The Plan uses medical policies as guidelines for coverage decisions within the member’s written benefits. Below are summaries of recent changes to The Plan’s medical policies. The detailed policies and complete Medical Policy Manual are available online at bridgespanhealth.com. We have included the section and policy number for your convenience.
Policy name | Summary of policy or change | Effective date | Section and policy number | Coding or implementation change | Pre-authorization change |
---|---|---|---|---|---|
New investigational policy for the use of ablation of peripheral nerves to treat pain. | February 1, 2024 | Surgery #236 | Adding CPT codes: 0440T, 0441T, 0442T and continue investigational denial. Adding CPT codes 64624, 64640 and add investigational denial for this policy. Adding CPT code 64999 and continue unlisted review. | N/A | |
Clarifying documentation requirements for:
| February 1, 2024 | Surgery #187 | N/A | N/A | |
Clarifying that the clonoSEQ B-cell test, but not the T-cell test, may be considered medically necessary. | December 1, 2024 | Genetic Testing #88 | N/A | N/A | |
| December 1, 2024 | Surgery #12.28 | N/A | N/A | |
Clarifying provider type and added context for continuation treatment. | November 1, 2024 | Behavioral Health #18 | N/A | N/A | |
Edited policy for clarity | November 1, 2024 | Durable Medical Equipment #83.11 | N/A | N/A | |
Edited policy for clarity | November 1, 2024 | Durable Medical Equipment #87 | N/A | N/A | |
| November 1, 2024 | Surgery #60 | N/A | N/A | |
New policy to address lower extremity sensory prostheses. | October 1, 2024 | Durable Medical Equipment #95 | Added new Q4 HCPCS codes L8720, L8721 with investigational denial for this new policy. | N/A | |
New policy to address amplitude-modulated radiofrequency electromagnetic fields (AM RF-EMF) for cancer treatment. | October 1, 2024 | Durable Medical Equipment #96 | Added new Q4 HCPCS code E0767 with investigational edit for this new policy | N/A | |
| October 1, 2024 | Genetic Testing #64 | Added new Q4 CPT codes 0476U, 0477U, 0516U with investigational denial. | N/A | |
| October 1, 2024 | Genetic Testing #74 | Added new Q4 CPT codes 0488U, 0494U with investigational denial. | N/A | |
Added four new investigational tests to policy. | October 1, 2024 | Laboratory #77 | Added new Q4 CPT codes 0506U, 0510U, 0512U, 0513U with investigational denial. | N/A | |
Added C9354 to policy as investigational. | October 1, 2024 | Medicine #170 | Adding HCPCS: C9354 with always investigational denial | N/A | |
New policy to address digital therapeutic products for gait training. | October 1, 2024 | Medicine #175.06 | Added new Q4 HCPCS code E3200 with investigational edit for this new policy | N/A | |
| October 1, 2024 | Surgery #12.03 | N/A | N/A | |
Clarified pelvic inflammatory disease criteria. | October 1, 2024 | Surgery #218 | N/A | N/A | |
Clarified that the policy addresses Guardant Shield test and continue investigational determination. | September 1, 2024 | Genetic Testing #86 | N/A | N/A | |
Adding requirement of professional attestation related to cost to list of required documentation with no change to current criteria. | September 1, 2024 | Medicine #49 | N/A | N/A | |
| September 1, 2024 | Medicine #148 | N/A | N/A | |
Updated to include trabecular bone score for vertebral fracture risk as investigational. | September 1, 2024 | Radiology #48 | Add CPT codes 77089, 77090, 77091, 77092 to the policy with always investigational edit. | N/A | |
| September 1, 2024 | Utilization Management #19 | N/A | Updated the policy title on the preauth website for this policy. | |
Clarified use of ASAM criteria to determine medical necessity. | August 1, 2024 | Behavioral Health #35 | N/A | N/A | |
Clarified policy criteria with no change to intent. | August 1, 2024 | Surgery #12.01 | N/A | N/A | |
New medical policy. | August 1, 2024 | Surgery #221 |
| Add CPT codes 0483T, 0484T to the preauth website for this policy. | |
New medical policy. | August 1, 2024 | Surgery #235 | Add CPT codes 0338T, 0339T with investigational edit for this policy. | N/A | |
New policy will address folate testing. | June 1, 2024 | Laboratory #79 |
| N/A |
Policy name | Archive date | Policy number |
---|---|---|
No policies archived in past six months | N/A | N/A |