Provider Quick Alert

February 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
BI062   V
Preventive Health Benefit 01/01/19
Diabetic eye exam is covered once every year under preventive benefit for diabetics without any known diabetic eye disease.
BI382   C
Bio-Engineered Skin and Soft Tissue Substitutes
01/01/19
Codes updated and aligned with BI383.
BI570   V
Tele-Screening for Diabetic Retinopathy 01/01/19 Diabetic tele-retinal eye exam is covered once every year under preventive benefit for diabetics without any known eye complications.
BI423
GLP-1 Agonists 01/03/19 Retired policy.
BI453 
Corticosteriod Beta Agonist Combo Products 01/03/19 Retired policy.
BI527
Proton Pump Inhibitors 01/03/19 Retired policy.
BI579
Inhaled Corticosteriods 01/17/19 Retired policy.
BI169   C
Macular Degeneration Treatments and Diabetic Macular Edema Treatments
02/01/19
Clarified codes for low-dose and high-dose bevacizumab. Added note regarding limits per treatment for low-dose bevacizumab.
BI275   V
Cimzia 02/01/19 Added criteria for coverage of treatment for plaque psoriasis.
BI299   C
Avastin
02/01/19
Clarified codes for low-dose and high-dose bevacizumab. Added note regarding limits per treatment for low-dose bevacizumab.
BI305   V
Testosterone Replacement Therapy 02/01/19
Updated covered/non-covered products. Testosterone gel 1.62% covered; Androgel 1.62% not covered.
BI309   V
Yervoy 02/01/19 Added approved indications of advanced renal-cell cancer and metastatic colorectal cancer.
BI480   V
Opdivo 02/01/19
Updated to include first line treatment in combination with Yervoy for advanced renal cell cancer.
BI482   V
Hepatitis C Treatment with Direct Acting Antivirals (DAA) 02/01/19 Replaced coverage of Epclusa with authorized generic version.
BI576   V
Trelegy Ellipta 02/01/19
Removed Utibron/Bevespi - no longer covered.
BI599  New
Olumiant 02/01/19 New ---  Used to treat rheumatoid arthritis; specialty drug covered under pharmacy benefit.
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI401   V
Xeljanz
03/01/19 Updated to include criteria for Psoriatic Arthritis and Ulcerative Colitis.
BI416   V, C
Heart Transplants
03/01/19
Added criteria for VAD as bridge to transplant or destination therapy.
BI598  New
Mepsevii 03/01/19 New ---  Mepsevii is used to treat mucopolysaccharidosis VII (MPS VII, Sly syndrome).
BI602  New
Lutathera 03/01/19 New ---  Used in the treatment of specific gastroenteropancreatic neuroendocrine tumors (NETs).
BI600  New
Restasis 04/01/19 New ---  Used to treat keratoconjunctivitis sicca.
BI601  New
Xiidra 04/01/19 New ---  Used to treat dry eye disease.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.
1901 MK 007