Policy Updates June 2014

The information outlines updates to policies that are effective this month. To view the updated policy in its entirety, select the policy name.

Policy Name Affected Physicians Updates Effective Date
Repository Corticotropin (Acthar® Gel)
  • Family medicine physicians
  • Neurologists
  • Nephrologists
  • With this update, we will no longer cover repository corticotropin (Acthar Gel) injections for any condition other than the treatment of children two years old and under with West syndrome (also known as infantile spasms).
  • This includes the following diagnosis and HCPCS codes:
    • Diagnosis codes: 345.60, 345.61
    • HCPCS code: J0800

This will continue to require precertification for outpatient procedures. Claims submitted without precertification will be denied.

  • 06/13/2014

The appearance of an item or procedure in this update indicates only that we have recently adopted or revised a policy. It does not imply that we provide coverage for the items or procedures listed. In the event of an inconsistency or conflict between the information provided below and the posted policy, the provisions of the posted policy will prevail.