{"id":8636,"date":"2024-12-09T21:46:47","date_gmt":"2024-12-09T21:46:47","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8636"},"modified":"2024-12-09T21:46:47","modified_gmt":"2024-12-09T21:46:47","slug":"medical-policy-update-dec-2024","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-update-dec-2024\/","title":{"rendered":"Medical Policy Update (Dec. 2024)"},"content":{"rendered":"

Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org\/Providers\/Resources.<\/a> Once on the Resources page, click on Behavioral Health\/Medical Policies to learn more.<\/p>\n\n\n\n\n\n\n\n\n\n\n
Policy Review<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n
Update<\/strong><\/td>\nBreast Surgery<\/strong><\/p>\n
    \n
  • Policy updated to add Z85.3 to the list of ICD-10 codes for Breast Cancer; effective 11\/1\/2024.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Medical Policies<\/strong><\/td>\nPANS\/PANDAS<\/strong><\/p>\n
    \n
  • Annual Review with no changes; effective 2\/1\/2025.<\/li>\n<\/ul>\n

     <\/p>\n

    Chimeric Antigen Receptor Therapy<\/strong><\/p>\n

      \n
    • Updated due to CPT code changes; effective 1\/1\/2025.<\/li>\n
    • Removed CPT codes 0537T-0540T and added CPT codes 38225-38228 PA required.<\/li>\n
    • No change to criteria<\/li>\n<\/ul>\n

       <\/p>\n

      Prostate Procedures (BPH and Prostate Cancer)<\/strong><\/p>\n

        \n
      • Updated due to CPT code changes; effective 1\/1\/2025.<\/strong><\/li>\n
      • CPT codes 51721, 55881, 55882, 53865, 53866 added to policy as experimental\/investigational.<\/li>\n
      • No change to criteria.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Updates<\/strong><\/td>\nTransanal Endoscopic Microsurgery (medical policy) will be retired, effective 1\/1\/2025, due to low utilization.<\/td>\n<\/tr>\n
Behavioral Health Policies<\/strong><\/td>\nRecovery Coaching<\/strong><\/p>\n
    \n
  • New policy; effective 1\/1\/2025.<\/li>\n
  • Commercial line of business only.<\/li>\n<\/ul>\n

     <\/p>\n

    Recovery Support Navigator (RSN)<\/strong><\/p>\n

      \n
    • New policy; effective 1\/1\/2025.<\/li>\n
    • Commercial line of business only.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Benefit Reminder<\/strong><\/td>\nHealth New England Medicare Advantage plans<\/strong><\/p>\n
    \n
  • Annual Wellness Visit: <\/em><\/strong>Covered once per calendar year.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Policy Review<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n
<\/td>\n\n
    \n
  • Provides greater flexibility and convenience for both providers and members.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    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. Policy Review Notes Update Breast Surgery Policy updated to add Z85.3 to the list of ICD-10 codes for Breast Cancer; effective 11\/1\/2024. Medical Policies PANS\/PANDAS Annual Review with […]<\/p>\n","protected":false},"author":11,"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-8636","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-2fi","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8636","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\/11"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8636"}],"version-history":[{"count":3,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8636\/revisions"}],"predecessor-version":[{"id":8639,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8636\/revisions\/8639"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8636"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8636"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8636"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}