{"id":8705,"date":"2025-07-02T19:54:31","date_gmt":"2025-07-02T19:54:31","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8705"},"modified":"2025-07-02T19:54:31","modified_gmt":"2025-07-02T19:54:31","slug":"medical-policy-updates-new-policies-july-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-updates-new-policies-july-2025\/","title":{"rendered":"Medical Policy Updates\/New Policies (July 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\n\n\n\n
Updates<\/em><\/strong><\/td>\nNotes<\/em><\/strong><\/td>\n<\/tr>\n
Medical Policy \u2013 New<\/strong><\/td>\nTranscatheter Tricuspid Valve Interventions<\/strong><\/p>\n
    \n
  • New Policy effective 10\/1\/2025<\/li>\n
  • Transcatheter Tricuspid Valve Replacement (TTVR) is covered for Medicare Advantage when the items and services are furnished in the context of a CMS-approved CED study and medical necessity criteria are met.<\/li>\n
  • Experimental for Commercial and MassHealth<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Medical Policy \u2013 Annual Review<\/strong><\/td>\nTranscatheter Aortic Valve Replacement (TAVR)<\/strong><\/p>\n
    \n
  • Annual Review effective 10\/1\/2025<\/li>\n
  • No changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nCosmetic and Reconstructive Procedures<\/strong><\/p>\n
    \n
  • Annual Review effective 9\/1\/2025<\/li>\n
  • Added criteria for vein graft in stapedotomy<\/li>\n
  • Updated coding table:\n
      \n
    • Added CPT 15769<\/li>\n
    • Added CPT 40525-42225 (cleft plate\/palate repair) – PA not required<\/li>\n
    • Removed CPT 56805, 56835, 57335 (see Gender Affirming Services policy)<\/li>\n
    • Removed not covered for MassHealth from CPT 56835<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
 <\/p>\n

 <\/td>\n

Hyperbaric Oxygen (HBO) Therapy<\/strong><\/p>\n
    \n
  • Annual Review effective 10\/1\/2025<\/li>\n
  • Removed \u201cNo untreated pneumothorax\u201d from requirements for all indications<\/li>\n
  • Removed \u201cNutritional evaluation performed\u201d from requirements of Diabetic Foot Ulcer and Lower Extremity Wound<\/li>\n
  • Added clarification to Delayed Soft Tissue Radionecrosis<\/li>\n
  • Added to indications considered experimental investigational:\n
      \n
    • Chemotherapy induced hemorrhagic cystitis<\/li>\n
    • Interstitial cystitis<\/li>\n<\/ul>\n<\/li>\n
    • Updated coding table: Added A4575 as experimental\/investigational<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nProton Beam Therapy<\/strong><\/p>\n
    \n
  • Annual Review effective 10\/1\/2025<\/li>\n
  • No changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nReconstructive Repair of Pectus Deformity<\/strong><\/p>\n
    \n
  • Annual Review effective 9\/1\/2025<\/li>\n
  • No criteria changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nSacroiliac Joint Fusion for the Treatment of Adult Low-Back Pain<\/strong><\/p>\n
    \n
  • Annual Review effective 9\/1\/2025<\/li>\n
  • Added revision of SI joint stabilization to Experimental\/Investigational section<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nIntradialytic Parenteral Nutrition<\/strong><\/p>\n
    \n
  • Annual Review effective 9\/1\/2025<\/li>\n
  • No criteria changes<\/li>\n
  • Removed prior authorization requirement<\/li>\n
  • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nRhinoplasty and Other Nasal Surgeries<\/strong><\/p>\n
    \n
  • Annual Review effective 10\/1\/2025<\/li>\n
  • Added criteria for Reconstructive Rhinoplasty<\/li>\n
  • Added criteria for Revision Rhinoplasty<\/li>\n
  • Added criteria for Tip Rhinoplasty<\/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-8705","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-2gp","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8705","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=8705"}],"version-history":[{"count":4,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8705\/revisions"}],"predecessor-version":[{"id":8710,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8705\/revisions\/8710"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8705"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8705"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8705"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}