News
Effective December 2, 2021: Clinical Policies
Fecha:
29/09/21
Superior HealthPlan has updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on December 2, 2021, at 12:00AM.
POLICY
| APPLICABLE PRODUCTS
| NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
|
|---|
DME
(CP.MP.107)
| Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter
| Policy updates include:
- Updated policy to remove neuromuscular stimulator, functional neuromuscular stimulator, and peroneal nerve stimulator, which was transferred to CP.MP.48 Neuromuscular Electrical Stimulation (NMES)
- Replaced existing Standing Frames criteria with new initial request and replacement request criteria
- Revised section on pneumatic compression devices to state that they are not proven safe and effective for lymphedema of the abdomen, trunk, chest, genitals, or neck; and for arterial insufficiency
- Added criteria for Wheelchair-mounted Assistive Robotic Arm (JACO)
- Reorganized Standing Frame criteria and required that replacement requests also meet existing criteria for the initial request
- For initial request under 18, added "and one of the following: Developmental delay in ambulation and ≥ 18 months of age; Documented neurological or neuromuscular impairments and ≥ 1 year of age”
- Required that documentation supports
- meeting height and weight requirements
- alert and responsive to stimuli
- no contraindications to standing program
- and caregiver trained, available, and able to safely assist
- Removed requirement for “able to tolerate upright position”
- Added informational note
- Removed requirement for replacement requests not due to physiological changes to meet existing criteria and reformatted criteria. Contents table renumbered
|
Nerve Blocks for Pain Management (CP.MP.170)
| Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter
| Policy updates include:
- Added refractory chronic pancreatitis as an indication for celiac plexus block to section III and updated background accordingly
- Added ICD -10 codes K86.0 & K86.1 to support coverage criteria
- Changed “Experimental/investigational” language in section V. and VI.E. to “insufficient evidence to support…”.Under section VI, moved “Note” for visibility
- Added insufficient evidence to support peripheral nerve block for treatment of trigeminal neuralgia to VI.D, removed G50.0 from list of ICD 10 codes that support coverage criteria and updated background accordingly
|
To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.
Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.
For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.
