24-933m Stay Compliant By Reviewing the Changes to Medical Policies for Medicare

Date: 08/30/24

View new clinical policies and updates to existing policies

The medical policies listed in this update were approved by Centene’s National Medicare Quality Improvement Utilization Management Committee and are effective as of August 1, 2024.

For a complete description of the background, criteria, references, and coding implications for these Medicare medical policies, go to the Medicare Prior Authorization Medical Clinical Policies page.

Apply the Medicare National Coverage Decisions (NCDs) and applicable Local Coverage Decisions (LCDs) local policies for primary coverage guidance.

Clinical policies effective August 1

The following are Medicare clinical policies that have been approved for use. The listed policies are in alphabetical order and are effective as of August 1, 2024.

New policies:

• MC.CP.MP.184 Home Ventilators
• MC.CP.MP.249 Omisirge^®
• MC.CP.MP.190 Outpatient Oxygen Use
• MC.CP.MP.247 Transplant Service Documentation Requirements

Change to existing policy:

• MC.CP.MP.170 Peripheral Nerve Blocks – Added criteria III.B. regarding genicular nerve blocks.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone 800-929-9224 or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.