Provider Quick Alert

December 29, 2017
Visit the Providers section of to review all Medical Coverage Policies .
New and Amended Medical Policies

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI038 Genetic Testing 01/01/18
Updated to note specific code, 84999, for MyPath Melanoma. Updated to note code 81541 for Prolaris.
BI342 Nutritional Counseling in Chronic Disease
Added code for cystic fibrosis with intestinal problems.
Added statement: One unit = 15 minutes.
BI344 Physician Extenders 01/01/18
Listed excluded codes and high level codes to Claim Statement.
BI390 Truvada 01/01/18 Retired policy.
BI394 Lumbar Spinal Fusion 12/01/17 Updated for spelling correction.
BI463 Tazarotene Topical 01/01/18 Retired policy.
BI529 Telemedicine Payment Policy 01/01/18 Updated definitions of originator site according to change in Arkansas law. Place of Service 02 (home) can be used as the originator site for any telemedicine visit irrespective of diagnosis. Modifiers GT or 95 can be used with telemedicine visits.
BI570 Tele-Screening for Diabetic Retinopathy 01/01/18 New policy. Store-and-forward technology is now covered when the screening images are reported by an ophthalmologist or optometrist.
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI062 Preventive Health Benefit 03/01/18
Updated osteoporosis screening guidelines.
BI066 Contact Lenses 02/01/18 The gas permeable hard contact lens (V2531) are covered with diagnosis codes for Keratoconus.
BI189 Gastric Pacemaker 02/01/18 Clarified regarding the use of non-specific codes.
BI216 Bone Mineral Density Studies 02/01/18 Clarified indications for preventive screening versus indications for medical testing and PA requirement. Aligned with BI062 and U.S. Preventive Services Taskforce Guidelines.
BI217 Orthotic Devices and Orthotic Services 02/01/18 Deleted outdated or non-pertinent codes. Aligned with BI534 and BI553.
BI301 Liver Lesion Treatment 03/01/18 Clarified verbiage for pre-authorization requirement.
BI382 Bio-engineered Skin & Soft Tissue Substitutes 02/01/18 Added indication for Alloderm, which is covered to help prevent a post-operative syndrome after parotid gland surgery. Does not require pre-authorization with added procedure codes.
BI534 Back Braces 02/01/18 Updated covered back brace codes.
BI549 Oral Mesalamine Products 03/01/18 Changed first-line mesalamine agent from Lialda to Apriso.
BI553 Knee Braces 02/01/18 Updated codes. Listed non-covered knee braces and their additions: L2390, L2405, L2415, L2425, L2430, L2492, L2750, L2755, L2768, L2780, L2785, L2800.
Covered: L2760 (additions to orthotics for lineal adjustment for growth)
BI571 Impella (pVAD) 03/01/18 New policy. Heart pump that may temporarily improve blood output through an externally introduced catheter. Pump will be reviewed for appropriateness. Experimental uses are not covered.
BI572 iStent 03/01/18 New policy. Device is implanted in the eye to help drain excess fluid buildup associated with glaucoma. Pre-authorization is required. Not covered if eye pressure is normal with two or less medications.
1712 MK 006