Florida Blue Cross Blue Shield January 2018 Medical Policy Updates

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New:

Revised:

Asfotase alfa (StrensiqTM) – Review and revision to guideline; position statement, references.
Azacitidine (Vidaza®) Injection – Review and revision to guideline; consisting of updating position statement and references.
Bezlotoxumab (Zinplava) Injection – Review and revision to guideline consisting of updating the position statement and references.
Botulinum Toxins – Review and revision to guideline consisting of updating the position statement, program exceptions, dosing/administration, precautions, and references.
Capecitabine (Xeloda®) Tablets – Review and revision to guideline; consisting of updating position statement and references.
Clotting Factors and Coagulant Blood Products – Revision to guideline; consisting of updating position statement to include Rebinyn.
Dupilumab (Dupixent) Injection – Revision to the guideline consisting of updating the position statement in regards to the prerequisite requirements for members receiving systemic immunosuppressant therapy or phototherapy.
Edaravone (Radicava) – Review and revision to guideline; position statement, references.
Everolimus (Afinitor®, Afinitor Disperz®) Tablets – Revision to guideline; consisting of updating position statement, coding and references.
Gonadotropin Releasing Hormone Analogs and Antagonists – Review and revision to guideline consisting of updating the position statement, precautions, and references.
Infliximab Products, infliximab (Remicade®), infliximab-dyyb (Inflectra®), infliximab-abda (Renflexis®) – Review and revision to guideline; consisting of revising position statement.
Ixekizumab (Taltz®) Injection – Revision to guideline consisting of the description section, position statement, dosage/administration, billing/coding information, related guidelines, definitions, and referenced, based on the new FDA-approved indication for the treatment of adults with active psoriatic arthritis.
Nusinersen (Spinraza) – Review and revision to guideline; Updating position statement, coding, references.
Palbociclib (Ibrance) – Revision to guideline; updated position statement with NCCN recommendations.
PCSK9 Inhibitors – Revision to guideline consisting of updating the position statement in regards to documentation requirements and inclusion of alternative non-HDL-C goals. The description section, dosage/administration, and references were updated based on the expanded FDA-approved indication for Repatha.
Pembrolizumab (Keytruda) Injection – Revision to guideline; consisting of updating position statement, description, coding and references.
Pyrimethamine (Daraprim) – Review and revision to guideline consisting of updating position statement and references.
Regorafenib (Stivarga®) Tablets – Review and revision to guideline; consisting of updating position statement and references.
Ribociclib (Kisqali) – Revision to guideline; updated position statement with NCCN recommendations.
Sunitinib Malate (Sutent®) Capsules – Review and revision to guideline; consisting of updating position statement, description, coding, dosing and references.
Trifluridine-Tipiracil (Lonsurf®) Capsule – Review and revision to guideline consisting of updating position statement, coding and references.
Vemurafenib (Zelboraf™) – Revision to guideline; consisting of updating position statement, description, dosing, coding and references.
Ziv-aflibercept (Zaltrap®) IV – Review and revision to guideline; consisting updating position statement and references.
Abatacept (Orencia®) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab is now a preferred product for psoriatic arthritis, and use of three preferred products is required. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis indication.
Adalimumab (Humira®) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use.
Allergy Testing and Immunotherapy – Annual CPT/HCPCS coding update: added 86008; revised 86003, 86005.
Allogeneic Bone Marrow and Stem Cell Transplantation – Annual CPT/HCPCS coding update: deleted 38220.
