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Effective April 15, 2022: Clinical Payment Policy Revision - Testing for Select Genitourinary Conditions

Date: 01/19/22

Superior HealthPlan presents a revised payment policy to communicate the medical necessity criteria for the diagnostic evaluation of vaginitis in member/enrollees > 13 years of age. As a result, the following policy has been added, and is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation:

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Testing for Select Genitourinary Conditions (CP.MP.97)*

04/15/2022

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan, Medicare (Wellcare By Allwell [HMO and HMO SNP])

Policy revised to add procedural codes 81513 and 81514 as not medically necessary tests for select genitourinary conditions 

* UPDATES Current Testing for Select Genitourinary Conditions (CP.MP.97)

To review all payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Superior Provider Services at:

  • 1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS], CHIP, Wellcare By Allwell (HMO and HMO SNP)
  • 1-877-687-1196 (Ambetter from Superior HealthPlan)