Medical Policy Update for September 12, 2023

Removed the following statement from Note 3 under When Not Covered section, “In individuals under 18 years of age not already diagnosed with diabetes.” Medical Director review 8/2023.

Specialty Matched Consultant Advisory Panel review 8/16/2023. References added.

Updated description for clarity. Moved the following statement from Policy Guidelines to When Covered section for clarity, “The receiving facility in an interfacility transfer should be the nearest participating facility that can provide the necessary care unless there are extenuating circumstances. In the case of inability, lack of capacity, or refusal of the nearest participating facility to accept the patient, the patient should then be transferred to the next nearest participating facility that can provide the necessary care. Review by a Health Plan Medical Director is required in these circumstances.” Medical Director review 8/2023. No change to policy statement.

CPT codes 33274 and 33275 removed from Billing/Coding section effective 4/1/23.