Federal and state law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over medical policy and clinical guidelines (and medical policy takes precedence over clinical guidelines) and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that the services are rendered must be used. This document supplements any previous medical policy and clinical guideline updates that may have been issued by Empire. Please include this update with your Provider Manual for future reference.
Please note that medical policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Empire’s medical policies and clinical guidelines can be found at empireblue.com.
*Note: These updates may not apply to all ASO Accounts as some accounts may have non-standard benefits that apply.
Medical Policy Updates
Revised Medical Policy Effective 07-30-2019
(The following policy was revised to expand medical necessity indications or criteria.)
- MED.00129 - Gene Therapy for Spinal Muscular Atrophy
Clinical Guideline Updates
Archived Clinical Guideline Effective 10-01-2019
(The following guideline has been archived and has been replaced by AIM guidelines.)
- CG-MED-80 - Positron Emission Tomography (PET) and PET/CT Fusion
September 2019 Empire Provider News