Please refer to the table below for claims edits that will go into effect on Nov. 27, 2018:
| Policy | Description | Affected plans |
| Low dose CT scan for lung cancer screening | We will deny G0297 (Low dose CT scan (LDCT) for lung cancer screening) when billed by any provider more frequently than once per year. Guidance: Centers for Medicare & Medicaid Services |
Medicare only |
| Valstar® code J9357 | Valrubicin (intravesical) should be reported with an appropriate bladder instillation procedure code CPT 50391 or 51720. Guidance: FDA–approved package insert in prescribing information and the pharmaceutical compendium. |
Commercial and Medicare |
| Iluvien® code J7313 | When fluocinolone acetonide intravitreal implant (J7313) is injected into the eye (vitreous), it should be reported on the same claim with the appropriate injection procedure code CPT 67028. Guidance: Drug Manufacturer |
Commercial and Medicare |
