Clinical Review Criteria (August 2024)

Posted on August 5, 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.

• Percutaneous Neuroablation
  • Effective 8/1/2024
  • Updated with non-coverage of Intraosseous Basivertebral Nerve Ablation (CPT codes 64628 and 64629) as it is not covered by MassHealth.
• Cosmetic and Reconstructive Procedures
  • Update effective 8/1/2024
  • Removed prior authorization from CPT 67911
• Rhinoplasty and Other Nasal Surgeries
  • Annual Review effective 9/1/2024
  • Minor criteria and code updates
  • MassHealth guidelines added for Medicaid
  • Added CPT codes 31242 and 31243 as experimental/investigational (codes were effective on 1/1/2024)

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