Clinical Review Criteria

Posted on April 1, 2024

Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more.

The following policies were reviewed:

• Community-Based Acute Treatment/Youth Clinical Crisis Stabilization (CBAT/YCCS) Program and Intensive Community-Based Acute Treatment (ICBAT) Program (Behavioral Health)
  • Youth Clinical Crisis Stabilization services (YCCS) defined
  • No change to criteria
• Community Crisis Stabilization (CCS) (Behavioral Health)
  • No change to criteria
  • References updated
• Autologous Chondrocyte Implantation or Transplantation
  • No change to criteria
  • References updated
• Gender Affirming Services
  • No change to criteria
• Ambulatory Electrocardiograph Monitoring
  • Previously called Ambulatory Cardiac Monitoring
  • Minor changes to the Implantable Ambulatory Electrocardiographic (AECG) monitoring section
  • Added CPT 0605T (previously E&I)
• Balloon Dilation of the Eustachian Tube
  • No changes to criteria

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. You may also send an email to providerrelations@hne.com.

Categories: Provider Newsletter