Medical Policy Update (Nov. 2024)

Posted on November 11, 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.

Cochlear Implant

• Annual Review, effective 12/1/2024.
• All lines of business transitioned to InterQual with the exception of guidelines for MassHealth or Medicare.

Speech Therapy for Autism Disorders

• Annual Review, effective 12/1/2024.
• Minor criteria changes.
• Definitions updated.
• Removed all references to Pervasive Developmental Disorder (PDD).

Speech Language Pathology (SLP) Services

• Annual Review, effective 12/1/2024.
• No changes.

Musculoskeletal Surgery: Arthroplasty

• Effective date changed to 1/1/2025 (informational).

Breast Surgery policy

• Effective 11/1/2024.
• Z85.3 added to the list of applicable diagnosis codes for breast cancer.

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