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Medical Policy Update for March 7, 2023
| Medical Guidelines | Reason for Update |
|---|---|
| Ablation and Neural Therapy Procedures for Headache and Pain Management | Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Ambulance and Medical Transport Services | Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy. |
| Balloon Ostial Dilation (Balloon Sinuplasty) | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Bone Morphogenetic Protein | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Chelation Therapy | Description of Procedure or Service updated for clarity. References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy statement. |
| Clinical Trial Services | Description of Procedure or Service updated for clarity. References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy. |
| Complementary and Alternative Medicine | Related policies updated. References updated. Specialty Matched Consultant Advisory Panel review 02/2023. Medical Director review 2/2023. No change to policy statement. |
| Dynamic Posturography | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Electrical Stimulation for the Treatment of Arthritis | References updated. Description section updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy statement. |
| Implantable Bone Conduction Hearing Aids | The following was removed from the Benefits Application section: “This health benefit plan provides coverage for MEDICALLY NECESSARY hearing aids, including implantable bone-anchored hearing aids (BAHA), and related services that are ordered by a DOCTOR or a licensed audiologist for each MEMBER under the age of 22. Benefits are provided for one hearing aid per hearing-impaired ear, and replacement hearing aids when alterations to an existing hearing aid are not adequate to meet the MEMBER’S needs. This benefit is limited to once every 36 months for MEMBERS under age 22. Benefits are also provided for the evaluation, fitting, and adjustments of hearing aids or replacement of hearing aids, and for supplies, including ear molds”. Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Infusion Therapy in the Home | Minor edit to When Covered section for clarity. References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy. |
| New policy developed. BCBSNC will provide coverage for Inpatient Interfacility Transfers when it is determined to be medically necessary because the medical criteria and guidelines are met. Medical Director Review 12/2022. Notification given 12/30/2022 for effective date 3/7/2023. | |
| Intravenous Antibiotic Therapy for Lyme Disease | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Microprocessor-Controlled Prostheses for the Lower Limb | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Observation Room Services | References updated. Added the following codes to Billing/Coding section: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy statement. |
| Orthopedic Applications of Stem Cell Therapy | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Orthotics | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Powered Exoskeleton for Ambulation in Patients with Lower Limb Disabilities | Regulatory Status updated. Policy Guidelines updated. E1399 removed from Billing/Coding section. Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Private Duty Nursing Services | References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Removed the following statement from Policy Guidelines: “All PDN requests will be discussed with a Medical Director.” Medical Director review 2/2023. No change to policy statement. |
| Semi-Implantable and Fully Implantable Middle Ear Hearing Aid | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Skilled Nursing Facility Care | References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director review 2/2023. No change to policy statement. |
| Skilled Nursing Services | References updated. Specialty Matched Consultant Advisory Panel review 2/2023. Medical Director Review 2/2023. No change to policy statement. |
| Subtalar Arthroereisis | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Synthetic Cartilage Implants for Joint Pain | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Three Dimensional Printed Orthopedic Implants | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Ultrasound Accelerated Fracture Healing Device | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
| Vestibular Function Testing | Specialty Matched Consultant Advisory Panel review 2/15/2023. |
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