{"id":7132,"date":"2021-12-23T17:27:24","date_gmt":"2021-12-23T17:27:24","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=7132"},"modified":"2021-12-23T18:40:59","modified_gmt":"2021-12-23T18:40:59","slug":"january-2022-clinical-review-criteria","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/january-2022-clinical-review-criteria\/","title":{"rendered":"January 2022 Clinical Review Criteria"},"content":{"rendered":"<p>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 &amp; Medicaid Services (CMS). In addition, Health New England reviews clinical policies and updates accordingly. These policies reside at <a href=\"http:\/\/www.healthnewengland.org\/Providers\/Resources\" target=\"_blank\" rel=\"noopener\">healthnewengland.org\/Providers\/Resources<\/a>. Once on the Resources page, click on <em>Behavioral Health\/Medical Policies<\/em> to learn more.*<\/p>\n<p><strong>Effective 1\/1\/2022,<\/strong> the following new codes and requirements will be in place.<\/p>\n<p><strong>The following CPT codes will need prior authorization:<\/strong><br \/>\n\u2022 33267<br \/>\n\u2022 33268<br \/>\n\u2022 33269<br \/>\n\u2022 43497<br \/>\n\u2022 61736<br \/>\n\u2022 61737<br \/>\n\u2022 64628<br \/>\n\u2022 64629<\/p>\n<p><strong>The following CPT codes are experimental investigational and are being replaced with new codes.<\/strong><br \/>\n\u2022 Codes 0548T-0551T are replaced by:<br \/>\no 53451<br \/>\no 53452<br \/>\no 53453<br \/>\no 53454<\/p>\n<p>\u2022 Code 0365T is replaced by:<br \/>\no 68841<\/p>\n<p>\u2022 Code 0355T is replaced by:<br \/>\no 91113<\/p>\n<p><strong>The following policies have been updated:<\/strong><\/p>\n<p>\u2022 Upper airway stimulator device (UAS)\/hypoglossal nerve stimulation (HGNS) (Inspire)<br \/>\no 0466T, 0467T and 0468T have been deleted<br \/>\no 64582, 64583, 64584 have been added<\/p>\n<p>\u2022 Cochlear implants and BAHA (bone anchored hearing aid)<br \/>\no 69715 is deleted<br \/>\no 69715 and 69719 have been added<\/p>\n<p><em>*Please note, new\/revised policies may not appear until closer to the effective date.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 &amp; Medicaid Services (CMS). In addition, Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org\/Providers\/Resources. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"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":[110],"class_list":["post-7132","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter","tag-clinical-review-criteria"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1R2","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/7132","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=7132"}],"version-history":[{"count":4,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/7132\/revisions"}],"predecessor-version":[{"id":7144,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/7132\/revisions\/7144"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=7132"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=7132"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=7132"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}