Provider Quick Alert

June 29, 2018
Review all  Medical Coverage Policies at
New and Amended Medical Policies

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
Updated code J7328 --- Hyaluronan/derivative (Gelsyn-3); it is non-formulary and is not covered.

BI508 BRCA Testing 01/01/18
BRCA testing requests from ordering providers need to be submitted within 14 days of collection of blood specimen.
BI534 Back Braces
Updated codes.
BI130 Erythropoietin Therapy 06/01/18
Updated criteria.
Cardioverter Defibrillators 06/01/18 Added omitted code and description.
BI340 Xeloda 06/01/18 Added an indication per updated NCCN guidelines.
BI038 Genetic Testing 07/01/18
Added indication for myRisk genetic screening panel for high risk patients eligible for BRCA or Lynch Syndrome screening.
Hypnotherapy 07/01/18 Removed PA and clarified hypnotherapy requirements and contraindications.
BI129 Tumor Markers 07/01/18 Removed a diagnosis requirement from payment configuration.
BI162 Urinary Incontinence Treatments 07/01/18 Updated code.
BI217 Orthotic Devices and Services 07/01/18 Clarified verbiage that orthotic management (97760 and 97763) requires pre-authorization. Also, updated codes - 97762 is a deleted code.
BI237 Biofeedback 07/01/18 Clarified coverage verbiage, removed PA for appropriate diagnosis, added new mental health codes and referred to BI273. Modified Biofeedback PA requirement ---  no PA for specific conditions (when covered), but PA needed beyond 10 sessions.
BI273 Outpatient Therapy for Mental Health and Substance Disorders 07/01/18
Aligned with BI237 for Biofeedback.
Coming Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
Dexamethasone Intravitreal Implant
08/01/18 Updated ICD10 codes for coverage.
Pulmonary Function Testing
Removed PA requirements for some PFT's (94726-94729). 
Neuromuscular Electrical Stimulation
Reinstituted PA requirement.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.
1806 MK 007