{"id":8563,"date":"2024-06-04T12:43:31","date_gmt":"2024-06-04T12:43:31","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8563"},"modified":"2024-06-04T12:43:31","modified_gmt":"2024-06-04T12:43:31","slug":"clinical-review-criteria-june-2024","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-june-2024\/","title":{"rendered":"Clinical Review Criteria (June 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>. Once on the Resources page, click on <strong><em>Behavioral Health\/Medical Policies <\/em><\/strong>to learn more.<\/p>\n<ul>\n<li><strong>Nutritional counseling<\/strong>\n<ul>\n<li>No changes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Lymphedema- Surgical Treatment<\/strong>\n<ul>\n<li>No changes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Blepharoplasty and Browplasty <\/strong>\n<ul>\n<li>No changes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Cosmetic and Reconstructive Procedures<\/strong>\n<ul>\n<li>Criteria in section E4 clarified; no other change to criteria.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Bariatric Surgery <\/strong>\n<ul>\n<li>MassHealth adults will use MassHealth criteria instead of Health New England criteria, effective 7\/1\/2024.<\/li>\n<li>Other criteria clarified with no significant change.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Infertility Treatment<\/strong>\n<ul>\n<li>Effective May 1, residency requirements have been removed from the policy.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<ul>\n<li><strong>Sacroiliac Joint Fusion\u00a0 for the Treatment of Adult Low-Back Pain<\/strong>\n<ul>\n<li>Effective 7\/1\/2024.<\/li>\n<li>Minor changes, definitions added.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Photochemotherapy (PUVA) &#8211; Phototherapy &#8211; Laser Treatments &#8211; Photodynamic Therapy\u00a0 (PDT)<\/strong>\n<ul>\n<li>Effective 7\/1\/2024.<\/li>\n<li>No significant changes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Preimplantation Genetic Testing<\/strong>\n<ul>\n<li>Effective 7\/1\/2024.<\/li>\n<li>No significant changes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Percutaneous Neuroablation<\/strong>\n<ul>\n<li>Effective 8\/1\/2024.<\/li>\n<li>Replaces Radiofrequency Ablation policy with updated criteria.<\/li>\n<li>Removed Thermal destruction of intraosseous basivertebral nerve (CPT codes 64628 and 64629) from the experimental list and covered when criteria is met.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Breast Surgery<\/strong>\n<ul>\n<li>Effective 8\/1\/2024.<\/li>\n<li>InterQual criteria replaced internal criteria for Reconstructive Breast Surgery, Surgical Management of Breast Implants, Female Breast Reduction, and Surgical Treatment of Gynecomastia.<\/li>\n<li>LCD L35001 added for Reduction Mammoplasty.<\/li>\n<\/ul>\n<\/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\">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. Nutritional counseling No changes. &nbsp; Lymphedema- Surgical Treatment No changes. &nbsp; Blepharoplasty and Browplasty No changes. &nbsp; Cosmetic and Reconstructive Procedures Criteria in section E4 clarified; no other [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","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":[1],"tags":[],"class_list":["post-8563","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2e7","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8563","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=8563"}],"version-history":[{"count":1,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8563\/revisions"}],"predecessor-version":[{"id":8570,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8563\/revisions\/8570"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8563"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8563"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8563"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}