Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

March 2019

Updates to Medical Policies


Harvard Pilgrim regularly reviews our commercial medical policies and prior authorization criteria and makes updates based on the current clinical literature and best practices. As part of this ongoing review, we have updated the following medical policies for commercial plans:

  • Breast Surgeries Medical Policy – added language to specify coverage for breast implant removal following anaplastic large cell lymphoma due to a ruptured breast implant (regardless of the indication for initial implant placement) and inverted nipple correction
  • Hysterectomy Medical Policy – expanded coverage of prophylactic hysterectomy in conjunction with bilateral salpingo-oophorectomy
  • Transgender Health Services Medical Policy – prior authorization no longer required for the following CPT codes: 21235, 54520, 58720, 14041, 14301, 14040, 58661, and 55866.

For complete information, please refer to the updated clinical medical policies.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Harvard Pilgrim Network Meeting: Sign Up for the Mass. Event

CLINICIAN CORNER

Update: Emergency Care and Controlled Substances

Updates to Medical Policies

Udenyca Now Covered with Prior Authorization

Reminder: Anser IFX, UST, and VDZ Tests Not Covered

OFFICE ASSISTANT

Guidance Regarding Procedures Designated as a “Separate Procedure”

Keep Panel Status and Demographic Information Up to Date

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator