Print

Date Printed: January 18, 2018: 01:05 PM

WHAT’S NEW

1/15/18

New MCGs

1. Benralizumab (Fasenra)

Revised MCGs:

1. Asfotase alfa (StrensiqTM) - Review and revision to guideline; position statement, references.

2. Azacitidine (Vidaza®) Injection - Review and revision to guideline; consisting of updating position statement and references.

3. Bezlotoxumab (Zinplava) Injection - Review and revision to guideline consisting of updating the position statement and references.

4. Botulinum Toxins - Review and revision to guideline consisting of updating the position statement, program exceptions, dosing/administration, precautions, and references.

5. Capecitabine (Xeloda®) Tablets - Review and revision to guideline; consisting of updating position statement and references.

6. Clotting Factors and Coagulant Blood Products - Revision to guideline; consisting of updating position statement to include Rebinyn.

7. Dupilumab (Dupixent) Injection - Revision to the guideline consisting of updating the position statement in regards to the prerequisite requirements for members receiving systemic immunosuppressant therapy or phototherapy.

8. Edaravone (Radicava) - Review and revision to guideline; position statement, references.

9. Everolimus (Afinitor®, Afinitor Disperz®) Tablets - Revision to guideline; consisting of updating position statement, coding and references.

10. Gonadotropin Releasing Hormone Analogs and Antagonists - Review and revision to guideline consisting of updating the position statement, precautions, and references.

11. Infliximab Products, infliximab (Remicade®), infliximab-dyyb (Inflectra®), infliximab-abda (Renflexis®) - Review and revision to guideline; consisting of revising position statement.

12. Ixekizumab (Taltz®) Injection - Revision to guideline consisting of the description section, position statement, dosage/administration, billing/coding information, related guidelines, definitions, and referenced, based on the new FDA-approved indication for the treatment of adults with active psoriatic arthritis.

13. Nusinersen (Spinraza) - Review and revision to guideline; Updating position statement, coding, references.

14. Palbociclib (Ibrance) - Revision to guideline; updated position statement with NCCN recommendations.

15. PCSK9 Inhibitors - Revision to guideline consisting of updating the position statement in regards to documentation requirements and inclusion of alternative non-HDL-C goals. The description section, dosage/administration, and references were updated based on the expanded FDA-approved indication for Repatha.

16. Pembrolizumab (Keytruda) Injection - Revision to guideline; consisting of updating position statement, description, coding and references.

17. Pyrimethamine (Daraprim) - Review and revision to guideline consisting of updating position statement and references.

18. Regorafenib (Stivarga®) Tablets - Review and revision to guideline; consisting of updating position statement and references.

19. Ribociclib (Kisqali) - Revision to guideline; updated position statement with NCCN recommendations.

20. Sunitinib Malate (Sutent®) Capsules - Review and revision to guideline; consisting of updating position statement, description, coding, dosing and references.

21. Trifluridine-Tipiracil (Lonsurf®) Capsule - Review and revision to guideline consisting of updating position statement, coding and references.

22. Vemurafenib (Zelboraf™) - Revision to guideline; consisting of updating position statement, description, dosing, coding and references.

23. Ziv-aflibercept (Zaltrap®) IV - Review and revision to guideline; consisting updating position statement and references.

1/1/18

New MCGs

2. Noninvasive Fractional Flow Reserve Measurement

Revised MCGs:

1. Abatacept (Orencia®) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab is now a preferred product for psoriatic arthritis, and use of three preferred products is required. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis indication.

2. Adalimumab (Humira®) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use.

3. Allergy Testing and Immunotherapy - Annual CPT/HCPCS coding update: added 86008; revised 86003, 86005.

4. Allogeneic Bone Marrow and Stem Cell Transplantation - Annual CPT/HCPCS coding update: deleted 38220.

5. Anakinra (Kineret®) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis indication.

6. Apheresis, Plasmapheresis and Plasma Exchange - Annual CPT/HCPCS coding update: deleted 36515; revised 36516.

7. Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer - Annual CPT/HCPCS update. Added codes 81520, 81521; deleted code 0008M.

