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Provider Quick Alert

October 4, 2021
Review all Medical Coverage Policies at
Coming Amendments

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

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI022  V
Immunization Coverage12/01/20Added Covid-19 Codes
BI062  V
Preventive Health Benefit01/01/22Covered the recommendations from the USPSTF regarding healthy weight and weight gain in pregnancy. AND screening for gestational diabetes.
BI101  V
Cartilage Transplants of Lower Extremity09/01/21Updated verbiage within policy and removed statement of validation needed, because there is no way to validate.
BI120  V
Hepatitis A Vaccine09/01/21Updated criteria for medical necessity.
BI194  V
Vision Therapy12/01/21Updated policy verbiage and background information.
BI195  V
Tykerb12/01/21Updated breast cancer criteria and added criteria for bone cancer and colorectal cancer.
BI258  V
Stelara10/01/21Updated age for coverage of plaque psoriasis to 6 and older.
BI516  V
Buprenorphine / Naloxone Combo Products10/01/21Updated requirement for prescriber to have CSA-X waiver.
Diclofenac Gel 3%10/01/21Retired

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.

2109 MK 008