Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - September 2020

Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

 

• Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020*
  
  
• Updates for specialty pharmacy are available - September 2020*
  
  
• Reimbursement policy update: Distinct Procedural Services - Modifiers 59, XE, XP, XS, XU (Professional)*
  
  
• Reimbursement policy update: Frequency Editing (Professional)*