{"id":8417,"date":"2023-11-01T13:59:25","date_gmt":"2023-11-01T13:59:25","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8417"},"modified":"2023-11-01T13:59:25","modified_gmt":"2023-11-01T13:59:25","slug":"clinical-review-criteria-3","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-3\/","title":{"rendered":"Clinical Review Criteria"},"content":{"rendered":"<p>Health New England reviews clinical policies and updates accordingly. These policies reside at <a href=\"https:\/\/healthnewengland.org\/Providers\/Resources\" target=\"_blank\" rel=\"noopener\">healthnewengland.org\/Providers\/Resources<\/a>. Once on the Resources page, click on <strong><em>Behavioral<\/em> Health\/Medical Policies<\/strong> to learn more.<\/p>\n<p><a href=\"https:\/\/healthnewengland.org\/Portals\/_default\/Shared%20Documents\/providers\/2023\/Cosmetic_Reconstructive_Procedures.pdf?ver=c8NcJ7hKMBb5I1qAoIwqLw%3d%3d\" target=\"_blank\" rel=\"noopener\">Cosmetic and Reconstructive Procedures<\/a>:<\/p>\n<ul>\n<li>Coding guidance updated. CPT 15847 not covered for all lines of business.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/healthnewengland.org\/Portals\/_default\/Shared%20Documents\/providers\/2022\/Knee%20Braces-Criteria-External.pdf?ver=3a2ShcSmNyuAA_i232nYEA%3d%3d\" target=\"_blank\" rel=\"noopener\">Knee Braces<\/a>: Clarification<\/p>\n<ul>\n<li>HNE\u2019s policy is retired as of 11\/1. Please refer to our Durable Medical Benefit Manager\u2019s (Northwood) policy for criteria.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/healthnewengland.org\/Portals\/_default\/Shared%20Documents\/providers\/2023\/Cardiac_Monitor_Criteria.pdf?ver=z9xOyg2wi2wtScIqb6BR_g%3d%3d\" target=\"_blank\" rel=\"noopener\">Ambulatory Cardiac Monitoring<\/a>: Effective 1\/1\/2024<\/p>\n<ul>\n<li>PA required for an implantable cardiac monitor<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/healthnewengland.org\/Portals\/_default\/Shared%20Documents\/providers\/2023\/Insertion_of_Wireless_Pulmonary_Artery_Pressure_Sensor_Monitoring.pdf?ver=WPS88WV_RDWYW4EIfwv5ew%3d%3d\" target=\"_blank\" rel=\"noopener\">Insertion of Wireless Pulmonary Artery Pressure Sensor &amp; Monitoring (i.e., CardioMEMS)<\/a>:<\/p>\n<ul>\n<li>added section C<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/healthnewengland.org\/Portals\/_default\/Shared%20Documents\/providers\/2023\/Breast_Surgery.pdf?ver=c8NcJ7hKMBb5I1qAoIwqLw%3d%3d\" target=\"_blank\" rel=\"noopener\">Breast Surgery<\/a>: Clarification<\/p>\n<ul>\n<li>Section V (Risk-Reducing (Prophylactic) Mastectomy), removed \u201cInflammatory Breast<br \/>\nCancer\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/healthnewengland.org\/Portals\/_default\/Shared%20Documents\/providers\/2023\/Bone_Grafts_for_Spinal_Defects.pdf?ver=c8NcJ7hKMBb5I1qAoIwqLw%3d%3d\" target=\"_blank\" rel=\"noopener\">Bone Grafts for Spinal Defects<\/a>: Clarification<\/p>\n<ul>\n<li>removed PA for 20930 for MassHealth and Medicare Advantage due this being a nonpayable code for these plans<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or send an email to <a href=\"mailto:providerrelations@hne.com\" target=\"_blank\" rel=\"noopener\">providerrelations@hne.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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. Cosmetic and Reconstructive Procedures: Coding guidance updated. CPT 15847 not covered for all lines of business. &nbsp; Knee Braces: Clarification HNE\u2019s policy is retired as of 11\/1. Please [&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":[],"class_list":["post-8417","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2bL","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8417","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=8417"}],"version-history":[{"count":2,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8417\/revisions"}],"predecessor-version":[{"id":8423,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8417\/revisions\/8423"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8417"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8417"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8417"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}