Provider Quick Alert

December 31, 2018
Review all  Medical Coverage Policies at
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
Pap Smear Codes
Retired policy.
Coding for Obstetrical Care 12/06/18
Retired policy.
BI011   C
Computer Aided Diagnosis (CAD) Mammography
Added diagnosis code Z85.3 --- personal history of breast cancer.
BI063   V
Non Face-to-Face Services 01/01/19
Made reference to BI529 for telemedicine services and to provider manual for transitional care.  
BI120   V
Hepatitis A Vaccine 09/01/18 Removed pre-authorization requirements. Covered as routine preventive benefit <18 years old and PRN medical benefit 18 or older.
BI162   V
Urinary Incontinence Treatments 01/01/19 Toviaz will be nonformulary 1/1/2019.  Medications requiring pre-authorization identified/clarified.
BI330   V
Transurethral Radiofrequency Treatment 01/01/19
Was E/I; still E/I based on more current research.
BI464   V
Urinary Antispasmodics 01/01/19 Removed nonformulary products (Gelnique and Toviaz).
BI534   V
Back Braces 01/01/19
Back brace codes not listed in Medical policy statement are considered not medically necessary and therefore are not covered. Added diagnosis for coverage of back braces.  
BI580  New
Emergency Department Care 01/01/19 New ---  Added K59.00- K59.09: Constipation will be denied/pended for medical record review.
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI306   V
Obstructive Sleep Apnea
02/01/19 Eliminated accreditation requirements for HSTs. 
BI363   V
Balloon Sinuplasty
Balloon dilation of Eustachian tube considered experimental and/or investigational.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.
1812 MK 007