Provider Quick Alert

October 2017
Visit the Providers section of  QualChoice.com to review all Medical Coverage Policies .
New and Amended Medical Policies

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI011 Computer Aided Diagnosis (CAD) Mammography 08/01/17 Included verbiage from BI436 and BI476, which are to be retired. State legislature added requirements for ultrasound to be included as a preventive screening (if needed) along with mammogram or breast tomosynthesis.
BI152 Strabismus Surgery 10/01/17 Updated indication for adults having strabismus surgery.
BI165 Multiple Sclerosis 10/01/17 Added to policy a new drug and a new code: C9494.
BI496 PCSK9 Inhibitors 10/01/17 Added diagnoses with criteria for coverage on HeFH and ASCVD. Added reauthorization criteria.
BI555 Bavencio 10/01/17 Added new HCPCS code.
BI556 Imfinzi 10/01/17 Added new HCPCS code.
Coming Amendments



Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI036 Treanda 11/01/17 Added code J9034 with additional indication, guidelines and diagnoses.
BI038 Genetic Testing 11/01/17 Added reference to BI129.
BI129 Tumor Markers 11/01/17 Removed pre-authorization requirements from CPT Code 81519 and added indications per National Comprehensive Cancer Network (NCCN) guidelines.
BI144 Orencia 11/01/17 Added indication for psoriatic arthritis in coverage criteria.
BI395 Clinical Trial Coverage 11/01/17 Added verbiage based on issues with clinical trials requiring specifics on services.
BI560 Iressa 11/01/17 New Benefits Interpretation for treating lung cancer and central nervous system cancers. Covered under pharmacy benefits.
BI561 Votrient 11/01/17 New Benefits Interpretation for treating kidney cancer and soft tissue sarcoma. Covered under pharmacy benefits.
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