Billing chart: Blues highlight medical, benefit policy changes

22867, 22868, 22869, 22870

Basic benefit and medical policy

Interspinous/interlaminar distraction devices

Interspinous or interlaminar distraction devices are considered established as a treatment of neurogenic intermittent claudication and spinal stenosis resulting in leg, buttock or groin pain, with or without back pain, or when used as a stabilization device following decompressive surgery. They may be considered useful therapeutic options for patients meeting specified patient selection criteria, effective Sept. 1, 2017.

Inclusions (must meet all):

• Patients age 40 or older suffering from (intermittent neurogenic claudication) secondary to a confirmed diagnosis of lumbar spinal stenosis.
• The patient must have a history of moderately impaired physical function with demonstrated relief when in flexion from their symptoms of leg, buttock or groin pain, with or without back pain.
• Patients must have undergone six months of non-operative conservative treatment including non-steroidal therapy, comprehensive physical therapy, and epidural injection series before to be considered for surgery.

Exclusions:

• Allergic to titanium or titanium alloy.
• Spinal anatomy or disease that would prevent implant of the device or cause the device to be unstable in situ, such as significant instability of the lumbar spine, e.g., isthmic spondylolisthesis or degenerative spondylolisthesis greater than grade 1.0 (on a scale of 1 to 4); an ankylosed segment at the affected levels; acute fracture of the spinous process or pars interarticularis.
• Prior fusion or decompressive laminectomy at any index lumbar level.
• Radiographically compromised vertebral bodies at any lumbar levels caused by current or past trauma or tumor (e.g., compression fracture).
• Severe facet hypertrophy that requires extensive bone removal that would cause instability.
• Significant scoliosis (Cobb angle greater than 25 degrees).
• Grade II or greater spondylolisthesis.
• Isthmic spondylolisthesis or spondylolysis (pars fracture).
• Cauda equina syndrome, defined as neural compression causing neurogenic bowel or bladder dysfunction.
• Diagnosis of severe osteoporosis (T score of <-1.0 [WHO definition of osteopenia]).
• Active systemic infection or infection localized at the site of implantation.
• Body mass index > 40kg/m2.
• Back or leg pain of unknown etiology.
• Axial back pain only, with no leg, buttock or groin pain.
• Active or chronic infection — systemic or local.

J7199

Basic benefit and medical policy

Rebinyn^® (Coagulation Factor IX [Recombinant], GlycoPEGylated)

Effective May 31, 2017, Rebinyn^® (Coagulation Factor IX [Recombinant], GlycoPEGylated) is covered for FDA-approved indications that is indicated for use in adults and children with hemophilia B for on-demand treatment and control of bleeding episodes and for perioperative management of bleeding intravenously. Rebinyn (Coagulation Factor IX [Recombinant], GlycoPEGylated) should be reported with NOC code J7199, until a permanent code is established.

Pharmacy doesn’t require preauthorization of this drug.

17106, 17107, 17108

Basic benefit and medical policy

Payable codes

The diagnosis codes below are now payable for the procedure codes at left.

0440T, 0441T, 0442T

Basic benefit and medical policy

Cryoablation for treatment of peripheral neuropathy is experimental

Cryoablation (i.e., cryoneurolysis or cryoanalgesia) for the treatment of peripheral neuropathy is experimental. It hasn’t been scientifically demonstrated to improve patient clinical outcomes, effective Jan. 1, 2018.