December 2019 Clinical Review Criteria
Posted on December 16, 2019
Health New England’s Clinical Policies have been updated and can be found on the Provider Resources page at healthnewengland.org/providers/resources. On the Resources page, click on “Behavioral Health/Medical Policies” to learn of the changes.
Reviewed with Changes effective 1/1/20
- Drug Testing (communicated change in November communication)
Medical Policies Reviewed with Changes effective 2/1/20
- Artificial Intervertebral Cervical Disc
- Bronchial Thermosplasty
- Corneal Cross-Linking
- Gastric Electrical Stimulation (GES) Enterra Therapy System
- Gender Reassignment Surgery
- Home Health Care Services for MassHealth
- Outpatient Physical and Occupational Therapy
- Sacral Nerve Stimulation and Electrical Percutaneous Tibial Nerve Stimulation
Behavioral Health Policies Reviewed with Changes effective 2/1/20
- Admission and Concurrent for Clinical Stablization
- Community Based Acute Treatment (CBAT) Program and Intensive Community Based Acute Treatment (ICBAT) Program
- Community Crisis
- Family Stabilization Team
- Transcranial Magnetic Stimulation (TMS)
New Policies effective 11/13/19
- Chimeric Antigen Receptor T-Cell Therapy (CAR-T Cell Therapy) Kymriah and Yescarta
- Knee Arthroplasty and Knee Arthroscopy for MassHealth
- Lutetium LU 177 Dotatate Therapeutic (Lutathera)
- Skin and Soft Tissue Substitutes
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