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Effective January 1, 2024: Retired Medicare Clinical and Clinical Payment Policies

Date: 02/28/24

To comply with the 2024 CMS Final Rule, the following clinical policies and clinical payment policies and associated payment edits were retired for all Wellcare By Allwell (HMO, HMO D-SNP) effective January 1, 2024.   

As a result, the following list of policies have been retired, and the applicable Medicare covered services and procedures covered without requiring prior authorization, and applicable clinical payment edits removed.

  • Digital Electroencephalography Spike Analysis  (CP.MP.105)        
  • Bronchial Thermoplasty  (CP.MP.110)         
  • Homocysteine Testing  (CP.MP.121)          
  • Laser Therapy for Skin Conditions  (CP.MP.123)          
  • ADHD Assessment and Treatment (CP.MP.124)
  • Evoked Potential Testing (CP.MP.134)
  • Measurement of Serum 1,25-dihydroxyvitamin D (CP.MP.152)
  • H. Pylori Serology Testing  (CP.MP.153)          
  • Thyroid Hormones and Insulin Testing in Pediatrics  (CP.MP.154)         
  • Electroencephalography in the Evaluation of Headache (CP.MP.155)          
  • Cardiac Biomarker Testing (CP.MP.156)
  • Polymerase Chain Reaction Respiratory Viral Panel Testing (CP.MP.181)
  • GI Pathogen Nucleic Acid Detection Panel Testing  (CP.MP.209)          
  • Pulmonary Function Testing  (CP.MP.242)          
  • Ultrasound in Pregnancy  (CP.MP.38)            
  • Testing for Select Genitourinary Conditions  (CP.MP.97)       
  • Urodynamic Testing (CP.MP.98)            
  • Wheelchair Seating (CP.MP.99)            
  • Scan Comp Oph Diag Imaging  (OC.UM.CP.0014)
  • Bariatric Surgery (CP.MP.37) 
  • Bevacizumab (Avastin) (CP.PHAR.93) 
  • Cell-free Fetal DNA Testing (CP.MP.84) 
  • Deep Transcranial Magnetic Stimulation for the Treatment of Obsessive Compulsive Disorder (CP.BH.201) 
  • Diagnostic Testing Guidelines for 2019-Novel Coronavirus (CP.MP.183) 
  • DNA Analysis of Stool (CP.MP.125) 
  • Drugs of Abuse: Presumptive Testing (CP.MP.208) 
  • EEG in Evaluation of Headache (CP.MP.155) 
  • Endometrial Ablation (EA) (CP.MP.106) 
  • EpiFix Wound Treatment (CP.MP.140) 
  • Evoked Potentials (CP.MP.134) 

To review all clinical payment or payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Wellcare By Allwell (HMO, HMO SNP) Provider Services at 1-877-391-5921.