CommercialFebruary 1, 2019
Medical Policy and Clinical Guidelines: February 2019*
New Medical Policy |
Effective May 1, 2019 |
MED.00126 Fractional Exhaled Nitric Oxide and Exhaled Breath Condensate Measurements for Respiratory Disorders |
The measurement of exhaled nitric oxide is considered INV&NMN in the diagnosis and monitoring of asthma and other respiratory disorders · The measurement of exhaled breath condensate is considered INV&NMN in the diagnosis and monitoring of asthma and other respiratory disorders |
The below current Clinical Guidelines and/or Medical policies were reviewed and updates were approved
*requires precertification
Title |
Change |
Effective date |
CG-BEH-01 Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome |
• Added tests for metabolic markers in the blood, urine, tissue, or other biologic materials (also known as metabolomics), including but not limited to Amino Acid Dysregulation Metabotype (ADDM) testing as NMN
- Added existing CPT PLA code 0063U (NMN); added new CPT psych testing codes 96112, 96113, 96121, 96130-96133, 96136-96139, 96146 replacing 96101-96103, 96111, 96118-96120 & new CPT 81171, 88172 for AFF2 gene replacing Tier 2 eff 01/01/19 |
5/1/2019 |
CG-MED-79 Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems |
• Content moved from MED.00100 • No change to clinical indications |
1/3/2019 |
CG-MED-80 Positron Emission Tomography (PET) and PET/CT Fusion* |
• Content moved from RAD.00002 • No change to clinical indications |
1/3/2019 |
CG-SURG-27 Sex Reassignment Surgery* |
• Added criteria requiring referral letters to mastectomy MN statement |
5/1/2018 |
PUBLICATIONS: February 2019 Anthem Ohio Provider Newsletter
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