Anakinra (Kineret®) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis indication.
Apheresis, Plasmapheresis and Plasma Exchange – Annual CPT/HCPCS coding update: deleted 36515; revised 36516.
Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer – Annual CPT/HCPCS update. Added codes 81520, 81521; deleted code 0008M.
Autologous Bone Marrow and Stem Cell Transplantation – Annual CPT/HCPCS coding update: deleted 38220.
Balloon Ostial Dilation (Balloon Sinuplasty) and Implantable Devices – Annual HCPCS code update. Added 31298.
Bezlotoxumab (Zinplava) Injection – Annual HCPCS coding update: added HCPCS code J0565 and removed code C9490.
Bio-Engineered Skin and Soft Tissue Substitutes, Amniotic Membrane and Amniotic Fluid – Annual CPT/HCPCS update. Added codes Q4176-Q4182; revised codes Q4132, Q4133, Q4148, Q4156, Q4158, Q4162, Q4163.
Brodalumab (Siliq®) Injection – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab (Cosentyx) is now a preferred product for plaque psoriasis.
Cardiac Monitoring Devices – Annual CPT/HCPCS update. Added codes 0497T and 0498T.
Certolizumab Pegol (Cimzia®) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis when certolizumab pegol is used as self-administered therapy.
Clotting Factors and Coagulant Blood Products – Annual HCPCS coding update: added HCPCS codes J7210 and J7211, and deleted code C9140.
Cochlear Implants – Annual CPT/HCPCS coding update: added L8625.
Cognitive Rehabilitation – Annual CPT/HCPCS coding update: added 97127, G0515; deleted 97532. Revised program exceptions section. Reformatted guideline.
Continuous Monitoring of Glucose in the Interstitial Fluid – Annual CPT/HCPCS coding update: added 95249; revised 95250, 95251.
Contraceptive Drugs – Annual HCPCS coding update: added HCPCS code J7296 and deleted code Q9984.
Cryosurgical Ablation of Solid Tumors Other Than Liver or Prostate Tumors – Annual CPT/HCPCS update. Deleted code 0340T.
Dermabrasion, Chemical Peel, Salabrasion, and Acne Surgery – Annual CPT/HCPCS update. Added codes 96573, 96574; revised code 96567.
Digital Breast Tomosynthesis – Annual HCPCS code update. Deleted G0202, G0204 and G0206.
Drug Testing in Pain Management and Substance Abuse Treatment – Annual CPT/HCPCS update. Revised codes 80305-80307.
Edaravone (Radicava) – Annual HCPCS coding update: added HCPCS code C9493.
Endovascular Stent Grafts for Abdominal Aortic Aneurysms – Annual CPT/HCPCS update. Added codes 34701-34716; revised codes 34812 & 34820; deleted codes 34800-34805, 34825, 34826, 75952, 75953.
Etanercept (Enbrel®) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use.
Eteplirsen (Exondys 51) – Annual HCPCS coding update: added HCPCS code J1428 and removed code C9484.
Evoked Potentials, Intraoperative Neurophysiologic Monitoring, and Quantitative Electroencephalography (QEEG) – Annual CPT/HCPCS update. Revised code 95930.
Genetic Testing – Annual CPT/HCPCS update. Added codes 81230-81232, 81238, 81258-81269, 81328, 81334, 81335, 81346, 81448, 81541, 81551, 0011M, 0027U-0034; revised codes 81257, 81432, 81439; deleted code 0015U. Investigational test list updated and code 0020U added.
Golimumab (Simponi®, Simponi® Aria™) – Revision to guideline consisting of updating the description section, position statement, and references after golimumab IV (Simponi Aria) gained new FDA-approved indications for psoriatic arthritis and ankylosing spondylitis. The preferred self-administered biologic products were also updated according to indication for use.
Gonadotropin Releasing Hormone Analogs and Antagonists – Annual HCPCS coding update: added HCPCS code C9016.
Granisetron (Sustol®) injection – Annual HCPCS coding update: added HCPCS code J1627 and deleted code C9486.
Guselkumab (Tremfya) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab (Cosentyx) is now a preferred product for plaque psoriasis. Addition of HCPCS code C9029.
Hereditary Angioedema Drug Therapy – Annual HCPCS coding update: added HCPCS code C9015.
