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10/1/2024
10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
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The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 10/01/2024.

For more information related to these services, please refer to specific policies when applicable.​​​​​​

10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products351a8846-3067-4c2a-a88f-f7b55ca6c87d
8/28/2024
New Preventive Coverage of 21-valent Pneumococcal Vaccine for Medicare Advantage Members (Retroactively effective to June 17, 2024)
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The purpose of this communication is to provide notice regarding the new preventive coverage criteria for 21-valent pneumococcal vaccine for Medicare Advantage members.  Services covered are retroactively effective to June 17, 2024.​
New Preventive Coverage of 21-valent Pneumococcal Vaccine for Medicare Advantage Members (Retroactively effective to June 17, 2024)a3496d0d-256a-43ea-92b1-9fd121647897
8/12/2024
Pemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Medicare Advantage Members (Retroactively Effective to 03/22/2024)
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The purpose of this document is to communicate the Company's coverage position for pemivibart (Pemgarda) for pre-exposure prophylaxis for Coronavirus disease 2019 (COVID-19) for Medicare Advantage members.  Coverage for pre-exposure prophylaxis for Coronavirus disease 2019 (COVID-19) for Medicare Advantage ​members​ is retroactively effective to March 22, 2024.​
Pemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Medicare Advantage Members (Retroactively Effective to 03/22/2024)24a0284f-a81c-4cba-92e5-7412c466bc24
8/5/2024
Coverage of Cantharidin (Ycanth) Topical Solution Medicare Advantage Products (Retroactively Effective to 04/01/2024)
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The purpose of this document is to communicate that the Company has revised its coverage position for cantharidin (Ycanth)​ topical solution.  

The coverage position for cantharidin (Ycanth)​, represented by HCPCS code J7354, has been revised from non-covered to medically necessary.  This medically necessary coverage position is retroactively effective for dates of service beginning 04/01/2024. ​
​
Coverage of Cantharidin (Ycanth) Topical Solution Medicare Advantage Products (Retroactively Effective to 04/01/2024)28937e82-6884-402c-818b-f68a0440ba3a
5/28/2024
Update to the Preventive Coverage of Medicare Diabetes Prevention Program
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Retroactively effective to January 1, 2024, in alignment with the CMS expanded model of the Medicare Diabetes Prevention Program (MDPP), this communication is intended to provide updates to the MA00.003z Preventive Care Services policy for MDPP recommendation.  ​
Update to the Preventive Coverage of Medicare Diabetes Prevention Program593d2e65-47d5-4a12-9478-c4c97319b1c0
4/1/2024
04/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
0.1
​The intent of this document is to communicate Medicare Advantage product coverage determinations​ for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 04/01/2024, unless otherwise noted. For more information related to these services, please refer to specific policies when applicable.​​​​​​

04/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products9dae70d4-ef5c-4e1d-925e-e0e03dd2267e
3/4/2024
Expansion of Preventive Coverage of Diabetes Screening Tests for Medicare Advantage Members (Retroactively Effective 01/01/2024)
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Retroactively effective to January 1, 2024, the purpose of this document is to communicate the addition of hemoglobin A1c blood test to the preventive coverage of diabetes screening test and to update the frequency of the diabetes screening tests for Medicare Advantage members.​
Expansion of Preventive Coverage of Diabetes Screening Tests for Medicare Advantage Members (Retroactively Effective 01/01/2024)6174f35e-677a-411b-b7f8-fac2315327e2
2/26/2024
Coverage of the Administration at Home for Pneumococcal, Influenza, Hepatitis B, and COVID-19 Vaccination for Medicare Advantage Members (Retroactively Effective to 1/1/2024)
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To communicate the expansion of the administration at home procedure ​code to include additional vaccines (i.e., pneumococcal, influenza, hepatitis B) that can be administered in a home setting. ​​
Coverage of the Administration at Home for Pneumococcal, Influenza, Hepatitis B, and COVID-19 Vaccination for Medicare Advantage Members (Retroactively Effective to 1/1/2024)34ff30ed-5e46-4ba9-a1e2-f3055f8fe34d
2/12/2024
Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated February 12, 2024. Retroactively Effective to January 1, 2024.)
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This communication provides notice regarding information and procedure codes related to the coverage of SARS-CoV-2 (Coronavirus Disease 2019 [COVID-19]) vaccines and administration of the vaccines​ that have been granted US Food and Drug Administration (FDA) approval and/or have received an Emergency Use Authorization (EUA). Coverage of SARS-CoV-2 vaccines granted an EUA shall remain in effect during the applicable EUA declaration, unless the specific EUA for a SARS-CoV-2 vaccine has been terminated and/or revoked. ​

Coverage of the COVID-19 Vaccination for Medicare Advantage Members (Updated February 12, 2024. Retroactively Effective to January 1, 2024.)0b7dae7f-1f59-4e7f-b09c-ec13770e565c
1/26/2024
01/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 26, 2024; Retroactively Effective January 1, 2024)
0.1
The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. Procedure codes that represent these services are retroactively effective to 01/01/2024, unless otherwise noted. ​​ 
01/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 26, 2024; Retroactively Effective January 1, 2024)8f1996f4-a68b-4b48-984e-a9eca3898eaf
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