JHHC Medical Policies Update
These Medical Policies have been approved by the Medical Policy Advisory Committee (MPAC) Policy Effective Date: November 1, 2021
| Medical Policy | Line of Business | Provider Network | |||
|---|---|---|---|---|---|
| PCP (Family Practitioner, Internist, Pediatrician) |
Specialist* (Cardiologist, Neurologist, OB/GYN, Psychiatrist, Radiologist, Surgeon) |
Ancillary* (DME, Home Health, Infusion, PT/OT/ST) |
Facility* (Hospital, Lab Facility, Ambulatory Surgery Center, Skilled Nursing Facility, Hospice Facility, Radiology Facility) |
||
| CMS01.09 Continuity of Care and Access to Non-Participating Providers |
AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine, Pediatricians | Oncologists, Cardiologists, Neurologists, Infectious Disease Specialists, OB/GYN, Gastroenterologists, Dermatologists, Plastic surgeons, Pulmonologists, General Surgeons, Urologists, Rheumatologists, Endocrinologists, Orthopedists, Nephrologists, Transplant Surgeons, Otolaryngologists, Psychiatrists, Psychologists, Pain Management Specialists, Vascular surgeons, Thoracic surgeons, Cardiac surgeons | Home Health, PT, OT, ST, DME/DMS vendors | Hospital, Skilled Nursing Facility |
| CMS02.13 Bronchial Thermoplasty in the Treatment of Asthma | AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine | Pulmonologists, Allergist/ Immunologist | Hospital, Ambulatory Surgery Center | |
| CMS03.08 Reconstructive Surgery After Weight Loss Title updated to: Panniculectomy and Body Contouring Procedures |
AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine | Plastic Surgeons, Bariatric Surgeons, General Surgeons | Ambulatory Surgery Center, Hospital | |
| CMS07.05 Gender Affirmation Treatment & Procedures | AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine, Pediatricians | Plastic Surgeons, Gynecologists, Psychiatrists, General Surgeons, Clinical psychologists, Urologists, Clinical social workers, Mental health providers, Endocrinologists | Hospital, Lab Facility | |
| CMS14.04 Nutritional Treatment-Medically Necessary Food | AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine, Pediatricians | Endocrinologists, Oncologists, Cardiologists, Pulmonologists, Gastroenterologists, Nephrologists, OB/GYN, Geneticists | Nutritionist, Registered Dietitians, DME/DMS vendors | Hospital, Skilled Nursing Facility |
| CMS16.12 Pulse Electrical Stimulation for the Knee Title updated to: Pulse Electrical Stimulation Devices |
AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine | Orthopedic Surgeons, General Surgeons, Rheumatologists, Sports Medicine Specialists, Physical Medicine and Rehabilitation | DME, PT, OT, Home Health | Hospital, Skilled Nursing Facility |
| CMS19.07 Dynamic Splinting for the Treatment of Joint Stiffness and Contracture | AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine | Physical Medicine and Rehabilitation, General Surgeons, Sports Medicine Specialists | DME, Home Health, PT, | Hospital, Ambulatory Surgery |
| CMS21.01 Sacral Neuromodulation for Urinary Urgency Incontinence, Urinary Retention & Fecal Incontinence Title updated to: Sacral Neuromodulation for Overactive Bladder, Urinary Retention & Fecal Incontinence |
AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine | Urologists, Gynecologists, Uro-gynecologists, Gastroenterologists, Surgeons | Hospital, Ambulatory Surgery, Skilled Nursing Facility | |
| CMS23.07 Infertility Evaluation and Treatment | AdvMD EHP PPMCO USFHP |
Family Practice, Internal Medicine | OB/GYN, Reproductive Endocrinologists, Urologists, Andrologists | Hospitals, Lab Facilities | |
| CMS10.05 Applied Behavioral Analysis Policy is retiring |
AdvMD EHP PPMCO USFHP |
Internal Medicine, and Family Practice, Pediatricians | Psychiatrists, Psychologists, Behavior analysts | Hospital | |
Note: Effective July 10, 2023, Johns Hopkins HealthCare is now Johns Hopkins Health Plans