Medical Policy & Procedure Updates

Lighthouse Medical Policy Updates effective March 1, 2020:

1.    A new policy on Onasemnogene Abeparvovec-axgt (Zolgensma ®) will be implemented on March 1, 2020. Procedure codes J3490, J3590, 96365-96368 will require prior authorization and final CMO approval prior to coverage of Zolgensma treatment for Spinal Muscular Atrophy. For more information, please reference the policy here: 

PA.218 Zolgensma_Lighthouse.pdf


2.    A new policy on Cochlear Implants will be implemented on March 1, 2020 for Lighthouse Health Plan. Procedure codes 69930, 92700, L7510, L8614, L8615, L8616, L8617, L8618, L8619, L8623, L8624, L8627, L8628, L8629 will require prior authorization as outlined by the policy guidelines. For more information, please reference the policy here:

PA.219 Cochlear Implants_Lighthouse.pdf


3.    A new policy on Pain Management will be implemented on March 1, 2020. Procedure codes 64479, 64480, 64483, 64484, 20526, 27096, 28899, 64450, 64455, 64461, 64462, 64463, 64490, 64491, 64492, 64493, 64494, 64495, 77003 for Nerve Block, Paravertebral, Facet Joint, and SI injections, Epidural Injections. and Peripheral Nerve Blocks will require prior authorization as outlined by the policy guidelines. For more information, please reference the policy here: 

PA.220 Pain Management_Lighthouse.pdf

 

For questions or concerns regarding the new policies, please contact the Utilization Department at 1-844-824-8846.