{"id":6288,"date":"2021-02-10T16:26:31","date_gmt":"2021-02-10T16:26:31","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=6288"},"modified":"2021-02-10T16:36:42","modified_gmt":"2021-02-10T16:36:42","slug":"clinical-review-criteria-february-2021","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-february-2021\/","title":{"rendered":"Clinical Review Criteria – February 2021"},"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<\/strong> to learn of the changes.<\/p>\n

*Please note, new\/revised policies may not appear until closer to the effective date<\/em>.<\/p>\n

Reviewed and Updated (Effective date of 4\/1\/2021)<\/strong><\/h4>\n

Gender Reassignment Surgery<\/strong>
\n\u2022 Updated \u201cRequired Documentation\u201d
\n\u2022 Updated \u201cCovered Procedures\u201d
\n\u2022 Updated CPT code per AMA changes<\/p>\n

Removed:<\/em>
\n19303 Mastectomy, simple, complete
\n19304 Mastectomy, subcutaneous<\/p>\n

Added:<\/em>
\n19316 Mastopexy
\n19318 Breast reduction
\n19340 Insertion of breast implant on same day of mastectomy (i.e., immediate)
\n19342 Insertion or replacement of breast implant on separate day from mastectomy
\n19355 Correction of inverted nipples
\n19357 Tissue expander placement in breast reconstruction, including subsequent expansion
\n19361 Breast reconstruction with latissimus dorsi flap
\n19364 with free flap (e.g., fTRAM, DIEP, SIEA, GAP flap)
\n19367 with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap uni25B2
\n19368 with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging)
\n19369 with bipedicled transverse rectus abdominis myocutaneous (TRAM) flap
\n19380 Revision of reconstructed breast (e.g., significant removal of tissue, re-advancement and\/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction<\/p>\n

Changes:<\/em>
\n19325 Breast augmentation with implant
\n19328 Removal of intact breast
\n19330 Removal of ruptured breast implant, including implant contents (e.g., saline, silicone gel)
\n19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and\/or partial capsulectomy
\n19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents<\/p>\n

Surgical Management of Morbid Obesity<\/strong>
\n\u2022 Updated \u201cCriteria for Approval for Ages 18 and Over\u201d
\n\u2022 Updated \u201cDefinitions\u201d
\n\u2022 Updated \u201cCriteria for Approval\u201d
\n\u2022 Updated \u201cWhat is Not Covered\u201d<\/p>\n

Outpatient Hyperbaric Oxygen Therapy<\/strong>
\n\u2022 Updated \u201cDefinitions\u201d
\n\u2022 Updated \u201cCriteria for Approval\u201d<\/p>\n

Speech Therapy for Autism Disorders<\/strong>
\n\u2022 Updated \u201cLimitations\u201d<\/p>\n

Female Breast Reduction<\/strong>
\n\u2022 Changed Policy Title
\nFrom:<\/em> Female Reduction Mammoplasty
\nTo:<\/em> Female Breast Reduction
\n\u2022 Updated \u201cWhat is Not Covered\u201d
\n\u2022 Updated \u201cCodes\u201d
\nCode 19318 description changed to Breast Reduction.<\/p>\n

New (Effective date of 4\/1\/2021)<\/strong>
\nTransanal Endoscopic Microsurgery (TEMS)<\/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. *Please note, new\/revised policies may not appear until closer to the effective date. Reviewed and Updated (Effective date of 4\/1\/2021) Gender Reassignment Surgery \u2022 Updated \u201cRequired […]<\/p>\n","protected":false},"author":1,"featured_media":2739,"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-6288","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\/2016\/07\/survey.gif?fit=700%2C283","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1Dq","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6288","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=6288"}],"version-history":[{"count":3,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6288\/revisions"}],"predecessor-version":[{"id":6291,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6288\/revisions\/6291"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/2739"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=6288"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=6288"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=6288"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}