Insurance Updates:  February 17, 2021

By Policy and Advocacy Brief posted 02-17-2021 16:19

  

Insurance Updates:  February 17, 2021

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) North Dakota reviewed its Chemodenervation with Botulinum Toxin and Urological Supplies Policies.

Additionally, BCBS North Carolina updated its Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management Policy.

COVID-19 Updates:

Aetna

Aetna published its COVID 19 Patient Coverage News & Announcements provider bulletin:

Announcing for its:

  • Commercial members, Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19, effective through February 28.
  • Medicare Advantage members, Aetna will cover the cost of treatment of COVID-19 in provider offices and for hospital stays, effective through February 28.

Aetna also updated an announcement regarding that CVS Health has now established testing sites at more than 4,800 CVS Pharmacy locations across the country.

Read the update.

Aetna published its COVID 19 Telemedicine News (Commercial) & Announcements updating its provider bulletin to announce:

  • Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care and behavioral health through March 31.
  • For all Medicare Advantage members, cost share waivers for specialist telehealth visits expired on January 31.

Read the update.

BCBS Rhode Island

BCBS Rhode Island published its TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of COVID-19 during the COVID-19 Crisis Policy

Read the update.

BCBS Western NY

BCBS Western NY published its Provider Information Regarding COVID 19 (Coronavirus) News & Announcements announcing:

Audio with video visits (CPT codes 99212-5) to be paid FFS at 100% of in-office rates.

Read the update.

Cigna

Cigna published its COVID 19 News (Individuals and Families) Announcements provider bulletin announcing that Cigna is waiving out-of-pocket costs for COVID-19 FDA-approved testing until April 20.

Read the update.

 

National Insurance Carriers/MACs Updates:

BCBS North Carolina

BCBS North Carolina reviewed its Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management Policy adding the following CPT code:

  • 0005U – Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score

Read the update.

BCBS North Dakota

BCBS North Dakota reviewed its Chemodenervation with Botulinum Toxin Policy adding the following to its medically necessary criteria for Botox:

  • Benign prostatic hyperplasia in adults who no longer respond to medication and refuse surgical treatment with moderate to severe symptoms of urinary obstruction based on the American Urological Association (AUA) index, mean peak urinary flow rate less than 15 mL/sec with voided volume of at least 150 mL, and an enlarged prostate gland

Read the update.

BCBS North Dakota reviewed its Urological Supplies (Commercial) Policy adding HCPCS code:

T4539 – Incontinence product, diaper/brief, reusable, any size, each

Read the update.

CGS Administrators

CGS Administrators reviewed its Molecular Diagnostic Tests (MolDX) (J15) (A56973) Local Coverage Article (LCA) with the following changes to coding due to the Q1 2021 CPT/HCPCS code update and MoIDX program.

Added CPT code:

  • 0133U – Hereditary prostate cancer–related disorders, targeted mRNA sequence analysis panel (11 genes) (List separately in addition to code for primary procedure)

Removed CPT code:

  • 0021U – Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5’-UTRBMI1, CEP 164, 3’-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score
  • 0053U – Oncology (prostate cancer), FISH analysis of 4 genes (ASAP1, HDAC9, CHD1 and PTEN), needle biopsy specimen, algorithm reported as probability of higher tumor grade

Read the update.

Cigna

Cigna released its new Oncology Injectable (Gonadotropin-Releasing Hormone Analogs) (CA Commercial) Policy.

Read the update.

First Coast Service Options

First Coast Service Options retired its Prostate Biopsies (JN) (A52575) Local Coverage Article (LCA) effective February 4.

Read the update.

Noridian

Noridian reviewed its Prolaris Prostate Cancer Genomic Assay (MolDX) Local Coverage Article (LCA) adding the following HCPCS code:

  • 0228U – Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morning voided urine, algorithm reported as likelihood of prostate cancer

Read the update. (JE) (A57509)

Read the update (JF) (A57511)

Noridian reviewed its Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease (MolDX) Local Coverage Article (LCA) adding the following HCPCS code:

  • 0228U – Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morning voided urine, algorithm reported as likelihood of prostate cancer

Read the update (JE) (A57514)

Read the update (JF) (A57691)

Noridian reviewed its Prostate Cancer Genomic Classifier Assay for Men with Localized Disease Local Coverage Article (LCA) adding HCPCS code:

  • 0228U – Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morning voided urine, algorithm reported as likelihood of prostate cancer

Read the update (JE) (A57372)

Read the update (JF) (A57236)
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