Provider Quick Alert

October 1, 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
BI062 C, V
Preventive Health Benefit01/01/20Added codes (G0447 and G0473) to the language for obesity counseling, which is part of visits and not separately reimbursable when billed with the following codes: 99383 - 99387 or 99393 - 99397.
BI394  V
Spinal Surgery05/01/20Spinal injections performed by Physical Medicine and Rehabilitation (PM&R) physicians do not require pre-authorization.
BI038  V
Genetic Testing
10/01/20
Foundation1CDx panel (CPT 0037U) specifically is covered, based on NCCN and DNA Direct criteria.
BI096  V
Continuous Glucose Monitoring10/01/20Updated coverage criteria. Dexcom and Freestyle Libre are preferred products covered under the pharmacy benefit; Minimed is non-preferred product.
ADHD10/01/20Retired policy.
BI510  C, V
Darzalex10/01/20Updated to include Darzalex Faspro (C9062).
BI593  V
GI Drugs IC and IBS
10/01/20
Removed pre-authorization requirement for Linzess; removed Linzess as prerequisite drug for Amitiza in OIC.
BI600  
Restasis10/01/20Retired policy.
Xiidra10/01/20Retired policy.
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.
2009 MK 004