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) | |||
| MNG Title | Products Affected | Effective Date | Summary |
| Continuous Glucose Monitoring and Diabetes Management Devices for Tufts Health Together | Tufts Health Together | 9/1/2024 | MNG updated to reflect updates to MassHealth’s guidelines:
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| Genetic Testing: Cell Free DNA Testing for Fetal Trisomy | Tufts Health Plan Commercial | 9/1/2024 | MNG updated to align with coverage from Carelon. As a result, we may authorize maternal blood sampling of cell-free fetal DNA screening for trisomy 21, 18, and 13 in accordance with the criteria identified on the MNG. |
| Noncovered Investigational Services | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care | 9/1/2024 | Noncovered Investigational Services MNG updated to clarify that xenotransplantation (transplantation of living cells, tissues, or organs from one species to another) is not covered. |
| eviCore Clinical Guidelines for Sleep Management | Tufts Health Commercial, Tufts Health Direct, Tufts Health MA Together, Tufts Medicare Preferred | 9/1/2024 | Annual review, minor criteria updates/formatting changes. |