Provider Quick Alert
October 1, 2020
Medical Coverage Policies
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
Preventive Health Benefit
Added 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.
Spinal injections performed by Physical Medicine and Rehabilitation (PM&R) physicians do not require pre-authorization.
Foundation1CDx panel (CPT 0037U) specifically is covered, based on NCCN and DNA Direct criteria.
Continuous Glucose Monitoring
Updated coverage criteria. Dexcom and Freestyle Libre are preferred products covered under the pharmacy benefit; Minimed is non-preferred product.
Updated to include Darzalex Faspro (C9062).
GI Drugs IC and IBS
Removed pre-authorization requirement for Linzess; removed Linzess as prerequisite drug for Amitiza in OIC.
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.
Provider Relations Representatives
2009 MK 004