ProviderMatters

Provider Updates (May 2025)

Posted on May 2, 2025

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.

 

Updates Notes
Medical Policy Respiratory Pathogen Panel Testing

  • Effective 07/01/2025
  • CPT codes 87632, 87633, 0223U
  • Added to the experimental/investigational list
  • All lines of business
Payment Policies Administrative Necessary Days

  • Effective 07/01/2025
  • Added new drug codes for denial
  • G0481-G0483
  • Medicaid line of business
Prescription Drugs   Humatin

  • Effective 07/01/2025
  • Prior Authorization required thru Optum
  • Commercial line of business
 

 

 Fesoterodine

  • Effective 07/01/2025
  • No longer requires Step Therapy
  • Commercial line of business
Not Covered Drugs with Covered Formulary Alternative
  • The following are for Commercial line of business.
  • Effective 07/01/2025
Amcinonide cream, ointment and lotion

  • Formulary alternatives:
    • Generic topical steroids such as mometasone, triamcinolone and clobetasol
 

 

 Chlorzoxazone 250 mg tablet

  • Formulary alternatives:
    • Chlorzoxazone 500 mg tablets
Clemastine syrup, suspension and chewable

  • Formulary alternatives:
    • Clemastine 2.68 mg tablets
 

 

 Clindamycin-tretinoin gel 1.2-0.025%

  • Formulary alternatives:
    • Topical clindamycin and tretinoin as separate agents
Humira

  • Formulary alternative:
    • adalimumab biosimilar
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Categories: Provider Newsletter

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