Medical Policy Updates

View any medical policy or medical necessity criteria changes that will be implemented in the next 60 days or more.

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Medical Policy Updates
Use the Policy Number, Policy Title, or CPT Codes to find and view the full medical policy.
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Policy # Policy Title Change Type Summary of Changes Effective Date Provider Notification Date
12.01.020 Briumvi, Lemtrada, Ocrevus, Tysabri New Implementation of public facing guidelines for Briumvi, Lemtrada, Ocrevus, and Tysabri. BCBSWY has historically held prior authorization requirements for these medications but the criteria was furnished by our Pharmacy Benefit Manager and was cumbersome for providers to access. This is a posting of the criteria set. Please note that authorizations are subject to a one year authorization period while units approved will be subject to standard dosing and quantity level limits. 09/15/2024 07/15/2024
12.01.059 Verkazia New Implementation of New guidelines regarding the use of Verkazia. This has historically held prior authorization requirements but was included with other pharmaceuticals for criteria [Ophthalmic Immunomodulators]. This new criteria allows for medication specific guidelines to ensure clear presentation of requirements. 09/15/2024 07/15/2024
12.01.057 Filsuvez New Implementation of New guidelines regarding the use of Verkazia. This is a new to market product. 09/15/2024 07/15/2024
12.01.058 Vyepti New Implementation of public facing guidelines for Vyepti. BCBSWY has historically held prior authorization requirements for this medication but the criteria was furnished by our Pharmacy Benefit Manager and was cumbersome for providers to access. This is a posting of the criteria set. 09/15/2024 07/15/2024
8.03.010 Cognitive Rehabilitation New Cognitive Rehabilitation will now be managed through prior authorization. 09/22/2024 07/22/2024
06.01.055 Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer Disease Update Policy Title Changed; Clinical criteria updated to discuss requirements to ensure appropriate use for Alzheimer's Disease as well as FDG-PET criteria. 09/22/2024 07/22/2024
11.01.117 High Resolution Anoscopy Deleted No authorization will be required. 09/22/2024 07/22/2024
6.01.026 Oncologic Applications of Positron Emission Tomography Scanning (Geniourinary) Update Policy Title Changed; Clinical criteria updated for geniourinary oncolgic conditions and removal of all other oncologic indications. Other indications are listed in other policies. 09/22/2024 07/22/2024
15.01.002 Applied Behavioral Analysis New Implementation of public facing guidelines for Applied Behavioral Analysis. BCBSWY has historically held prior authorization requirements for these services. 09/22/2024 07/22/2024
06.01.067 Oncologic Applications of Positron Emission Tomography Scanning (Brain, Melanoma, Unknown Primary) New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.066 Oncologic Applications of Positron Emission Tomography Scanning (Thyroid, Neuroendocrine, Head and Neck) New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.064 Oncologic Applications of Positron Emission Tomography Scanning (Hematologic) New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.063 Oncologic Applications of Positron Emission Tomography Scanning (Bone and Sarcoma) New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.062 nan New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.061 Oncologic Applications of Positron Emission Tomography Scanning (Gastrointestinal and Pancreatic) New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.051 Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment New Implementation of New guidelines. 09/22/2024 07/22/2024
7.01.044 Implantable Cardioverter Defibrillators New Implementation of New guidelines 09/22/2024 07/22/2024
06.01.065 Oncologic Applications of Positron Emission Tomography Scanning (Lung) New Implementation of New guidelines. 09/22/2024 07/22/2024
06.01.006 Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography New Implementation of New guidelines. 09/22/2024 07/22/2024
15.01.001 Wearable Cardioverter Defibrillators New Implementation of New guidelines. 09/22/2024 07/22/2024
02.02.015 Wearable Cardioverter Defibrillators Deleted Archiving the criteria and replacing with New policy 15.01.001 09/22/2024 07/22/2024
06.01.020 Cardiac Applications of Positron Emission Tomography Scanning New Implementation of New guidelines. 09/22/2024 07/22/2024