Regence Medicare Advantage Medical Policy Updates
Last Updated: July 1, 2024
|
Changes to Regence Medicare Advantage Medical
Policies Announced |
Regence Medicare Advantage and its affiliated Plans use medical policies
as guidelines for coverage decisions within
the member’s written benefits. Below are
summaries of recent changes to the Medicare Advantage
medical policy manual.
We have included the section and policy number
for your convenience.
The
complete Medicare Medical Policy Manual with detailed policies are available
online at http://blue.regence.com/medicare/index.html. |
| |
|
|
Policy Name |
Summary
of Policy or Change |
Medicare Manual Section and
Policy #
|
| Electrical Stimulation and Electromagnetic Therapy Devices |
Updated policy to address stimulation for nerve regeneration.
Effective Date: July 1, 2024 |
Durable Medical Equipment, Policy No. M-83 |
| Genetic and Molecular Diagnostics – Next Generation Sequencing, Genetic Panels, and Biomarker Testing |
Added five new CPT codes to policy and updated Medicare guidance.
Effective Date: July 1, 2024 |
Genetic Testing, Policy No. M-64 |
| Genetic and Molecular Diagnostics – Testing for Cancer Diagnosis, Prognosis, and Treatment Selection |
Added several new tests and CPT codes to policy, with Medicare guidance when available.
Effective Date: July 1, 2024 |
Genetic Testing, Policy No. M-83 |
| Transcranial Magnetic Stimulation as a Treatment of Depression and Other Disorders |
Added codes related to Q3 2024 code set update.
Effective Date: July 1, 2024 |
Medicine, Policy No. M-148 |
| Investigational (Experimental) Services, New and Emerging Medical Technologies and Procedures, and Other Non-Covered Services |
Added codes related to Q3 2024 code set update.
Effective Date: July 1, 2024 |
Medicine, Policy No. M-149 |
| Benign Prostatic Hyperplasia Surgical Treatments |
Changed policy title from: Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) of the Prostate
Added guidance for transperineal laser ablation to policy.
Effective Date: July 1, 2024 |
Surgery, Policy No. M-210 |
| Digital Therapeutic Products for Post-traumatic Stress Disorder and Panic Disorder |
New Medicare Advantage policy addresses digital therapeutics for post-traumatic stress disorder and panic disorder, Freespira and NightWare.
Effective Date: May 1, 2024 |
Medicine, Policy No. M-175.05 |
| Subcutaneous Tibial Nerve Stimulation |
Changed policy title to align with Commercial medical policy; policy was previously titled Subcutaneous Tibial Nerve Stimiulation (STNS).
Effective Date: May 1, 2024 |
Surgery, Policy No. M-154 |
| Micro-Invasive Glaucoma Surgery (MIGS) and Laser Trabeculectomy and Trabeculostomy |
Changed policy title from:
Laser Trabeculotomy and Trabeculostomy
Expanded scope to include additional micro invasive surgeries such as stents.
Effective Date: May 1, 2024 |
Surgery, Policy No. M-227 |
| Electrical Stimulation and Electromagnetic Therapy Devices |
Policy updated to include new Noridian LCD L39591 which provides limited coverage for external upper limb tremor stimulators for essential tremor.
Effective Date: April 7, 2024 |
Durable Medical Equipment, Policy No. M-83 |
| Chemical Dependency and Substance Abuse Services |
Updated to include intensive outpatient programs per Medicare Benefit Manual Chapter 6.
Effective Date: April 1, 2024 |
Behavioral Health, Policy No. M-20 |
| Definitive Lower Limb Prostheses |
Policy updated to include new HCPCS codes for a pneumatic prosthetic knee (L5841) and the RevoFit System for socket volume adjustment (L5783).
Effective Date: April 1, 2024 |
Durable Medical Equipment, Policy No. M-18 |
| Powered Exoskeleton for Ambulation and Rehabilitation |
Policy title changed from Powered Exoskeleton for Ambulation.
Expanded policy scope to include powered exoskeleton devices for robot-assisted physical therapy.
Effective Date: April 1, 2024 |
Durable Medical Equipment, Policy No. M-89 |
| Upper Extremity Rehabilitation System with Brain-Computer Interface |
New policy that follows Commercial medical policy guidance.
Effective Date: April 1, 2024 |
Durable Medical Equipment, Policy No. M-94 |
| Genetic and Molecular Diagnostics – Testing for Inherited Cancer Risk |
New policy addresses genetic testing for hereditary cancer risk, which was previously in M-GT64.
Effective Date: April 1, 2024 |
Genetic Testing, Policy No. M-02 |
| Genetic and Molecular Diagnostics – Next Generation Sequencing, Genetic Panels, and Biomarker Testing |
Removed tests related to cancer from policy, as these are not addressed in new policies M-GT02 (hereditary cancer risk testing) and M-GT83 (other cancer-related testing).
