Posted on September 9, 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. We reviewed the following policies with no substantial changes. We either moved the content into our new template or retired the policy. Musculoskeletal Surgery: Arthroplasty (Notification of Effective […]
Posted on September 9, 2024
Unlisted Procedures & Services: Billing & Documentation Requirements Section Added block for Anesthesia Services Unlisted coded within the range of 00100 – 01999 along with documentation requirements. Medical Health Policies: Non-Emergent Transportation Effective 11/2/2024 Medicaid/BeHealthy transportation is directly covered by MassHealth – policy does not apply. For Medicare Advantage, will continue to follow guidance […]
Posted on September 9, 2024
Health New England is committed to reviewing our internal procedures and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: Balloon Dilation of the Eustachian Tube Effective 9/1/2024 Updated policy- procedures described by […]
Posted on September 9, 2024
Percutaneous hemodialysis arteriovenous (AV) fistulas are created using endovascular techniques without the need for a surgical incision and are also termed endo-AV fistulas or endoAVFs. 36836 describes the Ellipsys Vascular Access System. Under high frequency ultrasound guidance, an outer access cannula, guidewire, and vessel capture construct creates a connection of the vein to the artery […]
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 […]
Posted on July 2, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Prescription Drug Coverage- Commercial Note: Tier 1 – lowest copay level; Tier 2 – mid copay level; Tier 3 – highest copay level For 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier Step […]
Posted on July 2, 2024
Health New England is committed to reviewing our internal procedures, and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. Discarded Drugs & Biologicals Effective 6/1/2024 Reviewed with no changes Evaluation & Management Professional Services Effective 6/1/2024 Removal of expired codes […]
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 […]
Posted on June 4, 2024
Health New England is committed to reviewing our internal procedures, and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. Vaccines & Immunizations Effective 5/1/2024 Added Industry Standard Language Added additional language to Non-State Supplied Vaccines under Commercial Conditional Formatting Inpatient […]
Posted on June 4, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Brand Name Generic Name GPI Commercial Formulary status Aphexda MRX MOTIXAFORTIDE ACETATE 82502050102150 PA thru Magellan, T4 Daxxify MRX DAXIBOTULINUMTOXINA-LANM 90890045402140 PA thru Magellan, T4 Elrexfio MRX ELRANATAMAB-BCMM 213520281520** PA thru Magellan, T4 Eylea […]