Asuris Medicare Advantage and its affiliated Plans use medical policies as guidelines for coverage decisions within the member’s written benefits. Below are summaries of recent changes to the Medicare Advantage medical policy manual. We have included the section and policy number for your convenience.
The complete Medicare Medical Policy Manual with detailed policies are available online at https://www.asuris.com/provider/library/policies-guidelines/medical-policy/ma-medical-policy.
Policy name | Summary of policy or change | Effective date | Section and policy number |
|---|---|---|---|
New policy to address electromagnetic navigation bronchoscopy. | July 1, 2025 | Surgery #M-179 | |
Expanding post-service review of rotary air ambulance. | July 1, 2025 | Utilization Management #M-13 | |
Definitive Lower Limb Prostheses(href: https://beonbrand.getbynder.com/m/04fdc99710cd4e6f/" target: "_blank") | Clarified that policy does not address preparatory prostheses. | May 1, 2025 | Durable Medical Equipment #M-18 |
Updated policy with new Medicare correct coding and billing article for lymphedema compression garments. | May 1, 2025 | Durable Medical Equipment #M-92 | |
Removed reference to LCD Skin Substitute Grafts for Diabetic Foot and Venous Leg Ulcers, as this LCD now has an effective date of 1/1/2026. | May 1, 2025 | Medicine #M-170 | |
Added Medicare guidance for disposable negative pressure wound therapy devices and care. | April 1, 2025 | Durable Medical Equipment #M-42 | |
New policy for mechanical residual limb volume management systems (e.g., RevoFit) for upper extremity prostheses. | April 1, 2025 | Durable Medical Equipment #M-98 | |
Revised to align with the 2025 Q2 code update and updated Medicare guidance. | April 1, 2025 | Genetic Testing #M-64 | |
Revised to align with the 2025 Q2 code update and updated Medicare guidance. | April 1, 2025 | Genetic Testing #M-83 | |
Revised to align with the 2025 Q2 code update. | April 1, 2025 | Medicine #M-149 | |
Adding new LCD (L39812) and Article (A59697) addressing minimally invasive sacroiliac joint fusion. | April 1, 2025 | Surgery #M-193 | |
Updated criteria to use commercial policy for TYMS testing in the health plan service area. | March 1, 2025 | Laboratory #M-64 | |
Added additional guidance for wheelchair accessories. | February 1, 2025 | Durable Medical Equipment #M-37 | |
Added new NCD addressing implanted pulmonary artery pressure sensors for heart failure management. | February 1, 2025 | Medicine #M-33 | |
Removed retired LCD guidance. | February 1, 2025 | Medicine #M-49 | |
Added new Noridian LCD, Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers. | February 1, 2025 | Medicine #M-170 | |
New policy addresses the use of ablation of peripheral nerves to treat pain. | February 1, 2025 | Surgery #M-236 | |
Updated policy to address concurrent optical and electromagnetic stimulation for wound healing. | January 1, 2025 | Durable Medical Equipment #M-83 | |
Updated the policy in alignment with the 2025 Q1 annual code update and latest Medicare guidance. | January 1, 2025 | Genetic Testing #M-64 | |
Updated the policy in alignment with the 2025 Q1 annual code update and latest Medicare guidance. | January 1, 2025 | Genetic Testing #M-83 | |
Updated the policy in alignment with the 2025 Q1 annual code update. | January 1, 2025 | Medicine #M-149 | |
| January 1, 2025 | Surgery #M-235 | |
New policy addresses screening laboratory testing in asymptomatic individuals. | December 1, 2024 | Laboratory #M-80 | |
NCD 110.23 criteria for allogeneic HSCT for myelodysplastic syndrome (MDS) has been expanded. | December 1, 2024 | Transplant #M-45 |
Policy name | Archive date | Medicare Manual section and policy # |
|---|---|---|
None to report in past six months |