Updated Medicare guidance and links where appropriate.
Effective Date: April 1, 2024 |
Genetic Testing, Policy No. M-64 |
| Genetic and Molecular Diagnostics – Testing for Cancer Diagnosis, Prognosis, and Treatment Selection |
New policy specifically addressing genetic and molecular testing related to cancer diagnosis, prognosis, and treatment selection.
Effective Date: April 1, 2024 |
Genetic Testing, Policy No. M-83 |
| Investigational (Experimental) Services, New and Emerging Medical Technologies and Procedures, and Other Non-Covered Services |
Updated the policy to add a new code effective 4/1/2024.
Effective Date: April 1, 2024 |
Medicine, Policy No. M-149 |
| Cosmetic and Reconstructive Procedures |
Removed dermal filler codes from policy as this will be addressed through Pharmacy Policy.
Effective Date: April 1, 2024 |
Surgery, Policy No. M-12 |
| Coronary Intravascular Lithotripsy |
New Policy that points to Commercial policy SUR233 for coronary intravascular lithotripsy.
Effective Date: April 1, 2024 |
Surgery, Policy No. M-233 |
| Genetic and Molecular Diagnostics – Next Generation Sequencing, Genetic Panels, and Biomarker Testing |
Updated Medicare guidance and links where appropriate, including new guidance for the SelectMDx, Colvera, and DecisionDx DiffDx-Melanoma tests.
Effective Date: March 1, 2024 |
Genetic Testing, Policy No. M-64 |
| Intensity Modulated Radiotherapy (IMRT) of the Central Nervous System (CNS) Head, Neck and Thyroid |
New IMRT policies replace previous Intensity Modulated Radiation Therapy (IMRT), M-MED136.
No change in intent or policy criteria.
Effective Date: March 1, 2024 |
Medicine, Policy No. M-164 |
| Intensity Modulated Radiotherapy (IMRT) of the Thorax, Abdomen, Pelvis, and Extremities |
New IMRT policies replace previous Intensity Modulated Radiation Therapy (IMRT), M-MED136.
No change in intent or policy criteria.
Effective Date: March 1, 2024 |
Medicine, Policy No. M-165 |
| Intensity Modulated Radiotherapy (IMRT) for Breast Cancer |
New IMRT policies replace previous Intensity Modulated Radiation Therapy (IMRT), M-MED136.
No change in intent or policy criteria.
Effective Date: March 1, 2024 |
Medicine, Policy No. M-166 |
| Intensity Modulated Radiotherapy (IMRT) for Tumors in Close Proximity to Organs at Risk |
New IMRT policies replace previous Intensity Modulated Radiation Therapy (IMRT), M-MED136.
No change in intent or policy criteria.
Effective Date: March 1, 2024 |
Medicine, Policy No. M-167 |
| Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) of the Prostate |
Added new Local Coverage Determination (LCD) and Article guidance.
Effective Date: March 1, 2024 |
Surgery, Policy No. M-210 |
| Behavioral Health (Psychiatric) Services |
Updated references for level of care place determination criteria.
Effective Date: February 1, 2024 |
Behavioral Health, Policy No. M-19 |
| Intraosseous Radiofrequency Ablation of the Basivertebral Nerve |
Updated to remove Commercial policy guidance and point to a new LCD effective 1/28/2024.
Effective Date: February 1, 2024 |
Surgery, Policy No. M-225 |
| Stem Cell and Bone Marrow Transplants |
Changing policy guidance from Commercial policy to new Local Coverage Determination (LCD) and Article regarding allo-HCT for relapsed/refractory lymphomas. Policy had been pointing to Commercial guidance for this indication. Commercial guidance allowed same coverage as new LCD and Article.
Effective Date: February 1, 2024 |
Transplant, Policy No. M-45 |
| The following
is a list of recently archived policies: |
Policy Name |
Summary
of Policy or Change |
Medicare Manual Section and
Policy #
|
| Genetic and Molecular Diagnostics – Single Gene or Variant Testing |
Archive Date: April 1, 2024 |
Genetic Testing, Policy No. M-20 |
| Intensity Modulated Radiation Therapy (IMRT) |
Archive Date: March 1, 2024
See new medical policies M-MED164, M-MED165, M-MED166, M-MED167 that replaced this medical policy |
Medicine, Policy No. M-136 |
| Inpatient Rehabilitation Facility (IRF) Services |
Archive Date: February 1, 2024 |
Utilization Management, Policy No. M-03 |
| Skilled Nursing Facility (SNF) Services |
Archive Date: February 1, 2024 |
Utilization Management, Policy No. M-08 |
