Clinical Review Criteria (July 2024)

Posted on July 2, 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.

Breast Surgery

• Updated to remove reference to Schnur Sliding Scale as this scale is no longer used
• No change to effective date of 8/1/2024

Prostate Procedures (BPH and Prostate Cancer)

• Effective 9/1/2024
• Descriptions updated
• Removed LCD L37485
• Added criteria for prostatic urethral lift to the prostate cancer section
• Criteria reordered with no changes
• Added CPT 53855 as experimental/investigational

Arthroplasty

• Effective 9/1/2024
• Name changed from Total Ankle Replacement to Musculoskeletal Surgery: Arthroplasty
• Added criteria and codes for shoulder, hip and knee joint replacement and revision; ankle joint replacement
• References updated

Transcatheter Aortic Valve Replacement (TAVR)

• New Policy effective 9/1/2024

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