Medical Policy and Coding Updates - July 2022
Summary
Effective July 1, 2022, the Designated Centers of Excellence policy for total knee or total hip replacement (7.01.568) is archived, and for dates of service beginning July 1, 2022, providers use the medical necessity criteria in Hip Arthroplasty in Adults (7.01.573) and Knee Arthroplasty in Adults (7.01.550). Effective July 1, 2022, codes J9271 and J9299 now require medical necessity review including site of service and prior authorization, and codes J0739, J1306, J2779 and J2998 now require medical necessity review and prior authorization. The same date removed medical necessity review for codes C9090 and C9091, and removed medical necessity and prior authorization review for code 11960 under gender transition/affirmation surgery.
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