Home Prothrombin Time Monitoring – Annual CPT/HCPCS coding update: added 93792; deleted 99363. Revised Reimbursement Information (deleted 99364) and Program Exceptions sections. Reformatted guideline.
Human Papillomavirus (HPV) Testing – Annual CPT/HCPCS update. Added code 0500T.
Hydroxyprogesterone Caproate – Annual HCPCS coding update: added HCPCS codes J1726 and J1729, and deleted codes Q9985 and Q9986.
Immune Globulin Therapy – Annual HCPCS coding update: added HCPCS code J1555.
Implantable Bone-Conduction and Bone-Anchoring Hearing Aids – Annual HCPCS code update. Added L8618, L8624, L8625 and L8694. Revised L8691 code descriptor.
Investigational Services – Annual CPT/HCPCS update. Added codes 64912, 64913, 0479T-0481T, 0483T-0493T, 0499T; revised code 0384T; deleted codes 93982, 0178T-0180T, 0293T-0300T, 0302T-0307T. Code 0020U deleted; see MCG 05-82000-28.
Ixekizumab (Taltz®) Injection – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab (Cosentyx) is now a preferred product for plaque psoriasis.
Minimally Invasive Fusion Techniques – Annual CPT/HCPCS coding update: deleted 0309T. Reformatted guideline.
Neuropsychological Testing – Revision: deleted repeat testing in 12 months restriction; revised Billing/Coding Information section; reformatted guideline.
Nusinersen (Spinraza) – Annual HCPCS coding update: added HCPCS code J2326 and deleted code C9489.
Ocrelizumab (Ocrevus®) Infusion – Annual HCPCS coding update: added HCPCS code J2350
Olaratumab (Lartruvo) – Annual HCPCS coding update: added HCPCS code J9285 and deleted code C9485
Percutaneous Electrical Nerve Stimulation (PENS) – Annual CPT/HCPCS coding update: deleted 64565 from Billing/Coding Information section. Revised Programs Exceptions section. Reformatted guideline.
Physical Therapy (PT) and Occupational Therapy (OT) – Revision: updated Reimbursement Information section.
Positron Emission Tomography (PET Scan) Miscellaneous Applications – Annual HCPCS code update. Deleted A9599.
Positron Emission Tomography (PET) Cardiac Applications – Annual HCPCS code update. Added 0482T.
Psychiatric Services – Revision: updated Reimbursement Information section.
Radiofrequency Ablation of Solid Tumors Other Than Liver Tumors – Annual HCPCS code update. Revised 32998 code descriptor.
Sarilumab (Kevzara) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis indication.
Secukinumab (Cosentyx) – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukiumab (Cosentyx) was added as a preferred product for axial spondyloarthritis, plaque psoriasis, and psoriatic arthritis.
Teriparatide (Forteo®) – Review and revision to guideline; consisting of updating position statement.
Tocilizumab (Actemra®) Injection – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis when tocilizumab is used as self-administered subcutaneous therapy.
Tofacitinib (Xeljanz, Xeljanz XR) Tablets – Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use.
Transcranial Magnetic Stimulation – Annual review; revised position statement. Updated references.
Transcutaneous Electric Nerve Stimulation (TENS) – Annual CPT/HCPCS coding update: added 64550.
Treatments for Varicose Veins/Venous Insufficiency – Annual CPT/HCPCS update. Added codes 36465, 36466, 36482, 36483; revised codes 36468, 36470, 36471.
Tumor/Genetic Markers – Annual CPT/HCPCS update. Added code 0026U.
Ustekinumab (Stelara™) – Revision to guideline consisting of updating the description section, position statement, and references after expanded FDA-approved indication for plaque psoriasis to include adolescent patients. The preferred self-administered biologic products were also updated according to indication for use. Addition of HCPCS code J3358 and deletion of code Q9989.
Vagus Nerve Stimulation – Annual CPT/HCPCS coding update: revised 64550.
Ventricular Assist Devices and Total Artificial Hearts – Annual CPT/HCPCS coding update: added 33927, 33928, 33929, Q0477; deleted 0051T, 0052T, 0053T.
Viscosupplementation, Hyaluronan Injections (e.g. Synvisc®) – Annual HCPCS coding update: revision to description of HCPCS code J7321.

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

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