BCBS Massachusetts Medical Policy Updates – September 2018

September 2018 Medical Policy Updates:

• Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
• Botulinum Toxin Injection
• Cardiac Computed Tomography (CT) for Quantitative Evaluation of Coronary Calcification
• Computed Tomographic Angiography Coronary Arteries (CCTA)
• Computed Tomography (CT) Abdomen
• Computed Tomography (CT) Abdomen and Pelvis Combination
• Computed Tomography (CT) Cardiac (Structure)
• Computed Tomography (CT) Cervical Spine
• Computed Tomography (CT) Chest
• Computed Tomography (CT) CT Colonography (Virtual Colonoscopy)
• Computed Tomography (CT) Head
• Computed Tomography (CT) Lower Extremity
• Computed Tomography (CT) Lumbar Spine
• Computed Tomography (CT) Neck for Soft Tissue Evaluation
• Computed Tomography (CT) Orbit, Sella Turcica, Posterior Fossa, Temporal Bone, including Mastoids
• Computed Tomography (CT) Paranasal Sinus & Maxillofacial Area
• Computed Tomography (CT) Pelvis
• Computed Tomography (CT) Thoracic Spine
• Computed Tomography (CT) Upper Extremity
• Corneal Collagen Cross-linking
• CT Angiography (CTA) Abdomen and Pelvis Combination
• CT Angiography (CTA) Abdominal Aorta and Bilateral Iliofemoral Lower Extremity
• CT Angiography (CTA) and MR Angiography (MRA) Abdomen
• CT Angiography (CTA) and MR Angiography (MRA) Lower Extremity
• CT Angiography (CTA) and MR Angiography (MRA) Pelvis
• CT Angiography (CTA) and MR Angiography (MRA) Upper Extremity
• CT Angiography (CTA) Chest (Non Coronary)
• CT MR Angiography (CTA MRA) Head Cerebrovascular
• CT MR Angiography (CTA MRA) Neck
• Diaphragmatic Phrenic Nerve and Diaphragm Pacing Systems
• Endovascular Procedures for Intracranial Arterial Disease – Atherosclerosis and Aneurysms
• Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies
• Fetal MRI
• Functional Magnetic Resonance Imaging (fMRI) Brain
• Genotype Guided Tamoxifen Treatment
• Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas
• Insulin Delivery Devices
• Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease
• Intravenous Immunoglobulin
• InVitro Chemoresistance and Chemosensitivity Assays
• Magnetic Resonance Imaging (MRI) Abdomen – Cholangiopancreatography (MRCP) Abdomen
• Magnetic Resonance Imaging (MRI) Bone Marrow Blood Supply
• Magnetic Resonance Imaging (MRI) Breast
• Magnetic Resonance Imaging (MRI) Cardiac
• Magnetic Resonance Imaging (MRI) Cervical Spine
• Magnetic Resonance Imaging (MRI) Chest
• Magnetic Resonance Imaging (MRI) Head Brain
• Magnetic Resonance Imaging (MRI) Lumbar Spine
• Magnetic Resonance Imaging (MRI) of the Lower Extremity Joint and Non-Joint
• Magnetic Resonance Imaging (MRI) Orbit, Face & Neck (Soft Tissues)
• Magnetic Resonance Imaging (MRI) Pelvis
• Magnetic Resonance Imaging (MRI) Temporomandibular Joint (TMJ)
• Magnetic Resonance Imaging (MRI) Thoracic Spine
• Magnetic Resonance Imaging (MRI) Upper Extremity (Any Joint)
• Magnetic Resonance Imaging (MRI) Upper Extremity (Non-Joint)
• Magnetic Resonance Spectroscopy
• Medical Technology Assessment NonCovered Services
• Miscellaneous Genetic and Molecular Diagnostic Tests
• MR Angiography (MRA) Chest
• MR Angiography (MRA) Spinal Canal
• Nuclear Cardiology Cardiac Blood Pool Imaging
• Nuclear Cardiology Infarct Imaging
• Nuclear Cardiology Myocardial Perfusion Imaging
• Percutaneous Tibial Nerve Stimulation for Voiding Dysfunction
• Pharmacy Specialty List
• Plastic Surgery
• Positron Emission Tomography (PET) Brain
• Positron Emission Tomography (PET) Myocardial Imaging
• Positron Emission Tomography, Other PET Applications, Including Oncologic Tumor Imaging
• Proteomic Testing for Systemic Therapy in Non-Small-Cell Lung Cancer
• RSV Immunoprophylaxis
• Serological Diagnosis of Celiac Disease
• Transcatheter Aortic-Valve Implantation for Aortic Stenosis

