Medicare has revised the coverage rules for some healthcare procedures. To be covered, procedures generally must be received through a provider in your plan’s provider network, and some services may require prior authorization from Peoples Health.
You can learn more about these coverage changes by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048. If you have received any of these treatments on or after the effective dates and would like to seek reimbursement, contact member services.
On Nov. 29, 2017, Medicare issued a memo clarifying that it is delaying the date the Medicare Diabetes Prevention Program is available to eligible beneficiaries. The program will be available beginning April 1, 2018. A description of the program is included in the 2018 Evidence of Coverage.
On May 25, 2017, Medicare began covering supervised exercise therapy for members when the therapy is referred by a physician. Members with intermittent claudication (leg cramping typically caused by obstruction of the arteries) are eligible when treatment is for symptomatic peripheral artery disease. Up to 36 sessions over a 12-week period are covered if certain conditions are met. A second referral is required for additional sessions.
On Dec. 7, 2016, Medicare began covering percutaneous image-guided lumbar decompression (PILD) for members enrolled in certain CMS-approved clinical studies and who have lumbar spinal stenosis. PILD is a noninvasive procedure that uses specially designed instruments to relieve lower back pain from the condition. To be covered, the surgery must be performed on or after the date above.
The Centers for Medicare & Medicaid Services issued a mid-year benefit update covering percutaneous left atrial appendage closures when the procedure is done for patients with non-valvular atrial fibrillation and according to an FDA-approved indication for the procedure with an approved device. The coverage applies for services received on or after Feb. 8, 2016. Coverage requires that patients have: