Provider Quick Alert

July 31, 2020
Review all  Medical Coverage Policies at QualChoice.com.
New and Amended Medical Policies
P = Payment Change
C = Code Change
V = Verbiage Change

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI033   C
Viscosupplementation 07/01/20 Added new code.
BI052  
Obesity Treatment
07/01/20
Retired policy.
BI133   C
Hematopoietic Colony-Stimulating Factors 07/01/20 Added new code.
BI157   C
Immune Globulin
07/01/20
Added new code.
BI170   C
Provigil 07/01/20 Added new code.
BI171  C
Rituximab
07/01/20
Added new code.
BI391  C
Factor Products
07/01/20
Added new code.
BI535  C
Eucrisa 07/01/20 Added new code.
BI641   New
Ketamine 08/01/20 New policy.
BI644  C
Enhertu
07/01/20
Added new code.
BI646   C
Padcev 07/01/20 Added new code.
BI647   C
Reblozyl
07/01/20
Added new code.
BI652   C
Adakveo 07/01/20 Added new code.
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI394 V
Spinal Surgery 10/01/20 Interspinous/interlaminar process stabilization/spacer device and its removal are considered experimental and investigational.
For questions about QualChoice Medical Coverage Policies, please contact your Provider Relations Representative 
 at 800.235.7111 or 501.228.7111, ext. 7004, Monday through Friday, 8:00 a.m. to 5:00 p.m.

2007 MK 007