Added 9/18/2018;

• Intensity Modulated Radiation Therapy – IMRT – of the Prostate
• Endobronchial Brachytherapy
• Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines
• KRAS NRAS and BRAF Variant Analysis in Metastatic Colorectal Cancer
• Intensity-Modulated Radiation Therapy – IMRT – of the Breast and Lung
• Intensity-Modulated Radiation Therapy – IMRT – Abdomen and Pelvis
• Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds
• Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
• Genetic Testing for Developmental Delay Intellectual Disability, Autism Spectrum Disorder and Congenital Anomalies
• Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
• Cellular Immunotherapy for Prostate Cancer
• Intraoperative Radiation Therapy
• Radiofrequency Ablation of Primary or Metastatic Liver Tumors
• Radioembolization for Primary and Metastatic Tumors of the Liver
• Genetic Testing for Familial Cutaneous Malignant Melanoma
• Saturation Biopsy for Diagnosis and Staging of Prostate Cancer
• Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early Stage Breast Cancer
• Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease
• High-Dose Rate Temporary Prostate Brachytherapy
• Charged-Particle – Proton or Helium Ion – Radiation Therapy
• Oncologic Applications of Photodynamic Therapy, Including Barretts Esophagus
• Genetic Testing for Hereditary Pancreatitis
• Polysomnography and Home Sleep Testing
• Management of Obstructive Sleep Apnea APAP and CPAP Devices
• Bi-Level Positive Airway Pressure – BPAP Devices
• Management of Obstructive Sleep Apnea – OSA Oral Appliances
• Multiple Sleep Latency Testing – MSLT and Maintenance of Wakefulness Testing – MWT
• Genetic Testing for Germline Mutations of the RET Proto-Oncogene in Medullary Carcinoma of the Thyroid
• Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
• Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain
• BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
• Cryosurgical Ablation of Primary or Metastatic Liver Tumors
• Transcatheter Arterial Chemoembolization – TACE – to Treat Primary or Metastatic Liver Malignancies
• Genetic Testing for Li-Fraumeni Syndrome
• Benign Skin Lesions
• Genetic Testing for Fanconi Anemia
• Moderate Penetrance Variants Associated With Breast Cancer in Individuals at High Breast Cancer Risk
• Electronic Brachytherapy for Nonmelanoma Skin Cancer
• Circulating Tumor DNA and Circulating Tumor Cells for Cancer
• Computed Tomographic Angiography Coronary Arteries (CCTA)
• Intensity Modulated Radiation Therapy – IMRT – Central Nervous System Tumors
• Gene Therapy for Inherited Retinal Dystrophy Luxturna
• Preauthorization Request Form for Gene Therapy for Inherited Retinal Dystrophy

Click here to view the Blue Cross Blue Shield Massachusetts Medical Policy Updates »

Policy Alerts monitors Commercial and Medicare medical policies for changes. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. When reviews occur out of cycle they often go unnoticed. Policy Alerts keeps you updated when Payers make coverage changes to medical policies affecting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on medical Insurance decisions in real-time. When changes occur, instant email alerts are delivered to your inbox. Clients have access to detailed coverage reports and medical policies through the interactive Policy Alerts Dashboard portal. Save time each month and keep focused on important Payer medical policy reviews and coverage decisions affecting your business!

Policy Alerts takes a client-focused hands-on approach and is constantly working to provide our customers with helpful insights and actionable analytics. We understand what our clients need and are dedicated to providing timely, accurate, and always up-to-date reports.

Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.