CP.MP.110

Bronchial Thermoplasty

Codes 31660 and 31661 are considered not medically necessary because the long-term safety and effectiveness has not been proven.

Marketplace

CP.MP.105

Digital EEG Spike Analysis

Digital EEG spike analysis is considered medically necessary for members who have intractable epilepsy with a need for presurgical evaluation.

Marketplace

CC.PP.050

Robotic Surgery

Code S2900 will not be paid because it is an add-on code billed in addition to the primary surgical procedure code and it denotes separate reimbursement for the robotic technique.

Marketplace

CP.MP.149

Testing for Rupture of Fetal Membranes

AmniSure, Actim PROM and the ROM Plus Fetal Membranes Rupture Test (tests billed with CPT® code 84112) are not medically necessary for members as they have not been shown to improve clinical outcomes over standard methods of diagnosis.

Marketplace

CP.MP.99

Wheelchair Seating

Special wheelchair seating cushions are medically necessary for the indications outlined in the policy.

Marketplace

CP.MP.100

Allergy Testing (Revision)

Revision to the existing policy to include additional accepted diagnosis codes as well as non-payable procedure codes.

Marketplace

CP.MP.97

Testing of Select GU Conditions (Revision)

Revision to the existing policy to include additional diagnosis codes that will deny payment for CPT 87798.

Marketplace