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News & AnnouncementsUpdate to the Preventive Coverage of Medicare Diabetes Prevention Program5/28/2024
NotificationsEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous  administrationMA08.044i5/21/2024 10:00 AM8/19/20245/21/2024Medical Necessity Criteria
NotificationseviCore Lab ManagementMA06.034n5/31/2024 11:00 AM7/1/20245/31/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsMultiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy ServicesMA00.050b5/31/2024 2:00 PM7/1/20245/31/2024Coverage and/or Reimbursement Position
New PoliciesAuricular ProsthesesMA05.0685/20/20245/20/2024This is a New Policy.
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ao4/1/20244/1/20245/1/2024Medical Necessity Criteria5/1/2024
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ao4/1/20244/1/20245/3/2024Medical Necessity Criteria
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)MA08.009u5/6/20245/6/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesBotulinum Toxin AgentsMA08.017k5/6/20245/6/2024Medical Necessity Criteria
Updated PoliciesTracheostomy Care SuppliesMA05.034a4/6/2024 11:00 AM5/6/20245/6/2024Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesExperimental/Investigational ServicesMA00.005ak4/1/20245/6/2024Medical Coding
Updated PoliciesDurvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)MA08.123d5/6/20245/6/2024Medical Necessity Criteria
Updated PoliciesEnteral Nutritional TherapyMA08.003h5/6/20245/6/2024General Description, Guidelines, or Informational Update
Updated PoliciesMogamulizumab-kpkc (Poteligeo®)MA08.102f5/20/20245/20/2024Medical Necessity Criteria
Updated PoliciesExternal Breast ProsthesesMA05.033c5/20/20245/20/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PoliciesAmivantamab-vmjw (Rybrevant®)MA08.148a5/20/20245/20/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesMirvetuximab soravtansine-gynx (Elahere™)MA08.159b5/20/20245/20/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesEvinacumab-dgnb (Evkeeza®) MA08.133c4/24/2024 10:00 AM5/27/20245/28/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Reissue PoliciesReimbursement for Components of Comprehensive Laboratory PanelsMA01.006a1/1/20245/1/20245/1/2024
Reissue PoliciesLumbar Interspinous Process Decompression SystemMA11.048c1/1/20245/1/20245/1/2024
Reissue PoliciesHigh-Frequency Chest Wall Oscillation DevicesMA05.001i1/1/20245/1/20245/1/2024
Reissue PoliciesSeat Lift MechanismsMA05.011b1/1/20245/1/20245/1/2024
Reissue PoliciesAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)MA08.050b1/1/20245/1/20245/1/2024
Reissue PoliciesExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)) – Casimersen (Amondys 45)MA08.084c1/1/20245/1/20245/1/2024
Reissue PoliciesVagus Nerve Stimulation (VNS)MA11.019k1/2/20245/1/20245/1/2024
Reissue PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyMA11.099d9/25/20235/1/20245/1/2024
Reissue PoliciesDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsMA11.014g10/1/20215/1/20245/1/2024
Reissue PoliciesElectroconvulsive Therapy (ECT)MA14.001a1/1/20245/1/20245/1/2024
Reissue PoliciesAllergy ImmunotherapyMA07.055d1/1/20245/1/20245/1/2024
Reissue PoliciesBurosumab-twza (Crysvita®)MA08.099b1/1/20245/1/20245/1/2024
Reissue PoliciesPatient Lifts MA05.031c1/1/20245/1/20245/1/2024
Reissue PoliciesIntravenous Chelation TherapyMA07.016c1/1/20245/1/20245/1/2024
Reissue PoliciesVentricular Assist Devices (VADs)MA11.011g1/1/20245/1/20245/1/2024
Reissue PoliciesDeep Brain Stimulation (DBS)MA11.005h1/2/20245/1/20245/1/2024
Reissue PoliciesEvaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)MA07.015a6/28/20175/1/20245/1/2024
Reissue PoliciesScreening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)MA09.013b1/1/20245/1/20245/1/2024
Reissue PoliciesInstrument-Based Vision ScreeningMA07.048a1/1/20165/15/20245/15/2024
Reissue PoliciesComplementary and Integrative Health ServicesMA12.001e4/1/20245/15/20245/15/2024
Reissue PoliciesHigh Osmolar Contrast AgentsMA09.005a12/30/20155/15/20245/15/2024
Reissue PoliciesBronchial ValvesMA11.0201/1/20245/15/20245/15/2024
Reissue PoliciesVoretigene Neparvovec-rzyl (Luxturna®) MA08.094c1/1/20245/15/20245/15/2024
Reissue PoliciesBelimumab (Benlysta®) for Intravenous UseMA08.057d1/1/20245/15/20245/15/2024
Reissue PoliciesPositron Emission Mammography (PEM)MA09.0151/1/20245/15/20245/15/2024
Reissue PoliciesPsychological TestingMA14.0021/1/20235/15/20245/15/2024
Reissue PoliciesConsultation ServicesMA00.049b1/1/20235/15/20245/15/2024
Reissue PoliciesPercutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)MA05.064a1/1/20245/29/20245/29/2024
Reissue PoliciesNucleoplastyMA11.1011/1/20155/29/20245/29/2024
Reissue PoliciesNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)MA05.058d1/1/20245/29/20245/29/2024
Reissue PoliciesPersonalized Vaccines (e.g., Provenge®)MA08.053b1/1/20245/29/20245/29/2024
Reissue PoliciesAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaMA11.105j1/1/20235/29/20245/29/2024
Reissue PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMA05.006i1/1/20245/29/20245/29/2024
Reissue PoliciesMechanical Stretching Devices for the Treatment of Joint Stiffness or ContracturesMA05.043b1/1/20245/29/20245/29/2024
Reissue PoliciesEvaluation and Treatment of Erectile Dysfunction (ED)MA11.079e1/2/20245/29/20245/29/2024
Reissue Policiescrizanlizumab-tmca (Adakveo®) MA08.109b1/1/20245/29/20245/29/2024
Reissue PoliciesRemoval of Breast ImplantsMA11.076g6/5/20235/29/20245/29/2024
Reissue PoliciesRozanolixizumab-noli (Rystiggo)MA08.164a1/1/20245/29/20245/29/2024
Reissue PoliciesMeasurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab MA06.019c1/1/20245/29/20245/29/2024
Reissue PoliciesGivosiran (Givlaari)MA08.1121/1/20245/29/20245/30/2024
Coding UpdateAbortionMA11.010c4/1/20245/1/20245/1/2024
Coding UpdateAbortionMA11.010c4/1/20245/2/2024
Coding UpdateDurable Medical Equipment (DME)MA05.044q4/1/20245/3/20245/3/2024
Coding UpdateDurable Medical Equipment (DME)MA05.044q4/1/20245/6/2024
Coding UpdateeviCore Lab ManagementMA06.034m4/1/20245/7/2024
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsMA00.030af4/1/20245/17/2024