Effective July 1, 2023, we’re updating the following behavioral health-related Medical Necessity Guidelines (MNGs), which are applicable for Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Together, Tufts Health RITogether, Tufts Health Unify, and Tufts Health Direct:
Transcranial Magnetic Stimulation (TMS):
We’re adopting customized InterQual criteria for clinical review of the services associated with this MNG. Claims containing procedure codes 90867, 90868 and 90869 will prompt InterQual review, and prior authorization will be required for these codes. For more information, please refer to the updated MNGs available on the Point32Health and Tufts Health Plan provider websites.
Psychological and Neuropsychological Testing and Assessment:
Our Psychological Testing and Assessment (Point32Health provider site, Tufts Health Plan provider site) and Neuropsychological Testing and Assessment (Point32Health provider site, Tufts Health Plan provider site) MNGs are being updated to utilize customized InterQual criteria for clinical review.
Prior authorization will be required for these services and the associated codes identified on the MNGs — these prior authorization requirements are existing for some of the applicable products listed above and new for others, but will apply broadly as of July 1, 2023.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong,