Medical policy updates
(Grand Rapids, Mich. - February 15, 2011)
The Priority Health Medical Affairs Committee met on Feb. 9, 2011, and made several changes to the company's medical policies. You'll find a complete, updated listing of all Priority Health medical policies in our online Provider Manual.
New/changed policies
Unless noted otherwise, these policies took effect on Feb. 16, 2011.
- Cosmetic and Reconstructive Surgery Procedures, number 91535
Summary: Blepharoptosis/Brow Ptosis Repair (91376), Facial Scar Revisions (91442) and Port Wine Stains and Vascular Malformations (91413) medical policies have been incorporated into this policy and were retired on 02/16/2011. - End Stage Renal Disease & Home Hemodialysis, number 91526
Summary: Home Hemodialysis (91512) has been incorporated into this policy and was retired on 02/16/2011. Criteria added for coverage of Intradialytic Parenteral Nutrition (IDPN). - Oral Surgery & Dental Extractions, number 91542
Summary: Dental Extractions (91523) has been incorporated into this policy and was retired on 02/16/2011. Language added to policy to clarify that restoration procedures are not a covered benefit. - Pharmacogenomics Testing, number 91570
Summary: Criteria added for the coverage of genotype testing for identification of the CYP2C19 variant of Cytochrome P450 and the KRAS Mutation Assay. Criteria also added to address non-coverage of genotyping for other Cytochrome P450 polymorphisms. - Spine Procedures, number 91581
Summary: Incorporates previously separate policies: Artificial Intervertebral Discs (91493), Radiofrequency Ablation for Back Pain (91541), Automated Percutaneous Lumbar Discectomy (APLD) (91519), AxiaLIF™ Axial Lumbar Interbody Fusion (91549) and IDET and Other Thermal Intradiscal Procedures (TIPs) (91438). These policies will be retired on 02/16/2011. Language added to clarify Radiofrequency Ablation (RFA) of the SI (sacroiliac) joint is not a covered benefit. - Markers for Digestive Disorders, number 91583 – Effective 03/18/2011
Summary: New policy created to address coverage and non-coverage of markers used in the assessment of digestive disorders. - Transcranial Magnetic Stimulation for Depression, number 91563 - Effective 03/18/2011
Summary: Several changes made to the criteria section. IDS-SR added as an evidence-based depression monitoring tool to determine if member has severe depression. Additional provider requirements also added to the policy.
More policies retired
The following medical policies were retired as of Feb. 1, 2011:
- Enhanced External Counterpulsation (EECP), policy number 91440: No longer needed
- Growth Hormone Replacement in Adults, policy number 91441: Now handled by Pharmacy
- Growth Hormone Therapy in Children, policy number 91460: Now handled by Pharmacy
