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Florida Blue Cross Blue Shield October 2017 Medical Policy Revisions
Click here to view the Florida Blue Cross Blue Shield October 2017 Medical Policy Revisions »
WHAT’S NEW
10/15/17
Revised MCGs:
- Abatacept (Orencia®) – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
- Adalimumab (Humira®) – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
- Afatinib (Gilotrif TM) Tablets – Review and revision to guideline, consisting of updating position statement, coding, references.
- Alectinib (Alecensa®) – Review and revision to guideline, consisting of updating position statement, coding, references.
- Alemtuzumab (Lemtrada TM) IV – Review and revision to guideline; consisting of updating position statement and references.
- Anakinra (Kineret®) – Review and revision to guideline consisting of updating description, position statement, coding/billing, definitions, related guidelines, and references
- Apremilast (Otezla®) Tablet – Review and revision to guideline consisting of updating description, position statement, dosage/administration, definitions, related guidelines, and references.
- Brachytherapy – Oncologic Applications – Revision; revised position statement. Updated references.
- Buprenorphine HCl (Probuphine ®) Subdermal Implant – Review and revision to guideline, consisting of updating position statement, coding, references.
- Ceritinib (Zykadia™) Capsules – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
- Certolizumab Pegol (Cimzia®) – Review and revision to guideline, consisting of updating position statement, coding, references.
- Computer Assisted Surgical Navigation – Review; no change in position statement. Updated references.
- Continuous Monitoring of Glucose in the Interstitial Fluid – Unscheduled review. Revised description section, position statement section, HCPCS coding section, reimbursement information section, and program exceptions section. Updated references.
- Crizotinib (Xalkori®) Capsules – Review and revision to guideline, consisting of updating position statement, coding, references.
- Dimethyl Fumarate (Tecfidera®) Capsule – Review and revision to guideline; consisting of updating position statement and references.
- Erlotinib (Tarceva®) Tablets – Review and revision to guideline, consisting of updating position statement, coding, references.
- Etanercept (Enbrel®) – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
- Fingolimod (Gilenya™) Capsule – Review and revision to guideline; consisting of updating the position statement and references.
- Fractionation and Radiation Therapy – Revision; revised position statement. Updated references.
- Gefitinib (Iressa) – Review and revision to guideline, consisting of updating position statement and references.
- Genetic Testing – Revision; CMA investigational position statement added for the evaluation of all other conditions of delayed development; Diagnosis Table, coding, and references updated.
- Golimumab (Simponi®, Simponi® Aria™) – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
- Granisetron (Sustol®) injection – Revision to guideline; consisting of updating position statement, description, and references.
- Ibrutinib (Imbruvica™) – Revision to guideline consisting of updating the description section, position statement, dosage/administration section, billing/coding information, and references based on a new FDA approved indication for chronic Graft versus Host Disease (cGVHD).
- Image-Guided Radiation Therapy for Treatment Planning and Delivery – Revision; revised position statement. Updated references.
- Immune Globulin Therapy – Review and revision to guideline; consisting of updating position statement, coding and references.
- In Utero (Intrauterine) Fetal Surgery for Correction of Malformations – Review; added position statement for myelomeningocele. Updated references.
- Infliximab Products [infliximab (Remicade®), infliximab-dyyb (Inflectra®), and infliximab-abda (Renflexis®)] – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
- Intensity-Modulated Radiation Therapy (IMRT) – Revision; revised position statement. Added Hodgkin and Non-Hodgkin lymphoma, thyoma and thymic carcinoma. Revised other malignancies. Updated references.
- Ipilimumab (Yervoy™) Injection – Revision to guideline; consisting of updating position statement and references.
- Ixekizumab (Taltz®) Injection – Review and revision to guideline consisting of updating description, position statement, dosage/administration, definitions, related guidelines, and references.
- Lumbar Spine Surgery – Revision: updated position statement section regarding intra-operative/surgically induced segmental instability.
- Magnetic Resonance Imaging (MRI) Abdomen and Pelvis – Revised position statement (musculoskeletal pelvic and fetal MRI). Updated references.
- Multigene Expression Assay for Predicting Recurrence in Colon Cancer – Review; investigational position maintained, description, program exception, and references updated.
- Multiple Sclerosis Self Injectable Therapy – Review and revision to guideline; consisting of updating position statement and references.
- Natalizumab (Tysabri®) IV – Review and revision to guideline; consisting of updating position statement and references.
- Necitumumab (PortrazzaTM) – Review and revision to guideline, consisting of updating position statement, coding, references.
- Neurolysis/Ablation – Revision: Revised MCG title and description section. Added clarifying language to Position Statement regarding when neurolysis is considered E/I. Revised ICD10 coding section, Reimbursement Information section, and definitions. Updated references.
- Nivolumab (Opdivo®) – Revision to guideline; consisting of updating position statement, description, coding, and references.
- Non-Covered Services – Added codes S1030, S1031, S1034, S1035, S1036, S1037. Deleted codes A4244, A4245, A4246, A4247, A4248, A4927, D1330, D9310, E0189, E1639, G0182, L3030, S0201, S0620, S0621, S8415, S9453, V2750.
- Olaparib (Lynparza TM) – Review and revision to guideline; consisting of updating position statement, description, dosing and references.
- Osimertinib (TagrissoTM) – Review and revision to guideline, consisting of updating position statement, coding, references.
- Pembrolizumab (Keytruda®) Injection – Revision to guideline; consisting of updating position statement, description, coding and references.
- Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty – Revision: revised description section. Added coverage statement for percutaneous radiofrequency kyphoplasty. Updated references.
- Radiofrequency Ablation of Liver Tumors – Scheduled review. Revised description section and position statement section. Updated references.
- Rituximab (Rituxan) and Rituximab hyaluronidase (Rituxan Hycela) – Revision to guideline; consisting of updating position statement and references.
- Secukinumab (Cosentyx) – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
- Special Treatment Procedure and Special Physics Consult – Revision; revised position statement. Updated references.
- Stereotactic Body Radiotherapy – Revision; revised position statement. Added Hodgkin and Non-Hodgkin lymphoma. Updated references.
- Stereotactic Radiosurgery (Intracranial) – Revision; revised position statement. Added Hodgkin and Non-Hodgkin lymphoma, thyoma and thymic carcinoma. Revised other malignancies. Updated references.
- Subtalar Arthroereisis – Review; investigational position maintained; guideline description, coding, and references updated.
- Teriflunomide (Aubagio®) Tablets – Review and revision to guideline; consisting of updating position statement and references.
- Teriparatide (Forteo®) – Revision to guideline; consisting of updating position statement and references.
- Tetrabenazine (Xenazine) and Deutetrabenazine (Austedo) – Review and revision to guideline; consisting of updating position statement and references.
- Tocilizumab (Actemra®) Injection – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
- Tofacitinib (Xeljanz, Xeljanz XR) Tablets – Review and revision to guideline consisting of updating description, position statement, definitions, related guidelines, and references.
- Ultrasound Osteogenesis Stimulators, Non-invasive – Review; no change in position statement. Updated references.
- Ustekinumab (Stelara™) – Review and revision to guideline consisting of updating description, position statement, coding/billing, definitions, related guidelines, and references.
- Vedolizumab (Entyvio™) Injection – Review and revision to guideline consisting of updating description, position statement, dosage/administration, coding/billing, definitions, related guidelines, and references.
Click here to view the Florida Blue Cross Blue Shield October 2017 Medical Policy Revisions »
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