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.