8. Autologous Bone Marrow and Stem Cell Transplantation - Annual CPT/HCPCS coding update: deleted 38220.

9. Balloon Ostial Dilation (Balloon Sinuplasty) and Implantable Devices - Annual HCPCS code update. Added 31298.

10. Bezlotoxumab (Zinplava) Injection - Annual HCPCS coding update: added HCPCS code J0565 and removed code C9490.

11. Bio-Engineered Skin and Soft Tissue Substitutes, Amniotic Membrane and Amniotic Fluid - Annual CPT/HCPCS update. Added codes Q4176-Q4182; revised codes Q4132, Q4133, Q4148, Q4156, Q4158, Q4162, Q4163.

12. Brodalumab (Siliq®) Injection - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab (Cosentyx) is now a preferred product for plaque psoriasis.

13. Cardiac Monitoring Devices - Annual CPT/HCPCS update. Added codes 0497T and 0498T.

14. Certolizumab Pegol (Cimzia®) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis when certolizumab pegol is used as self-administered therapy.

15. Clotting Factors and Coagulant Blood Products - Annual HCPCS coding update: added HCPCS codes J7210 and J7211, and deleted code C9140.

16. Cochlear Implants - Annual CPT/HCPCS coding update: added L8625.

17. Cognitive Rehabilitation - Annual CPT/HCPCS coding update: added 97127, G0515; deleted 97532. Revised program exceptions section. Reformatted guideline.

18. Continuous Monitoring of Glucose in the Interstitial Fluid - Annual CPT/HCPCS coding update: added 95249; revised 95250, 95251.

19. Contraceptive Drugs - Annual HCPCS coding update: added HCPCS code J7296 and deleted code Q9984.

20. Cryosurgical Ablation of Solid Tumors Other Than Liver or Prostate Tumors - Annual CPT/HCPCS update. Deleted code 0340T.

21. Dermabrasion, Chemical Peel, Salabrasion, and Acne Surgery - Annual CPT/HCPCS update. Added codes 96573, 96574; revised code 96567.

22. Digital Breast Tomosynthesis - Annual HCPCS code update. Deleted G0202, G0204 and G0206.

23. Drug Testing in Pain Management and Substance Abuse Treatment - Annual CPT/HCPCS update. Revised codes 80305-80307.

24. Edaravone (Radicava) - Annual HCPCS coding update: added HCPCS code C9493.

25. Endovascular Stent Grafts for Abdominal Aortic Aneurysms - Annual CPT/HCPCS update. Added codes 34701-34716; revised codes 34812 & 34820; deleted codes 34800-34805, 34825, 34826, 75952, 75953.

26. Etanercept (Enbrel®) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use.

27. Eteplirsen (Exondys 51) - Annual HCPCS coding update: added HCPCS code J1428 and removed code C9484.

28. Evoked Potentials, Intraoperative Neurophysiologic Monitoring, and Quantitative Electroencephalography (QEEG) - Annual CPT/HCPCS update. Revised code 95930.

29. Genetic Testing - Annual CPT/HCPCS update. Added codes 81230-81232, 81238, 81258-81269, 81328, 81334, 81335, 81346, 81448, 81541, 81551, 0011M, 0027U-0034; revised codes 81257, 81432, 81439; deleted code 0015U. Investigational test list updated and code 0020U added.

30. Golimumab (Simponi®, Simponi® Aria™) - Revision to guideline consisting of updating the description section, position statement, and references after golimumab IV (Simponi Aria) gained new FDA-approved indications for psoriatic arthritis and ankylosing spondylitis. The preferred self-administered biologic products were also updated according to indication for use.

31. Gonadotropin Releasing Hormone Analogs and Antagonists - Annual HCPCS coding update: added HCPCS code C9016.

32. Granisetron (Sustol®) injection - Annual HCPCS coding update: added HCPCS code J1627 and deleted code C9486.

33. Guselkumab (Tremfya) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab (Cosentyx) is now a preferred product for plaque psoriasis. Addition of HCPCS code C9029.

34. Hereditary Angioedema Drug Therapy - Annual HCPCS coding update: added HCPCS code C9015.

35. Home Prothrombin Time Monitoring - Annual CPT/HCPCS coding update: added 93792; deleted 99363. Revised Reimbursement Information (deleted 99364) and Program Exceptions sections. Reformatted guideline.

36. Human Papillomavirus (HPV) Testing - Annual CPT/HCPCS update. Added code 0500T.

37. Hydroxyprogesterone Caproate - Annual HCPCS coding update: added HCPCS codes J1726 and J1729, and deleted codes Q9985 and Q9986.

