Insurance Updates: August 17

By Policy and Advocacy Brief posted 08-17-2022 09:00

  

Insurance Updates:  August 17

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding botulinum toxin and prostate procedures.

BCBS North Carolina

BCBS North Carolina reviewed its Bundling Guidelines Reimbursement & Billing Document adding standby services to applicable services with associated reimbursement guidelines.

Read the update.

BCBS North Dakota

BCBS North Dakota reviewed its Chemodenervation with Botulinum Toxin Policy with the following changes:

  • Removed CPT code 53899
  • Revised applicable CPT codes associated with each drug
  • Updated list of ICD-10 diagnosis codes
  • Added initial authorization duration of 12 months

Read the update.

CGS Administrators

CGS Administrator reviewed its Next-Generation Sequencing Lab-Developed Tests for Inherited Cancer Syndromes (MoIDX) (J15) (A58734) Local Coverage Article (LCA) with the following change:

  • Under CPT/HCPCS codes group 2: codes deleted 81162, as the addition of this code in revision 1 was done in error.

Read the update.

CGS Administrators reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (A58065) Local Coverage Article (LCA) revising the code description for CPT Code 0016M due to the third quarter 2022 CPT/HCPCS code update, effective July 1.

Read the update.

Noridian

Noridian reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MoIDX) (JE) (A58181) Local Coverage Article (LCA) revising the code description for CPT Code 0016M due to the third quarter 2022 CPT/HCPCS code update, effective July 1.

Read the update. (JE, A58181)

Read the update. (JF, A58187)

Palmetto

Palmetto reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (JJ, JM) (A58028) Local Coverage Article (LCA) revising the code description for CPT code 0016M due to the third quarter 2022 CPT/HCPCS code update, effective July 1.

Read the update.

United Healthcare

United Healthcare reviewed its Prostate Services and Procedures Medical Policy removing cryosurgery of the prostate from applicable procedures with associated guidelines and adding a notation for procedures not addressed in this policy.

Read the update.

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