Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective February 11, 2014 (Posted December 10, 2013)

Medical Policy Revision
Allergy Immunotherapy (Desensitization) "Notification" Revised "When Covered" section, statement A. as follows: "Allergy Immunotherapy by subcutaneous injection is covered for patients with demonstrated hypersensitivity and severe and debilitating symptoms that cannot be adequately managed by prescription medications and avoidance of the allergen. Injections of airborne or insect venom allergens should be prepared for the patient individually." Added the following statement to "When not Covered" section: "Immunotherapy self-administered in the home setting is considered investigational." Description section updated. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 11/2013. Medical Director review 11/2013. Notification given 12/10/13 for effective date 02/11/14.
Allergy Testing "Notification" Specialty Matched Consultant Advisory Panel review 11/2013. References updated. Medical Director review 11/2013. Added the following statements to the "When Covered" section: "Repeat Allergy Skin Testing-a.) Repeat skin testing with multiple antigens is medically necessary for children who are Initially sensitive to food and indoor environmental exposures but later develop pollen and outdoor mold sensitivities. b.) Repeat skin testing may be considered medically necessary for adults who: i.)develop dramatic change of symptoms, ii.)have received three to five years of venom immunotherapy, iii.)are being evaluated for newly discovered purified or standardized allergens." Added the following statement to the "When not Covered" section: "Repeat skin testing with multiple antigens is considered not medically necessary when criteria in the covered section are not met." Policy noticed 12/10/13 for effective date 02/11/14.
Cardiovascular Disease Rist Tests "Notification" Description section updated. Added the following Policy Statements: "Cardiovascular disease risk panels are considered investigational. BCBSNC does not provide coverage for investigational services or procedures." Added the following tests as investigational: Brain Natriuretic Peptide and Leptin. Added the following statements to the "When not Covered" section: "Measurement of Brain Natriuretic Peptide (BNP) is considered investigational for predicting cardiovascular disease risk. Measurement of leptin is considered investigational for predicting cardiovascular disease risk. Cardiovascular disease risk panels, consisting of multiple individual biomarkers intended to assess cardiac risk, are considered investigational." Policy Guidelines updated. References updated. Added the following codes to the "Billing/Coding" section: Diagnosis codes 250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.1, 250.10, 250.11, 250.12, 250.13,250.2, 250.20, 250.21, 250.22, 268.9, 402, 402.1, 402.10, 402.11, 402.9, 402.90, 402.91, V17.2, V17.4, V17.41, V17.49, V72.6, V72.60, V72.62, V72.69, V77, V77.1, V77.8, V77.9, V77.91, V77.99, V81, V81.0, V81.1, V81.2. Added CPT code 83880. Added the following statement: "There is no specific CPT code for Leptin. CPT code 83520 or 83297 may be used." Medical Director review 11/2013. Policy noticed 12/10/13 for effective date 2/11/14.
Modifier Guidelines "Notification" In the "Policy" section, deleted modifier 22 from the list of modifiers that may affect claims payment. In the "Modifier Guidelines" section, bulleted section on Modifier 59: added codes 22633 and 22634 so that the statement reads: "Modifier 59 will not allow additional payment when appended to CPT4 codes 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048 when performed in conjunction with 22630, 22632, 22633 and/or 22634." Statement regarding anatomic-specific modifiers was reworded and modifiers LM and RI added to the list of coronary artery anatomic modifiers. In the "Policy Guidelines" section: deleted the statement "BCBSNC claims system processes only one modifier per CPT code." Notification given 12/10/13 for effective date 2/11/14. (adn)