus members will have access to NHP's PPO network, as well as MultiPlan's PHCS Healthy Directions providers when the member is outside NHP's service area. For greater flexibility, PPO Plus members have the option to see out-of-network providers at a higher cost share.  For more information, this  PPO Plus Fact Sheet is available for your reference. 

6-Tier Prescription Drug Program
To help address the rising costs of specialty medications, we've created new 6-tier Rx plans that will be available starting January 1, 2018. This new 6-tier formulary provides more value to employers and members by breaking out specialty medications into two tiers, with lower cost sharing for preferred specialty medications than non-preferred specialty medications. Here's how NHP will define our FlexRx 6 tier plans:
  • TIER 1 (low-cost generic) includes lower cost generic medications. Generic medications contain the same active ingredients as their brand name counterparts
  • TIER 2 (generic) includes higher cost generic medications
  • TIER 3 (preferred brand name) includes preferred brand name medications
  • TIER 4 (non-preferred brand name) includes non-preferred brand name medications
  • TIER 5 (preferred specialty) includes preferred specialty medications as specified by NHP
  • TIER 6 (non-preferred specialty) includes non-preferred specialty medications as specified by NHP
Acupuncture Benefit for Select Large Group Plans
Starting on January 1, 2018, select HMO and PPO Plus large group plans will have a new benefit design which will include coverage for acupuncture. 

Members in plans that include an acupuncture benefit will have no copay for the first 6 acupuncture visits, and will be covered for up to 20 total visits.  Prior to the service, please remember to always verify benefits and copay information for commercial members by contacting NHP Provider Service at providerservice@nhp.org or 855-444-4647.

    claim
Reminder: Claim-Authorization NPI Match

If authorization is required for a service, NHP requires that the NPI on the claim matches the NPI associated with the approved authorization. This requirement ensures that the correct approvals are in place and that appropriate provider entity is paid. When there is an NPI mismatch, your claim may deny.

   evicore
Radiation Therapy Pathways

In an effort to continue to refine the process, eviCore will add an Other Metastases Pathway for case build starting December 14 , 2017. Metastases is the development of secondary malignant growths at a distance from a primary site of cancer spread and current case build only allows cases to be built for Bone Metastases, Brain Metastases, or Oligometastases. The new pathway will be specific to metastases and will function in line with current case build practices for other cancer types. The associated interactive PDF worksheet  will be posted online.
 

The Other Metastases Pathway is based on ongoing efforts to reduce cases going to medical review. Adding this disease group will allow the radiation therapy team to collect clinical appropriate for metastases. Other Metastases was previously built through the existing Bone Metastases, Brain Metastases, Oligometastases, or Other Cancer Type Pathways but will now have a separate RC Code (RCMETS), physician worksheet, and pathway.

  

Click Here to access eviCore's website.


   PandT
Pharmacy & Therapeutics Updates

The Pharmacy & Therapeutics Committee has reviewed and updated medications. Click Here to access NHP's formulary updates effective March 1, 2018. 

Click Here to access NHP's Drug Lookup Tool.
   novol
Reminder: Medical Specialty Drug Updates Effective 1/1/18

As a reminder, additional medical specialty drugs requiring prior authorization through CVS Caremark have been added. See the below drug lists for the latest information: 
How To Submit Prior Authorization For These Drugs?
Submit your prior authorization requests to CVS Caremark via fax at 844-851-0882 or phone at 844-345-2803.

For additional information, visit   www.nhp.org/medicalspecialtydrugs.
  member
Enhanced Member Portal
  
NHP is committed to offering an optimal online experience for our providers and members. In 2017, we launched new features such as the Provider Enrollment Portal, an enhanced online provider directory and an InterQual Transparency Tool. 

We recently launched a refreshed member portal. This enhanced tool has a streamlined navigation to make it easier for our members to find the tools they need to manage their plan, health, and costs. The new responsive design also delivers an optimal user experience on smartphones, tablets, or desktops! 

   codes
New January 2018 CPT Codes 
  
Below is a summary of coverage, prior authorization and reimbursable status updates related to new CPT codes effective January 1, 2018. Note: This is not an all-inclusive list of new CPT codes. 

