Medical Policy Number
|
Medical Policy Name |
Effective Date of Change |
Description of Changes |
BI011 |
Computer Aided Diagnosis (CAD) Mammography |
08/01/17 |
Breast digital tomosynthesis (3D digital mammogram, codes 77061-77063) is covered for risk plans. |
BI062 |
Preventive Health Benefit |
09/01/17 |
Added ablative codes for screening colonoscopy. |
BI089 |
Remicade |
09/01/17 |
Updated criteria for drugs to treat psoriasis. |
BI099 |
Interferons |
09/01/17 |
Updated criteria on current recommendations/indications. |
BI143 |
Enbrel |
09/01/17 |
Updated criteria for drugs to treat psoriasis. |
BI153 |
Humira |
09/01/17 |
Updated criteria for drugs to treat psoriasis. |
BI163 |
Forteo |
09/01/17 |
Updated policy name & addition of new drug. |
BI165 |
Multiple Sclerosis |
09/01/17 |
Updated to reflect Rituximab & Ocrevus use in treatment of MS. |
BI171 |
Rituxan |
09/01/17 |
Updated to include use of Rituximab in primary progressive MS. |
BI238 |
HPV Testing |
09/01/17 |
Z-codes now pay as preventative. |
BI253 |
Hospital Acquired Conditions |
09/01/17 |
Defined process to identify criteria for claim adjustments. |
BI273 |
Mental Health & Substance Use Disorders |
09/01/17 |
Added codes for acute psychotherapy. |
BI306 |
Obstructive Sleep Apnea |
09/01/17 |
Added references supporting the use of auto-titrating CPAP devices in the home for patients without significant comorbidities. |
BI314 |
Zytiga |
09/01/17 |
Added alternative dosing regimen and supporting reference. |
BI366 |
Breast Reconstruction |
09/01/17 |
Added diagnosis codes to confirm need; pre-authorization is not required. |
BI391 |
Factor Products |
09/01/17 |
Added new code; removed deleted code. |
BI454 |
Otezla |
09/01/17 |
Updated therapy criteria for drugs used to treat psoriasis. |
BI483 |
Cosentyx |
09/01/17 |
Updated therapy criteria for drugs used to treat psoriasis. |
BI522 |
Taltz |
09/01/17 |
Updated therapy criteria for drugs used to treat psoriasis. |
BI554 |
Alunbrig |
09/01/17 |
New drug; used to treat types of lung cancer. |
BI555 |
Bavencio |
09/01/17 |
New drug; used to treat Merkel Cell Carcinoma (MCC) & advanced bladder cancer. |
BI556 |
Imfinzi |
09/01/17 |
New drug; used to treat advanced bladder cancer. |
BI557 |
Rydapt |
09/01/17 |
New drug; used to treat acute myeloid leukemia. |
BI558 |
Zejula |
09/01/17 |
New drug; used to treat recurrent ovarian cancer. |