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Musculoskeletal Medical Policy Updates Effective September 15, 2022

Audience: Participating Pain Medicine Practitioners, Orthopedic Surgeons, and Orthopedists

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment.  Providers can attach supporting documentation related to their comments.

The following updated medical policies have been reviewed and were approved on May 19, 2022, by the Corporate Medical Policy Committee, including practitioner representatives from all Health Plan regions. 
 
The corporate medical policies listed below have been updated to be consistent with eviCore Healthcare recommendations and are effective September 15, 2022. The policies apply to the services of all practitioners and facilities. The policies do not apply to all lines business; benefits are contract dependent. Please refer to the medical policy and the member’s subscriber contract.

7.01.90 – Lumbar Fusion for Adults – Updates include changes to the investigational criteria including the addition of devices/procedures. 

7.01.42 – Radiofrequency Facet and Sacroiliac Joint Ablation/Denervation – Updates include changes to clarifications of not medically necessary criteria, changes to the investigational criteria, including a new device/procedure, as well as the addition of a new policy guideline.

7.01.51 – Spinal Cord Stimulation / Dorsal Column Stimulation – Updates include changes to the medically appropriate criteria regarding the presence of a medical and/or psychological diagnosis, as well as changes/additions to investigational criteria.  

The rationale section of the medical policy provides information related to the Health Plan’s change in coverage criteria.

These services are subject to audit and policy updates at the Health Plan’s discretion. You can access the individual policies on the Medical Policies page.

If you have any questions regarding this policy, please contact your Provider Relations representative.
Thank you for the quality of care and service that you provide to our members.

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