{"id":8532,"date":"2024-04-26T14:41:37","date_gmt":"2024-04-26T14:41:37","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8532"},"modified":"2024-04-26T14:43:17","modified_gmt":"2024-04-26T14:43:17","slug":"clinical-review-criteria-may-2024","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-may-2024\/","title":{"rendered":"Clinical Review Criteria: May 2024"},"content":{"rendered":"<p>Health New England reviews clinical policies and updates accordingly. These policies reside at <a href=\"https:\/\/healthnewengland.org\/Providers\/Resources\"><strong>healthnewengland.org\/Providers\/Resources<\/strong><\/a><a href=\"https:\/\/healthnewengland.org\/Providers\/Resources\">.<\/a> Once on the Resources page, click on <strong><em>Behavioral Health\/Medical Policies <\/em><\/strong>to learn more.<\/p>\n<ul>\n<li><strong>Skin and Soft Tissue Substitutes: <\/strong>Updated MassHealth coverage due to new Guidelines for Medical Necessity Determination for Skin Substitutes. Q4159 Affinity, and Q4196, PuraPly now covered for this line of business only.<\/li>\n<\/ul>\n<ul>\n<li><strong>Infertility Treatment: <\/strong>Intra-Cytoplasmic Sperm Injection (ICSI) criteria clarified.<\/li>\n<\/ul>\n<ul>\n<li><strong>Prostate Procedures (BPH and Prostate Cancer):<\/strong>Updated criteria for high-energy water vapor thermotherapy for the Medicare line of business due to NGS retiring LCD L37808.<\/li>\n<\/ul>\n<ul>\n<li><strong>Behavioral Health Day Treatment: <\/strong>Reviewed with no changes.<\/li>\n<li><strong>Family Stabilization Team: <\/strong>Reviewed with no changes.<\/li>\n<li><strong>Inpatient Rehabilitation (ASAM Level 3.7) for Substance Abuse: <\/strong>Reviewed with no changes.<\/li>\n<li><strong>Neuropsychological Testing, Psychological Testing, and Neurobehavioral Status Exam: <\/strong>Medicare Advantage will use InterQual criteria vs LCD. Clarified Neurobehavioral Testing and psychological testing &#8211; no change to criteria.<\/li>\n<li><strong>Transcranial Magnetic Stimulation (TMS): <\/strong>Reviewed with no changes.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>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. You may also send an email to <a href=\"mailto:providerrelations@hne.com\"><u>providerrelations@hne.com<\/u><\/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. Skin and Soft Tissue Substitutes: Updated MassHealth coverage due to new Guidelines for Medical Necessity Determination for Skin Substitutes. Q4159 Affinity, and Q4196, PuraPly now covered for this [&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-8532","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-2dC","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8532","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=8532"}],"version-history":[{"count":2,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8532\/revisions"}],"predecessor-version":[{"id":8550,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8532\/revisions\/8550"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8532"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8532"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8532"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}