Medical policy updates

Updated: Dec. 27, 2019

Below are links to updated or new policies. Remember, you can always find the latest updates to policies in the Pending/retired/updated medical policy list of the Provider Manual.

Effective Dec. 26, 2019

Transcatheter Heart Valve Procedures - 91597
Added transcatheter tricuspid valves replacement for tricuspid valve disease as experimental and investigational.

Effective Dec. 4, 2019

Behavioral Health Residential Treatment - 91625

Medical Policy 91607, Mental Health Residential Treatment: Child & Adolescent has been merged with Medical Policy 91608, Mental Health Residential Treatment: Adult. Medical Policy number 91607 and 91608 has been retired.

Bone Density Studies - 91494

Added aromatase inhibition therapy as a risk factor for osteoporosis. Individuals on aromatase inhibition therapy would be eligible for bone mineral density studies. This is an expansion in coverage which aligns with Michigan Quality Improvement Consortium (MQIC), National Osteoporosis Foundation (NOF), and International Society for Clinical Densitometry guidelines.

Effective Jan. 1, 2020

Home Care - 91023

Beginning Jan. 1, 2020, all home health visits for members with a commercial group and individual plans will require prior authorization before the first visit. Today, these visits do not require authorization for the first 30 home health visits per plan year.