The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. For markets with carved-out pharmacy services, the applicable listings below are informational only.

 

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To search for specific policies or guidelines, visit http://www.empireblue.com/medicalpolicies/search.html.

 

Medical Policies

On September 13, 2018, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Empire BlueCross BlueShield HealthPlus (Empire).

 

Publish date

Medical Policy number

Medical Policy title

New or revised

10/17/2018

MED.00125

Biofeedback and Neurofeedback

New

10/17/2018

SURG.00103

Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)

Revised

 

Clinical UM Guidelines

On September 13, 2018, the MPTAC approved the following Clinical UM Guidelines applicable to Empire. This list represents the guidelines adopted by the medical operations committee for the Government Business Division on September 27, 2018.

 

Publish date

Clinical UM Guideline number

Clinical UM Guideline title

New or Revised

10/17/2018

CG-DME-46

Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Lower Limbs

New

10/17/2018

CG-SURG-90

Mohs Micrographic Surgery

New

9/20/2018

CG-DRUG-94

Rituximab (Rituxan®) for Non-Oncologic Indications

Revised

10/17/2018

CG-DRUG-107

Pharmacotherapy for Hereditary Angioedema

Revised

9/20/2018

CG-SURG-40

Cataract Removal Surgery for Adults

Revised



Featured In:
January 2019 Empire Provider Newsletter