Medical Policy Update for August 29, 2023

Medical Guidelines	Reason for Update
Abdominoplasty and Panniculectomy	References updated. Specialty Matched Consultant Review 8/2023. Medical Director review 8/2023. No change to policy statement.
Absorbable Nasal Implant for Treatment of Nasal Valve Collapse	References updated. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023.
Breast Surgeries	Updated Related Policies section. References updated. Updated “When Reduction Mammaplasty is covered” section D to change “risk factor” to “contributing factor”. Updated “Reconstructive Breast Surgery After Mastectomy” description. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement.
Colorectal Cancer Screening AHS-B0001	Reviewed by Avalon Q1 2023 CAB. No changes to policy statement.
Composite Allotransplantation of the Hand and Face	References updated. Specialty Matched Consultant Advisory Panel 8/2023. Medical Director review 8/2023. No change to policy statement.
Extracorporeal Photopheresis	Specialty Matched Consultant Advisory Panel review 8/16/2023. Updated description section. References added. No change to policy statement.
Laser Treatment of Port Wine Stains	References updates. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement.
Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification AHS-B0002	General review per Avalon CAB Q2 2023. Medical Director review 8/2023. No change to policy statement.
Reconstructive Eyelid Surgery and Brow Lift	Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. References updated. No change to policy statement.
Rhinoplasty	Updated references. Added Related Policy. Minor edit to the Policy Guidelines. No change to policy intent. Deleted terminated code C9749 from Billing/Coding section. Medical Director Review 8/2023. Specialty Matched Consultant Advisory Panel 8/2023.
Septoplasty	Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. Updated references. Added Related Policy.
Skin and Soft Tissue Substitutes	References updated. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No changes to policy statement.
Sleep Apnea: Diagnosis and Medical Management	When covered section updated for clarity. References added. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement.
Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome	References updated. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023. No change to policy statement.
Surgical Treatment for Lipedema	References updated. Medical Director review 8/2023. Specialty Matched Consultant Advisory Panel Review 8/2023. No change to policy statement.
Surgical Treatment of Chest Wall Deformities (Congenital or Acquired)	Specialty Matched Consultant Advisory Panel 8/2023. Medical Director review 8/2023. References updated. No change to policy statement.
Tinnitus Treatment	Reference added. Description section updated to include related policies, Minor edits to Policy Guidelines. No change to policy intent. Specialty Matched Consultant Advisory Panel review 8/2023. Medical Director review 8/2023.
Tumor-Treatment Fields Therapy	Specialty Matched Consultant Advisory Panel review 8/16/2023. Updated description policy guidelines and references. No change to policy statement.

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