May 2024 medical policy updates
Our Medical Advisory Committee (MAC), comprised of network physicians contracted with Priority Health, met in May and approved the medical policy updates described below.
Unless otherwise noted, the following updates will go into effect on June 1, 2024.
New medical policy
Computer Assisted Surgical Navigation (#91641)
This policy was developed to address the surge of computer assisted surgical (CAS) navigation technologies. The policy currently only addresses CAS navigation bronchoscopy, and the medical criteria follow National Comprehensive Cancer Network non-small cell lung cancer guidelines. The policy does not change existing coverage.
Coverage change
Experimental/Investigational/ Unproven Care/Benefit Exceptions (#91117)
Effective July 1, 2024, two codes for temporary prostatic stents (C9769 and 53855) will no longer be covered for Commercial and Medicaid lines of business.
Policies impacted by the TurningPoint cardiac program
These updates will take place when the cardiac authorizations program goes live.
The following medical policies will be retired because the procedures within their scope will be managed by TurningPoint Healthcare Solutions LLC (TurningPoint) through our new cardiac surgical authorizations program.
- Cardioverter Defibrillators (#91410)
- Drug Eluting Stents for Ischemic Heart Disease (#91580)
- Implantable Loop Recorder (#91618)
- Percutaneous Left Atrial Appendage Closure (#91605)
- Renal Artery Stenosis (#91561)
The following medical policies will be updated to indicate specific procedures will be managed by TurningPoint.
| Policy | Change |
| Balloon Sinus Ostial and Eustachian Tube Dilation (#91596) | CPT code C2625 (stent, noncoronary, temporary, with delivery system) which is currently not covered will be managed by TurningPoint |
| Carotid and Intracranial Artery Stenting (#91495) | The percutaneous transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s), including radiologic supervision and interpretation (CPT codes 0075T and 0076T), will be managed by TurningPoint |
| Transcatheter Heart Valve Procedures (#91597) | Aortic valve replacement, mitral valve repair or replacement, and tricuspid valve replacement will be managed by TurningPoint |
Updated medical policies
The following policies were updated to clarify language and experimental & investigational positions, or to align with updated industry standards.
- Breast Related Procedures (#91545)
- Cellular & Gene Therapy (#91638)
- Cosmetic and Reconstructive Surgery Procedures (#91448)
- Endoscopic Submucosal Dissection (ESD) (#91617)
- Enteral Nutritional Therapy (#91278)
- Hemophilia Management (#91569)
- Markers for Digestive Disorders (#91583)
- Peroral Endoscopy Myotomy (POEM) (#91616)
- Psychological Evaluation and Management of Non-Mental Health Disorders (#91546)
- Spine Procedures (#91581)
- Stem Cell or Bone Marrow Transplant (#91066)
- Stimulation Therapy and Devices (#91468)
- Transplant of Solid Organs (#91272)
For complete descriptions of the updates made: