Provider Quick Alert

November 1, 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
BI007 Electro-diagnostic Testing 11/01/17 Changed policy to state other areas of nerve issues. Updated medical statement for clarification.
BI038 Genetic Testing 11/01/17 Added new U codes.
BI129 Tumor Markers 11/01/17 Added new U codes.
BI157 Immune Globulin 11/01/17 Updated IgG level thresholds for IVIG infusion in hematologic malignancy.
BI245 Lipid Panel 10/01/17 Updated name of policy to Low Density Lipoprotein (LDL) Measurement.
BI269 Skilled Home Health Care 10/01/17 Added new codes to split RN versus LPN services. However, claims are paid the same because of tie to Medicaid rates.
BI345 Testing for Drugs of Abuse 10/01/17 Added new U codes (non-covered) and non-coverage for out-of-network testing (effective 01/01/18).
BI362 Kalydeco 10/01/17 Updated age limit to 2 years of age or older.
BI450 Lung Cancer Screening 11/01/17 Increased age from 79 to 80 to match USPSTF guidelines.
BI469 Keytruda 11/01/17 Added new indication and criteria for gastric cancer.
BI480 Opdivo 11/01/17 Added new indication and updated the approved diagnosis of hepatocellular cancer.
Coming Amendments



Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI010 Flu Immunizations 01/01/18 Updated to include under the standard flu payment:
 quadrivalent, trivalent, with or without preservatives, and intradermal or intramuscular injection. Any other immunization may need to be pre-authorized. Added new codes and verbiage from the Arkansas State Immunization Registry (WebIZ) that will be effective in 2018.
BI055 Midwife 01/01/18 Added POS 11 allowing midwives to triage patients under physician supervision.  
BI062 Preventive Health Benefit 12/01/17 Updated cholesterol screening guideline and added preventive low-to-moderate intensity statin guidelines.
BI448 Preventive Care Medications 12/01/17 Updated to include statin low-to-moderate dose recommendation.
1710 MK 014