November 2021 policy updates

Every third month, the Medical Advisory Committee (MAC) meets to review our medical policies. Read below to learn about our Nov. 2021 medical policy updates.

What’s changing

Policy name Change to policy 
Autism Spectrum Disorders #91615 Expanding coverage by eliminating age restrictions on Applied Behavioral Analysis (ABA) services
Colorectal Cancer Screening #91547 Expanding Commercial and Medicaid coverage by lowering age for average risk adults to being screening to 45 years old
Platelet Rich Plasma/ Platelet Rich Fibrin Matrix #91553 Expanding coverage due to a national coverage determination (NCD) 270.3 which allows coverage for platelet rich plasma for chronic non-healing diabetic wounds up to 20 weeks. This was previously limited to coverage with evidence development (CED).
Genetic Counseling Testing Screening #91540 Non-invasive prenatal testing (NIPT) no longer requires prior authorization
Stimulation Therapy Devices #91468 We’re separating out dorsal root ganglion stimulators from spinal cord/dorsal column stimulators.
Breast Related Procedures #91545 Clarified final stage of reconstruction and revision as the achievement of symmetry.
Spine Procedures #91581 Decreasing the list of procedures that will require prior authorization in 2022.
Orthotic Shoe Inserts s#91420 Prior authorization is not required for therapeutic shoes and inserts for Medicare members with diabetes.
Spine Center of Excellence #91531 Policy will retire on Jan. 1, 2022.