Posted on September 9, 2024
Percutaneous hemodialysis arteriovenous (AV) fistulas are created using endovascular techniques without the need for a surgical incision and are also termed endo-AV fistulas or endoAVFs. 36836 describes the Ellipsys Vascular Access System. Under high frequency ultrasound guidance, an outer access cannula, guidewire, and vessel capture construct creates a connection of the vein to the artery […]
Posted on August 5, 2024
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. Percutaneous Neuroablation Effective 8/1/2024 Updated with non-coverage of Intraosseous Basivertebral Nerve Ablation (CPT codes 64628 and 64629) as it is not covered by MassHealth. Cosmetic and Reconstructive Procedures […]
Posted on July 2, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Prescription Drug Coverage- Commercial Note: Tier 1 – lowest copay level; Tier 2 – mid copay level; Tier 3 – highest copay level For 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier Step […]
Posted on July 2, 2024
Health New England is committed to reviewing our internal procedures, and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. Discarded Drugs & Biologicals Effective 6/1/2024 Reviewed with no changes Evaluation & Management Professional Services Effective 6/1/2024 Removal of expired codes […]
Posted on July 2, 2024
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 Prostate Procedures (BPH […]
Posted on June 4, 2024
Health New England is committed to reviewing our internal procedures, and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. Vaccines & Immunizations Effective 5/1/2024 Added Industry Standard Language Added additional language to Non-State Supplied Vaccines under Commercial Conditional Formatting Inpatient […]
Posted on June 4, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Brand Name Generic Name GPI Commercial Formulary status Aphexda MRX MOTIXAFORTIDE ACETATE 82502050102150 PA thru Magellan, T4 Daxxify MRX DAXIBOTULINUMTOXINA-LANM 90890045402140 PA thru Magellan, T4 Elrexfio MRX ELRANATAMAB-BCMM 213520281520** PA thru Magellan, T4 Eylea […]
Posted on June 4, 2024
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. Nutritional counseling No changes. Lymphedema- Surgical Treatment No changes. Blepharoplasty and Browplasty No changes. Cosmetic and Reconstructive Procedures Criteria in section E4 clarified; no other […]
Posted on June 1, 2024
The mission of Health New England is to improve the health and lives of the people in our communities, and we are deeply committed to those individuals we serve every day. In addition, we believe everyone must have the opportunity to attain their full health potential with no disadvantage due to social or socially assigned […]
Posted on May 16, 2024
ATTENTION: HOME HEALTH, SKILLED NURSING, OT/PT SPEECH THERAPISTS, PCA The Massachusetts Executive Office of Health and Human Services (EOHHS) is hosting an upcoming Electronic Visit Verification (EVV) Overview Forum to inform providers, health plans, and other key stakeholders of the EVV solution and implementation. Please distribute to your Home Health, Personal Care Services, and Aging Services […]