Provider Quick Alert

May 1, 2017
New and Amended Medical Policies



Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI010 Flu Immunizations 01/01/17 Updated reimbursement referencing.
BI038 Genetic Testing 05/01/17 Updated verbiage on multiple testing options and for pre- authorization requests to be submitted by ordering providers. Vendor forms and retro requests are not accepted.
BI093 Varicose Vein Treatment 05/01/17 Updated verbiage to reflect that surgical treatment of intractable ulcerations secondary to venous stasis and varicose veins does not require trial of conservative management.
BI129 Tumor Markers 05/01/17 Updated verbiage on multiple testing options, and for pre- authorization requests to be submitted by ordering providers. Vendor forms and retro requests are not accepted.
Coming Amendments



Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI217 Orthotic Devices and Orthotic Services 06/01/17 Added L3995 to upper extremity fracture orthotic code to be covered without pre-
authorization. Referenced the new policy BI534 on Back Braces.
BI253 Hospital Acquired Conditions 07/01/17 Updated CMS list of preventable HACs (and corresponding codes) added for 2017.
BI265 Cardioverter-Defibrillators 07/01/17 Updated codes.
BI372 Women's Preventive Health Care - Contraception
 07/01/17 Added Kyleena IUD to code description.
BI508 BRCA Testing
 07/01/17 Genetic testing request will require submission by the ordering provider within 3 days of the collection of blood specimen. Added pancreatic cancer as a covered diagnosis for BRCA testing. 81162 BRCA with full dup/del analysis is covered. 81213 uncommon
BRCA dup/del variants is no longer covered.
BI333 Spinraza
 07/01/17 New policy for the treatment of Spinal Muscular Atrophy; it will require pre-authorization with diagnosis and clinical response confirmed by a pediatric neurologist.
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