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Provider Quick Alert

April 30, 2021
Review all Medical Coverage Policies at QualChoice.com.
Coming Amendments

P = Payment Change
C = Code Change
V = Verbiage Change

Medical Policy Number
 Medical Policy Name Effective Date of Change Description of Changes
BI479  V
Lynparza06/01/21Updated to include pancreatic adenocarcinoma and prostate cancer.
BI504  V
Lonsurf06/01/21Updated to include gastric cancer or gastroesophageal junction adenocarcinoma. Updated colorectal cancer.
BI505  V
Ninlaro06/01/21Updated to include systemic light chain amyloidosis and Waldenstrom macroglobulinemia/lyphoplasmacytic lymphoma. Updated multiple myeloma combination options.
BI506  V
Nucala06/01/21Added hypereosinophilic syndrome.
BI510  V
Darzalex06/01/21Updated multiple myeloma criteria. Added systemic light chain amyloidosis.
BI537  V
Rubraca06/01/21Updated criteria to include newly approved diagnosis for prostate cancer. Added requirements for dosing and for no previous failure of a PARP inhibitor.
BI613  V
Ultomiris06/01/21Added Atypical Hemolytic Uremic Syndrome.
BI616  V
Xospata06/01/21Added Myeloid/Lymphoid Neoplasm with Eosinophilia.
BI644  V
Enhertu06/01/21Added Gastric and Esophagogastric Junction Cancer.
BI647  V
Reblozyl06/01/21Updated to include myelodysplastic syndromes.
BI685   New
Polymerase Chain Reaction Respiratory Viral Panel Testing07/01/21Respiratory viral panels (RVPs) are considered medically necessary in a healthcare setting that cares for critically ill patients, such as the emergency department or inpatient hospital, including those in observation status. RVPs are considered not medically necessary for all other indications.
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.
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