Clinical Review Criteria – May 2020
Posted on May 4, 2020
Health New England’s Clinical Policies have been updated and can be found at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes.
Effective 7/1/2020:
Infertility Treatment – Specific to limitations for embryo transfers
• Members of any age will be required to follow ASRM (American Society for Reproductive Medicine) guidelines for embryo transfers.
• Health New England Criteria
o For members 35 years of age
With favorable prognosis-1 blastocyst
Others-2
o For members age 35-37
With favorable prognosis-2 blastocysts
Others-2
o For members age 38-40
With favorable prognosis-2 blastocysts
Others-3
o For members age 41 and older
There is insufficient data to recommend a limit. Caution should be exercised to reduce the risk associated with multiple births. The number of embryos transferred will be at the discretion of the treating specialist.
New Policy – Effective 7/1/2020
Endovenous Ablation Therapy of Varicose Veins
*Please note new/revised policies may not appear until closer to the effective date.
