Medical policy updates

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.

Effective May 14, 2020

Prophylactic Cancer Risk Reduction Surgery - 91508

Added family history as additional risk criteria when considering prophylactic simple mastectomy. This information was obtained from Comprehensive Cancer Network (NCCN) Guidelines for Genetic/Familial High-Risk Assessment: Breast and Ovarian.

Prior authorization is no longer required for the following procedures:

  • Prophylactic gastrectomy
  • Prophylactic hysterectomy
  • Prophylactic mastectomy
  • Prophylactic oophorectomy
  • Prophylactic salpingo-oophorectomy

Prior authorization is still required for prophylactic thyroidectomy.