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Provider Quick Alert

March 1, 2021
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
BI318  V
Cardiac Event Recorder11/01/20Transcatheter insertion or replacement of permanent leadless pacemaker (33274) is considered experimental and investigational for arrhythmias and all other indications because of insufficient evidence of its safety and effectiveness.
Bariatric Surgery02/01/21Added code 0097 for Anesthesia for bariatric procedures.
Coming Amendments

Medical Policy Number
 Medical Policy Name Effective Date of Change Description of Changes
Xyrem04/01/21Updated to include Xywav as covered with same criteria.
Lynparza04/01/21Updated to include coverage criteria for pancreatic adenocarcinoma.
Calquence04/01/21Updated to note Calquence should not be used in Imbruvica refractory mantle cell lymphoma patients.
Testing for Drugs of Abuse05/01/21Drug testing (CPT codes 80305 to 80377) are cumulatively covered for not more than once per day, or 2 per month and 24 per 12 months.
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.
2102 MK 004