Provider Quick Alert

May 1, 2019
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
BI124   C
Flow Cytometry 01/01/19 Configuration update. CPT codes 88184-88185 and 88187-88189 should be billed without any modifier. 
BI129   C
Tumor Markers
01/01/19
Added CPT code 81551 for ConfirmMDx for prostate cancer; new code effective 1/1/2018. This service is not covered.
BI013   C
Cosmetic Reconstructive Surgery 05/01/19
Added excluded Dx code.
BI038   C
Genetic Testing 05/01/19 Added coverage of 0037U (F1CDx panel) for NSCLC with pre-authorization.
BI062   V
Preventive Health Benefit 05/01/19
Aligned with Bright Futures pediatric screening guidelines.
BI363   C
Balloon Sinuplasty 05/01/19 Sinus endoscopy and surgery without balloon dilatation (CPT 31231-31294) are covered without pre-authorization. 
BI366   C
Breast Reconstruction 05/01/19
Added missing Dx code Z42.1 in Claim Statement.
BI617  New
Carrier Screening in Pregnancy 05/01/19 Policy outlines medical necessity criteria for cystic fibrosis (CF) and spinal muscular atrophy (SMA) carrier screening as well as carrier screening for members of Ashkenazi Jewish Ancestry (AJA) as recommended by the American College of Medical Genetics (ACMG) and the American College of Obstetricians and Gynecologists (ACOG).
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI301   C
Liver Lesion Treatment
07/01/19 Added radiopharmaceutical therapy admin codes (which currently pay without pre-authorization).
BI345   C
Testing for Drugs of Abuse
07/01/19
OON testing excluded for all plans 07/01/2019.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.
1904 MK 004