{"id":8575,"date":"2024-07-02T12:38:40","date_gmt":"2024-07-02T12:38:40","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8575"},"modified":"2024-07-02T14:39:21","modified_gmt":"2024-07-02T14:39:21","slug":"clinical-review-criteria-july-2024","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-july-2024\/","title":{"rendered":"Clinical Review Criteria (July 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<p><strong>Breast Surgery<\/strong><\/p>\n<ul>\n<li>Updated to remove reference to Schnur Sliding Scale as this scale is no longer used<\/li>\n<li>No change to effective date of 8\/1\/2024<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Prostate Procedures (BPH and Prostate Cancer)<\/strong><\/p>\n<ul>\n<li>Effective 9\/1\/2024<\/li>\n<li>Descriptions updated<\/li>\n<li>Removed LCD L37485<\/li>\n<li>Added criteria for prostatic urethral lift to the prostate cancer section<\/li>\n<li>Criteria reordered with no changes<\/li>\n<li>Added CPT 53855 as experimental\/investigational<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Arthroplasty<\/strong><\/p>\n<ul>\n<li>Effective 9\/1\/2024<\/li>\n<li>Name changed from Total Ankle Replacement to Musculoskeletal Surgery: Arthroplasty<\/li>\n<li>Added criteria and codes for shoulder, hip and knee joint replacement and revision; ankle joint replacement<\/li>\n<li>References updated<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Transcatheter Aortic Valve Replacement (TAVR)<\/strong><\/p>\n<ul>\n<li>New Policy effective 9\/1\/2024<\/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. Breast Surgery Updated to remove reference to Schnur Sliding Scale as this scale is no longer used No change to effective date of 8\/1\/2024 &nbsp; Prostate Procedures (BPH [&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":[92],"tags":[],"class_list":["post-8575","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-2ej","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8575","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=8575"}],"version-history":[{"count":3,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8575\/revisions"}],"predecessor-version":[{"id":8589,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8575\/revisions\/8589"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8575"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8575"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8575"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}