Updates to Non-Covered Services Medical Policy

Harvard Pilgrim is updating our commercial New Technology Assessment and Non-Covered Services Medical Policy, effective for dates of service beginning Sept. 1, 2021, to include the following services and technologies as non-covered:

  • Acutis Reveal Urinary Tract Infection Test
  • Cardio-Pulmonary Stethoscope
  • Cochlear Osia System
  • CustomFlexTM Artificial Iris, except for aniridia
  • EyeBOX Concussion Diagnosis Device
  • FITBONE Intramedullary Limb-Lengthening System
  • Genicular Nerve Blocks
  • inflow Intraurethral Valve-Pump
  • MolecuLight i:X
  • NanoKnife System
  • NOCISCAN Suite
  • PRECICE Intramedullary Limb-Lengthening System
  • Spiration Valve System
  • Vestibular Evoked Myogenic Potential (VEMP) Testing
  • Zephyr Endobronchial Valve System
  • µ-Cor™ Heart Failure and Arrhythmia Management System

For complete information, including coding, please refer to the updated New Technology Assessment and Non-Covered Services Medical Policy.

Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
Production Coordinator