38. Immune Globulin Therapy - Annual HCPCS coding update: added HCPCS code J1555.

39. Implantable Bone-Conduction and Bone-Anchoring Hearing Aids - Annual HCPCS code update. Added L8618, L8624, L8625 and L8694. Revised L8691 code descriptor.

40. Investigational Services - Annual CPT/HCPCS update. Added codes 64912, 64913, 0479T-0481T, 0483T-0493T, 0499T; revised code 0384T; deleted codes 93982, 0178T-0180T, 0293T-0300T, 0302T-0307T. Code 0020U deleted; see MCG 05-82000-28.

41. Ixekizumab (Taltz®) Injection - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukinumab (Cosentyx) is now a preferred product for plaque psoriasis.

42. Minimally Invasive Fusion Techniques - Annual CPT/HCPCS coding update: deleted 0309T. Reformatted guideline.

43. Neuropsychological Testing - Revision: deleted repeat testing in 12 months restriction; revised Billing/Coding Information section; reformatted guideline.

44. Nusinersen (Spinraza) - Annual HCPCS coding update: added HCPCS code J2326 and deleted code C9489.

45. Ocrelizumab (Ocrevus®) Infusion - Annual HCPCS coding update: added HCPCS code J2350

46. Olaratumab (Lartruvo) - Annual HCPCS coding update: added HCPCS code J9285 and deleted code C9485

47. Percutaneous Electrical Nerve Stimulation (PENS) - Annual CPT/HCPCS coding update: deleted 64565 from Billing/Coding Information section. Revised Programs Exceptions section. Reformatted guideline.

48. Physical Therapy (PT) and Occupational Therapy (OT) - Revision: updated Reimbursement Information section.

49. Positron Emission Tomography (PET Scan) Miscellaneous Applications - Annual HCPCS code update. Deleted A9599.

50. Positron Emission Tomography (PET) Cardiac Applications - Annual HCPCS code update. Added 0482T.

51. Psychiatric Services - Revision: updated Reimbursement Information section.

52. Radiofrequency Ablation of Solid Tumors Other Than Liver Tumors - Annual HCPCS code update. Revised 32998 code descriptor.

53. Sarilumab (Kevzara) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis indication.

54. Secukinumab (Cosentyx) - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Secukiumab (Cosentyx) was added as a preferred product for axial spondyloarthritis, plaque psoriasis, and psoriatic arthritis.

55. Teriparatide (Forteo®) – Review and revision to guideline; consisting of updating position statement.

56. Tocilizumab (Actemra®) Injection - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use. Tofacitinib (Xeljanz, Xeljanz XR) added as prerequisite therapy for rheumatoid arthritis when tocilizumab is used as self-administered subcutaneous therapy.

57. Tofacitinib (Xeljanz, Xeljanz XR) Tablets - Revision to guideline consisting of updating the preferred self-administered biologic products according to indication for use.

58. Transcranial Magnetic Stimulation - Annual review; revised position statement. Updated references.

59. Transcutaneous Electric Nerve Stimulation (TENS) - Annual CPT/HCPCS coding update: added 64550.

60. Treatments for Varicose Veins/Venous Insufficiency - Annual CPT/HCPCS update. Added codes 36465, 36466, 36482, 36483; revised codes 36468, 36470, 36471.

61. Tumor/Genetic Markers - Annual CPT/HCPCS update. Added code 0026U.

62. Ustekinumab (Stelara™) - Revision to guideline consisting of updating the description section, position statement, and references after expanded FDA-approved indication for plaque psoriasis to include adolescent patients. The preferred self-administered biologic products were also updated according to indication for use. Addition of HCPCS code J3358 and deletion of code Q9989.

63. Vagus Nerve Stimulation - Annual CPT/HCPCS coding update: revised 64550.

64. Ventricular Assist Devices and Total Artificial Hearts - Annual CPT/HCPCS coding update: added 33927, 33928, 33929, Q0477; deleted 0051T, 0052T, 0053T.

65. Viscosupplementation, Hyaluronan Injections (e.g. Synvisc®) - Annual HCPCS coding update: revision to description of HCPCS code J7321.

66. Wheelchairs and Wheelchair Accessories - Annual CPT/HCPCS coding update: added E0953, E0954 to section V.



Internet Privacy Statement   |   Terms of Use
 

Date Printed: January 18, 2018: 01:05 PM