The following codes are not covered for all lines of business effective 1/1/18:
CODE
DESCRIPTION
0479T
Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% of body surface area of infants and children
0480T
Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure)
0481T
Injection(s), autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation, when performed
0482T
Absolute quantitation of myocardial blood flow, positron emission tomography (PET), rest and stress (List separately in addition to code for primary procedure)
0483T
Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed
0484T
Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; transthoracic exposure (eg, thoracotomy, transapical)
0485T
Optical coherence tomography (OCT) of middle ear, with interpretation and report; unilateral
0486T
Optical coherence tomography (OCT) of middle ear, with interpretation and report; bilateral
0487T
Biomechanical mapping, transvaginal, with report
0488T
Preventive behavior change, online/electronic structured intensive program for prevention of diabetes using a standardized diabetes prevention program curriculum, provided to an individual, per 30 days
0489T
Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; adipose tissue harvesting, isolation and preparation of harvested cells including incubation with cell dissociation enzymes, removal of non-viable cells and debris, determination of concentration and dilution of regenerative cells
0490T
Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; multiple injections in one or both hands
0491T
Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; first 20 sq cm or less
0492T
Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
0493T
Near-infrared spectroscopy studies of lower extremity wounds (eg, for oxyhemoglobin measurement)
0494T
Surgical preparation and cannulation of marginal (extended) cadaver donor lung(s) to ex vivo organ perfusion system, including decannulation, separation from the perfusion system, and cold preservation of the allograft prior to implantation, when perform
0495T
Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; first two hours in sterile field
0496T
Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; each additional hour (List separately in addition to code for primary procedure)
0497T
External patient-activated, physician- or other qualified health care professional-prescribed, electrocardiographic rhythm derived event recorder without 24 hour attended monitoring; in-office connection
0498T
External patient-activated, physician- or other qualified health care professional-prescribed, electrocardiographic rhythm derived event recorder without 24 hour attended monitoring; review and interpretation by a physician or other qualified health care professional per 30 days with at least one patient-generated triggered event
0499T
Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed
0500T
Infectious agent detection by nucleic acid (DNA or RNA), human papillomavirus (HPV) for five or more separately reported high-risk HPV types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) (ie, genotyping)
0501T
Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission, analysis of fluid dynamics and simulated maximal coronary hyperemia, generation of estimated FFR model, with anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report
0502T
Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission
0503T
Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; analysis of fluid dynamics and simulated maximal coronary hyperemia, and generation of estimated FFR model
0504T
Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report
32994
Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation
55874
Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed
81230
CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22)
81231
CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7)
81283
IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant
81328
SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5)
81346
TYMS (thymidylate synthetase) (eg, 5-fluorouracil/5-FU drug metabolism), gene analysis, common variant(s) (eg, tandem repeat variant)
81521
Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk of distant metastasis
81541
Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score


The following codes are covered with prior authorization for all lines of business effective 1/1/18:
CODE
DESCRIPTION
33927
Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy
33928
Removal and replacement of total replacement heart system (artificial heart)
33929
Removal of a total replacement heart system (artificial heart) for heart transplantation (List separately in addition to code for primary procedure)
36465
Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)
36466
Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg
36482
Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated
36483
Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)
81105
Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-1a/b (L33P)
81106
Human Platelet Antigen 2 genotyping (HPA-2), GP1BA (glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-2a/b (T145M)
81107
Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex], antigen CD41 [GPIIb]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-3a/b (I843S)
81108
Human Platelet Antigen 4 genotyping (HPA-4), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-4a/b (R143Q)
81109
Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (eg, HPA-5a/b (K505E))
81110
Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-6a/b (R489Q)
81111
Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex, antigen CD41] [GPIIb]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-9a/b (V837M)
81112
Human Platelet Antigen 15 genotyping (HPA-15), CD109 (CD109 molecule) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-15a/b (S682Y)
81120
IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants (eg, R132H, R132C)
81121
IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common variants (eg, R140W, R172M)
81175
ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene sequence
81176
ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence analysis (eg, exon 12)
81232
DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6)
81238
F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence
81247
G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; common variant(s) (eg, A, A-)
81248
G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; known familial variant(s)
81249
G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; full gene sequence
81258
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant
81259
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence
81269
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; duplication/deletion variants
81334
RUNX1 (runt related transcription factor 1) (eg, acute myeloid leukemia, familial platelet disorder with associated myeloid malignancy), gene analysis, targeted sequence analysis (eg, exons 3-8)
81335
TPMT (thiopurine S-methyltransferase) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3)
81361
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE)
81362
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s)
81363
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); duplication/deletion variant(s)
81364
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence
81448
Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy-related genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1)
81520
Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score
81551
Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy


The following codes are covered but not separately reimbursable for all lines of business effective 1/1/18:
CODE
DESCRIPTION
99483
Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination; Medical decision making of moderate or high complexity; Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity; Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]); Medication reconciliation and review for high-risk medications; Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s); Evaluation of safety (eg, home), including motor vehicle operation; Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks; Development, updating or revision, or review of an Advance Care Plan; Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.


The following codes are covered with prior authorization but not separately reimbursable effective 1/1/18 (MassHealth plans only):
CODE
DESCRIPTION
93792
Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the INR monitor, obtaining blood sample
93793
Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed


The following behavioral health codes will redirect to Beacon Health Options if billed to NHP effective 1/1/18:
CODE
DESCRIPTION
99484
Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team.
99492
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies.
99493
Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
99494
Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure)


   mpr
Medical Policies
  
The following medical policy updates are effective January 1, 2018:
  • Acupuncture (All Products) - Annual review. Added language indicating certain select commercial plans now have coverage (limited to a total of 20 office visits per benefit period). Added clarifying language indicating guidelines apply to MassHealth members starting at the 21st visit. 
  • Definition of Skilled Care (MassHealth) - Language added to reflect revised MassHealth regulations; added skilled nursing home visits conducted for the purpose of medication administration. 
  • Home Health Care (MassHealth) - Language added to reflect revised MassHealth regulations; added skilled nursing home visits conducted for the purpose of medication administration.
Click Here to view all medical policies. 
On behalf of all of us at Neighborhood Health Plan, we thank you for the excellent care provided to our members and the continued collaboration extended to our staff.