Updates to Non-Covered Services Medical Policy

Effective for dates of service beginning Oct. 1, 2020, the following codes are being added to our commercial Non-Covered Services Medical Policy and will deny as provider-liable:

  • 61735 –Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; subcortical structure(s) other than globus pallidus or thalamus
  • 64640 –Destruction by neurolytic agent; other peripheral nerve or branch
  • 96931 –Reflectance confocal microscopy (RCM) for cellular and subcellular imaging of skin; image acquisition and interpretation and report, first lesion
  • 96932 –Reflectance confocal microscopy (RCM) for cellular and subcellular imaging of skin; image acquisition only, first lesion
  • 96933 –Reflectance confocal microscopy (RCM) for cellular and subcellular imaging of skin; interpretation and report only, first lesion
  • J7401 –Mometasone furoate sinus implant, 10 mcg
  • 53854 –Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy

In addition, lymphedema-related procedures and laser interstitial thermal therapy (LITT) will be added to the policy and no longer reimbursed. For more information, please refer to Harvard Pilgrim’s updated commercial Non-Covered Services Medical Policy.

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