{"id":8667,"date":"2025-04-07T18:26:57","date_gmt":"2025-04-07T18:26:57","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8667"},"modified":"2025-04-07T18:26:57","modified_gmt":"2025-04-07T18:26:57","slug":"medical-policy-update-april-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-update-april-2025\/","title":{"rendered":"Medical Policy Update (April 2025)"},"content":{"rendered":"

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and\/or your practice.<\/p>\n

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.<\/p>\n\n\n\n\n\n\n\n\n\n
Updates<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n<\/thead>\n
Medical Policies<\/strong><\/td>\nTranscatheter Pulmonary Valve Implantation (TPVI)<\/strong><\/p>\n
    \n
  • Effective June 1, 2025<\/li>\n
  • New Policy<\/li>\n<\/ul>\n

     <\/td>\n<\/tr>\n

\u00a0<\/strong><\/td>\nInsertion of Implantable Wireless Pulmonary Artery Pressure Sensor and Monitoring (i.e., CardioMEMS)<\/strong><\/p>\n
    \n
  • Effective June 1, 2025<\/li>\n
  • Annual review with following changes:\n
      \n
    • Updated CMS coverage<\/li>\n
    • Title updated with addition of \u201cImplantable\u201d<\/li>\n
    • Added to Criteria I: Individual is on maximally tolerated GDMT or has a documented intolerance to GDMT (e.g., hemodynamic instability)<\/li>\n
    • References updated<\/li>\n<\/ul>\n<\/li>\n
    • No coding changes<\/li>\n<\/ul>\n

       <\/td>\n<\/tr>\n

\u00a0<\/strong><\/td>\nNeurostimulators<\/strong><\/p>\n
    \n
  • Effective June 1, 2025<\/li>\n
  • The criteria for Deep Brain and Cortical Stimulation, as well as Gastric Electrical Stimulation, have been incorporated into the policy rather than being outlined in a separate document.<\/li>\n<\/ul>\n

     <\/td>\n<\/tr>\n

\u00a0<\/strong><\/td>\nBariatric Surgery<\/strong><\/p>\n
    \n
  • Effective June 1, 2025 \u00a0<\/strong><\/li>\n
  • Updated commercial line of business to follow Interqual criteria<\/li>\n
  • Updated references<\/li>\n<\/ul>\n

     <\/td>\n<\/tr>\n

\u00a0<\/strong><\/td>\nLymphedema – Surgical Treatment<\/strong><\/p>\n
    \n
  • Effective June 1, 2025<\/li>\n
  • Minor Criteria Changes<\/li>\n
  • References updated<\/li>\n
  • Codes 15830-15877 added (procedure addressed in existing policy)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

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

    Please read the following update related to various Health New England programs and changes that may have an impact on your patients and\/or your practice. 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 […]<\/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-8667","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-2fN","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8667","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=8667"}],"version-history":[{"count":2,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8667\/revisions"}],"predecessor-version":[{"id":8670,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8667\/revisions\/8670"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8667"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8667"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8667"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}