{"id":5294,"date":"2020-05-04T18:22:17","date_gmt":"2020-05-04T18:22:17","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=5294"},"modified":"2020-05-04T19:25:55","modified_gmt":"2020-05-04T19:25:55","slug":"clinical-review-criteria-april-2020","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-april-2020\/","title":{"rendered":"Clinical Review Criteria – April 2020"},"content":{"rendered":"

Health New England\u2019s Clinical Policies have been updated and can be found at healthnewengland.org\/providers\/resources<\/a>. Once on the Resources page, click on Behavioral Health\/Medical Policies to learn of the changes.<\/p>\n

Effective 6\/1\/2020<\/em><\/p>\n

Chondrocyte Transplant to the Knee<\/strong>
\n\u2022 Added 4 definitions
\n\u2022 Updated criteria \u201cFor Approval\u201d with adds, deletes and clarifications
\n\u2022 Updated \u201cWhat is Not Covered\u201d
\n\u2022 Under CPT Codes: Eliminated \u201c*Covered if selection criteria are met:\u201d<\/p>\n

Radiofrequency Ablation<\/strong>
\n\u2022 Added definitions
\n\u2022 Added under \u201cCriteria for Approval\u201d
\n\u2022 Updated \u201cWhat is Not Covered\u201d
\n\u2022 Adjusted codes:
\n o Deleted all ICD-10 codes
\n o Added 64999 Unlisted procedure, nervous system (Code is used for pulsed RFA that is NOT covered under HNE plan.)<\/p>\n

Blepharoplasty and Browplasty<\/strong>
\n\u2022 Added 4 new definitions
\n\u2022 Updated \u201cCriteria for Approval\u201d
\n\u2022 Under CPT Codes: Removed 67909<\/p>\n

Spinal Cord Stimulation<\/strong>
\n\u2022 Added 6 new definitions
\n\u2022 Updated \u201cCriteria for Approval\u201d
\n\u2022 Under CPT Codes: Title changed to be \u201cCPT Codes Configured to Require PA\u201d
\n\u2022 Under HCPCS Codes: Title changed to be \u201cHCPCS Codes Configured to Require PA\u201d<\/p>\n

Female Reduction Mammoplasty<\/strong>
\n\u2022 Under definitions: Tanner stages has been added
\n\u2022 Updated \u201cCriteria for Approval\u201d
\n\u2022 Updated \u201cWhat is Not Covered\u201d
\n\u2022 Adjusted codes: Eliminated ICD-10 codes<\/p>\n

Therapeutic Shoe and Orthotic Coverage<\/strong>
\n\u2022 Northwood, Inc., manages DME requests. This policy refers providers to links to the Northwood site.<\/p>\n

Formula and Enteral Nutrition<\/strong>
\n\u2022 Northwood, Inc., manages Formula and Enteral Nutrition requests. This policy refers providers to the link to the Northwood site.
\nSpeech Therapy for Autism Disorders
\n\u2022 Updated \u201cCoverage Guidelines\u201d
\n\u2022 Updated \u201cRequired Documentation\u201d
\n\u2022 Updated \u201cLimitations\u201d
\n\u2022 Eliminated \u201c**** For Speech Generating Devices refer to policy on HNE\u2019s medical policy website ****\u201d<\/p>\n

Photochemotherapy (PUVA), Phototherapy, Laser Treatments<\/strong>
\n\u2022 Updated \u201cDefinitions\u201d
\n\u2022 Updated \u201cCriteria for Approval\u201d
\n\u2022 Updated \u201cWhat is Not Covered\u201d
\n\u2022 Updated CPT Codes:
\n o Added to statement: \u201cPA Required After 36 Visits for Below CPT Codes\u201d
\n\u2022 Under CPT codes for laser treatments, added: \u201cPA After 36 Visits, Effective 7\/1\/2020\u201d<\/p>\n

Preimplantation Genetic Testing (PGT)\/Preimplantation Genetic Diagnosis (PGD)<\/strong>
\n\u2022 Added 3 new definitions<\/p>\n

Long-Term 30-Day Cardiac Monitoring<\/strong>
\n\u2022 Health New England has adopted InterQual criteria.
\n\u2022 HNE Nurse Reviewers use InterQual through Medecision\u2019s Aerial Medical Management System.
\n\u2022 InterQual criteria is available upon request by members and providers.<\/p>\n

*Please note new\/revised policies may not appear until closer to the effective date.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Health New England\u2019s Clinical Policies have been updated and can be found at healthnewengland.org\/providers\/resources. Once on the Resources page, click on Behavioral Health\/Medical Policies to learn of the changes. Effective 6\/1\/2020 Chondrocyte Transplant to the Knee \u2022 Added 4 definitions \u2022 Updated criteria \u201cFor Approval\u201d with adds, deletes and clarifications \u2022 Updated \u201cWhat is Not […]<\/p>\n","protected":false},"author":1,"featured_media":4610,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-5294","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2019\/04\/doctor-laptop.jpg?fit=2290%2C1527","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1no","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5294","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=5294"}],"version-history":[{"count":6,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5294\/revisions"}],"predecessor-version":[{"id":5300,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5294\/revisions\/5300"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/4610"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=5294"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=5294"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=5294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}