ICD-10 Q74.3 is officially defined as "Arthrogryposis multiplex congenita." code Q74.3 is referenced in 4 tracked payer policy changes from Health Net and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Q74.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Health Net updated 22 medical policies in Q4 2019, including new policies for Antithrombin III treatment, implantable hypoglossal nerve stimulation, and video EEG monitoring. Key changes include lowered colorectal cancer screening age to 45, updated bariatric surgery criteria, and multiple billing code additions/removals across various specialties.
Health Net updated 25 medical policies for Q4 2019, affecting prior authorization requirements, billing codes, and coverage criteria across multiple specialties. Key changes include new prior auth requirements for antithrombin III, hypoglossal nerve stimulation, and video EEG, plus updated criteria for bariatric surgery, cardiac risk assessment, and various pain management procedures.
Health Net updated 25+ medical policies in Q4 2019 with significant changes to prior authorization requirements, coverage criteria, and billing codes across multiple specialties. Key changes include updated bariatric surgery criteria, new DNA stool screening age range (45-85), added prior authorization requirements for various procedures, and terminology updates for gender-affirming procedures.
Aetna considers canes, crutches, and walkers medically necessary durable medical equipment when the member has a mobility limitation that significantly impairs participation in one or more mobility-related activities of daily living (MRADL) in the home, the member can safely use the device, and the functional deficit can be sufficiently resolved by the device. Axillary, articulated, spring-assisted crutches, sit-and-stand walking assistant crutches, walkers with enclosed frames, walking belts, and standard strollers are not considered medically necessary, and enhancement accessories such as style, color, seat attachments, tray attachments, baskets, or cup holders are not covered. The AutoAmbulator, battery or electronic powered walkers such as the Sully Walker, the Upsee mobility device, and the wearable freezing of gait detection system are considered experimental, investigational, or unproven.
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