POLICY
| APPLICABLE PRODUCTS
| NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
|
Facility-based Sleep Studies for Obstructive Sleep Apnea
(MC.CP.MP.248)
| Wellcare By Allwell (Medicare)
| Policy updates include:
- Changed I.B.3 into two indications in I.B.3 and 4 for clarity
- Updated wording in Criteria I.B.8.a.v. and added addition of disorders that interfere with HSAT
- Removed “moderate to-to-high-risk” verbiage in Criteria I.B.8.b. and updated outline of criteria
- Removed Epworth Sleepiness Scale criteria from I.B.8.b.i
- Added Criteria I.B.8.b.ii.c) which states, “Diagnosis of hypertension”
|
Outpatient Oxygen Use
(MC.CP.MP.190)
| Wellcare By Allwell (Medicare)
| Policy updates include:
- Removed criteria I.C. The qualifying blood gas study or pulse oximetry measurement was performed by a physician or by a qualified provider or supplier of laboratory services
- Added CPT E0447 to coding table
|
Short Inpatient Hospital Stay
(MC.CP.MP.182)
| Wellcare By Allwell (Medicare)
| Policy retired
|
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
(MC.CP.MP.22)
| Wellcare By Allwell (Medicare)
| Policy updates include:
- Added risk/benefit statement
- Added criteria:
- III.E.1-III.E.4. Extracranial oligometastatic disease, any of the following: One to three metastatic lesions involving the lungs, liver or bone; Primary tumor is breast, colorectal, melanoma, non-small cell lung, prostate, renal cell or sarcoma; Primary tumor is controlled; No prior history of metastatic disease
- III.F. Acoustic neuroma
- III.G. spinal tumors
- Added CPT codes 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77371, 77372, and 77432 to policy
|
Transplant Service Documentation Requirements
(MC.CP.MP.247)
| Wellcare By Allwell (Medicare)
| Policy updates include:
- Annual review
- References reviewed and updated
- Reviewed by external specialist
|
