January 2022 Clinical Review Criteria
Posted on December 23, 2021
Each year, new procedure codes (CPT) and Healthcare Common Procedure codes (HCPC) as well as changes to current codes are released to every health plan by the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS). In addition, 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.*
Effective 1/1/2022, the following new codes and requirements will be in place.
The following CPT codes will need prior authorization:
• 33267
• 33268
• 33269
• 43497
• 61736
• 61737
• 64628
• 64629
The following CPT codes are experimental investigational and are being replaced with new codes.
• Codes 0548T-0551T are replaced by:
o 53451
o 53452
o 53453
o 53454
• Code 0365T is replaced by:
o 68841
• Code 0355T is replaced by:
o 91113
The following policies have been updated:
• Upper airway stimulator device (UAS)/hypoglossal nerve stimulation (HGNS) (Inspire)
o 0466T, 0467T and 0468T have been deleted
o 64582, 64583, 64584 have been added
• Cochlear implants and BAHA (bone anchored hearing aid)
o 69715 is deleted
o 69715 and 69719 have been added
*Please note, new/revised policies may not appear until closer to the effective date.
