April medical policy updates

Below are links to updated policies. Remember, you can always find the latest updates to our medical policies, as well as brief descriptions of what changed, in the medical policies section on the Pending/retired/updated medical policy list web page.

Updates effective April 6, 2018

Home Care - 91023

Language removed addressing services rendered by a dietitian or nutritionist for overall training or consultative advice to the home health agency staff.

Osteoarthritis of the Knee - 91571

Criteria updated to reflect bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) injections are considered experimental, investigational or unproven, and therefore are not covered.

Platelet Rich Plasma/Platelet Rich Fibrin Matrix/Autologous Blood-Derived Products/BMAC - 91553

Language added to reflect Bone Marrow Aspirate Concentrate (BMAC)/mesenchymal stem cells are considered investigational. In addition, osteoarthritis added to list of indications for which platelet-rich plasma (PRP)/Autologous blood-derived growth factors/Bone Marrow Aspirate Concentrate (BMAC)/mesenchymal stem cells are considered investigational.

Transcranial Magnetic Stimulation for Depression - 91563

Language added to reflect that authorization for Transcranial Magnetic Stimulation (TMS) is determined by the clinical finding and TMS indications recommended by Behavioral Health InterQual®.

Effective March 12, 2018

Gastroparesis Testing & Treatment - 91572

Botulinum toxin (Botox®) is no longer covered for gastroparesis. It is considered to be experimental and investigational. Policy was updated to reflect the July 2017 P&T Committee decision for non-coverage.