Critical policy updates from Aetna, Cigna, and UnitedHealthcare to help RCM teams prevent denials and optimize revenue.
CPT 0932T, HCPCS C9305, E78.010-019
MS drugs, PAH therapies, Wakix
Rystiggo 63 days, Vyvgart 50 days
ESWT, Leqvio + PCSK9
Added CPT 0932T for noninvasive, echocardiogram-derived detection of heart failure using AI-supported methodologies.
Expanded treatment options including Dermofasciectomy, Digit Widget for PIP flexion contractures, and Sono-bath techniques.
Age threshold lowered to 45 years for average-risk adults aligned with USPSTF guidelines.
Expanded coverage for PAH therapies. Right heart catheterization now consistently required for eligibility.
Unified PA requirements across MS drug portfolio with reduced documentation burden for continuation therapy.
Step therapy now required: Trial of dextroamphetamine OR modafinil before Wakix approval.
Leqvio NOT covered when used concurrently with PCSK9 inhibitors. Added new ICD-10 codes for familial hypercholesterolemia.
Refined treatment intervals for FcRn blockers with updated CIDP diagnostic criteria.
Reaffirmed non-coverage for extracorporeal shock wave therapy (ESWT). DO NOT bill to UHC.
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