The chart below identifies updates to our Medical Necessity Guidelines. For additional details, refer to the Medical Necessity Guidelines page on our Point32Health provider website, where you can find coverage and prior authorization criteria for our Harvard Pilgrim and Tufts Health Plan lines of business.
| Updates to Medical Necessity Guidelines (MNG)
Visit the Medical Necessity Guidelines page on our Point32Health provider website |
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| MNG Title | Products Affected | Effective Date | Summary |
| Remote Patient Monitoring | All products | May 1, 2024 | New integrated Point32Health MNG, intended to serve as a coverage guideline – prior authorization will not be required.
CPT codes 99091, 99453, 99454, 99457, and 99458 will be covered when medically necessary for the treatment of heart failure or chronic obstructive pulmonary disease. |
| Genetic and Molecular Diagnostic Testing | Tufts Health Plan Commercial | March 1, 2024 | ThyGeNext and ThyraMIR will now be covered with prior authorization, along with CPT codes 81455, 0245U, and 0018U. |
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