Aetna’s recent changes include a policy update and two form updates. For Autologous Chondrocyte Implantation patients, Aetna’s policy has been updated. This policy list out the criteria required for the carrier to prefer this procedure medically important to repair cartilage defects of knee, as well as the criteria for when implants are considered experimental and investigational. Diagnoses that are not covered by adding discoid lateral meniscus tear were updated as well. Their two new forms are also updated:

Viscosupplementation medication request form

Osteoporosis injectable medication request form.

Cigna updated their medical coverage policy for miscellaneous musculoskeletal procedures that includes the removal of coverage for in-office diagnostic arthroscopy. According to the provider, in-office diagnostic arthroscopy or any upper or lower extremity joint for evaluation of joint pain and/or pathology is considered experimental, investigational, or unproven. Cigna also made changes to their Medical coverage policy for knee surgery.

United Healthcare Policy changes and updates relate mainly to the authorization of services. United Healthcare start reviewing the site of services in their prior authorization process. The site of services will be reviewed for medical necessity, and certain reviews concern musculoskeletal surgical procedures. When the procedure is performed, changes and modification to approved prior authorization is allowed within five days.

Blue Cross Blue Shield of Illinois updated their medical policy for orthopedic applications of PRP, which is not being covered at this time. Their new policy on non-covered physical therapy services include details about when physical therapy is not considered medically important, which ways are considered experimental, treatments that do not require a licensed physio therapist, and more.

We work hard to do everything we can that can help you to keep your orthopedic or radiology practice as efficient and successful as possible. We are here to help you as we are more than a billing company, our Revenue Cycle management, Coding education, Practice Management and Consulting services are also provided to bring your practice to new heights. We will be your true partner that is fully committed to your practice’s achievement.