Provider Quick Alert

July 1, 2019
Review all  Medical Coverage Policies at QualChoice.com.
New and Amended Medical Policies
P = Payment Change
C = Code C hange
V = Verbiage Change

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI014
Arterial Catheterization (CABG Charges) 07/01/19 Retired policy.
BI035
Autopsy
07/01/19
Retired policy.
BI037
Hospital PASS 07/01/19
Retired policy.
BI272   V
Obstetrical Ultrasound 06/01/19 Clarified verbiage.
BI317   V
Cardiac Event Recorder, External Loop Recorder 06/01/19
Zio patch ambulatory cardiac monitoring (0296T, 0297T and 0298T) is covered without pre-authorization. 
BI394   C
Lumbar Spinal Fusion 06/01/19 Updated codes 0213T-0215T, paravertebral facet joint injections, to be covered without pre-authorization. New codes 0219T-0222T, placement of posterior intrafacet implant, are considered experimental/investigational and are not covered.
BI613   C
Ultomiris 07/01/19
Added C9052 to the policy.
BI619   C
Elzonris
07/01/19
Added C9049 to the policy.
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI523   C
Tecentriq
08/01/19 Added coverage criteria for small cell lung cancer and breast cancer.
BI523   New
Symdeko
08/01/19 Used to treat cystic fibrosis; specialty drug covered under pharmacy benefit.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.
1906 MK 011