{"id":8688,"date":"2025-06-04T17:08:44","date_gmt":"2025-06-04T17:08:44","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8688"},"modified":"2025-06-04T17:10:46","modified_gmt":"2025-06-04T17:10:46","slug":"medical-policies-updates-june-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policies-updates-june-2025\/","title":{"rendered":"Medical Policies Updates (June 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

 <\/p>\n\n\n\n\n\n\n\n\n
Updates<\/em><\/strong><\/td>\nNotes<\/em><\/strong><\/td>\n<\/tr>\n
Medical Policies<\/strong><\/td>\nNutritional Counseling for Eating Disorders<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • Annual review<\/li>\n
  • Added ICD-10 codes F50.83 and F50.84 to list of medically necessary diagnosis codes<\/li>\n
  • No changes to criteria<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nBlepharoplasty and Browplasty<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • Annual review<\/li>\n
  • Description updated<\/li>\n
  • MassHealth guidelines added for Medicaid line of business<\/li>\n
  • Otherwise, minor criteria changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nBreast Surgery<\/strong><\/p>\n
    \n
  • Effective 08\/01\/2025<\/li>\n
  • Annual review<\/li>\n
  • Transitioned to InterQual criteria for Risk-Reducing (Prophylactic) Mastectomy<\/li>\n
  • CPT 19318 \u2013 Breast Reduction\/Reduction Mammaplasty removed from list of codes that do not require PA with diagnosis of breast cancer. Procedure will require PA regardless of diagnosis.<\/li>\n
  • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
 <\/p>\n

 <\/td>\n

Chimeric Antigen Receptor T-Cell Therapy<\/strong><\/p>\n
    \n
  • Effective 04\/01\/2025<\/li>\n
  • Annual review and update<\/li>\n
  • Updated MassHealth process for approval through the MassHealth Drug Utilization Review (DUR) Program<\/li>\n
  • Added C9301 to coding table<\/li>\n
  • Minor title revision<\/li>\n
  • No additional changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nPeripherally Implanted Nerve Stimulation (PNS), Peripheral Subcutaneous Field Stimulation (PSFS)<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • Annual review<\/li>\n
  • Percutaneous electrical nerve field stimulator (PENFS) system criteria added<\/li>\n
  • No significant criteria changes to peripheral nerve stimulation (PNS) or peripheral nerve field stimulation (PNFS)<\/li>\n
  • Coding table updated added 0702T and updated 64999 to include PENFS for MassHealth<\/li>\n
  • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n
    <\/td>\nGender Affirming Services<\/strong><\/p>\n
      \n
    • Effective 07\/01\/2025<\/li>\n
    • Annual review<\/li>\n
    • For members over 18, removed requirement that the surgeon must consult with the member\u2019s PCP and behavioral health provider.<\/li>\n
    • Added requirement for hormone replacement therapy (WPATH recommendation)<\/li>\n
    • 6 months of hormone therapy required before gender affirming services<\/li>\n
    • Increased Cryopreservation of Eggs or Sperm from one year to five years<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    <\/td>\nPercutaneous Neuroablation<\/strong><\/p>\n
      \n
    • Effective 07\/01\/2025<\/li>\n
    • Annual review<\/li>\n
    • CPT 64625, radiofrequency ablation to the SI joint, was updated to covered with prior authorization<\/li>\n
    • Adalimumab biosimilar<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    <\/td>\nPhotochemotherapy (PUVA) – Phototherapy – Laser Treatments – Photodynamic Therapy (PDT)<\/strong><\/p>\n
      \n
    • Effective 07\/01\/2025<\/li>\n
    • Annual review<\/li>\n
    • Removed prior authorization requirement after 35 visits<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    <\/td>\nAmbulatory Electrocardiograph Monitoring<\/strong><\/p>\n
      \n
    • Effective 07\/01\/2025<\/li>\n
    • Annual review<\/li>\n
    • Minor changes to criteria<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    <\/td>\nPreimplantation Genetic Testing<\/strong><\/p>\n
      \n
    • Effective 07\/01\/2025<\/li>\n
    • Annual review<\/li>\n
    • Criteria added for PGT-A (previously experimental\/investigational for all indications)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    <\/td>\nSkin and Soft Tissue Substitutes<\/strong><\/p>\n
      \n
    • Effective 06\/01\/2025<\/li>\n
    • Updated with coding and LCD changes<\/li>\n
    • Added new codes effective 4\/1\/2025 (all experimental\/investigational)<\/li>\n
    • Removed reference to LCD L39828 and LCA A59712 due to CMS delay of implementation<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    <\/td>\nBone Mineral Density Measurement\u00a0\u00a0<\/strong><\/p>\n
      \n
    • Effective 08\/01\/2025<\/li>\n
    • New Policy<\/li>\n
    • Codes added to not medically necessary: 78350 and 78351 for all lines of business, 76977 for Commercial and MassHealth only<\/li>\n
    • Codes added to experimental and investigational: 77089 and 77090<\/li>\n
    • Authorization not required<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\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-8688","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-2g8","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8688","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=8688"}],"version-history":[{"count":6,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8688\/revisions"}],"predecessor-version":[{"id":8707,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8688\/revisions\/8707"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8688"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}