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December CENTRAL FINAL December 2020 In This Issue Coverage Guidelines Revised for Chemodenervation – Botulinum Toxin .................................................. 2 Criteria Revised for Human Growth Hormone ........................................................................................... 6 Coverage Guidelines Revised for Electronystagmography (ENG) and Videonystagmography (VNG) Services ........................................................................................................................................... 7 Contents .......................................................................................................................................................... 13 Policy Revised Criteria for Wound Care Policy Highmark Blue Shield has revised criteria for E-31 Negative Pressure Wound Therapy Pumps/Vacuum Assisted Closure of Chronic Wounds. This revised Medical Policy will apply to professional providers and facility claims. The effective date is March 1, 2021. Place of Service: Please refer to Medical Policy E-31 Negative Pressure Wound Therapy Pumps/Vacuum Assisted Closure of Chronic Wounds, for additional information. Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Note: This publication may contain certain administrative requirements, policies, procedures, or other similar requirements of Highmark Inc. (or changes thereto) which are binding upon Highmark Inc. and its contracted providers. Pursuant to their contract, Highmark Inc. and such providers must comply with any requirements included herein unless and until such item(s) are subsequently modified in whole or in part. Medical Policy Update December 2020 Revised Criteria for Non- Powered Negative Pressure Wound Care Policy Highmark Blue Shield has revised criteria for E-47 Non-Powered Negative Pressure Wound Therapy System. This revised Medical Policy will apply to professional providers and facility claims. The effective date is March 1, 2021. Place of Service: Outpatient Please refer to Medical Policy E-47 Non-Powered Negative Pressure Wound Therapy System, for additional information. Coverage Guidelines Revised for Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon Highmark Blue Shield has revised criteria for Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon to update language regarding celiac disease and removing language in the policy regarding current episode of illness and prior conventional diagnostic testing. Diagnosis codes have been updated. This revised Medical Policy will apply to professional providers and/or facility claims. The effective date is March 1, 2021. Place of Service: Inpatient/Outpatient Please refer to Medical Policy G-41, Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon, for additional information. Coverage Guidelines Revised for Chemodenervation – Botulinum Toxin Highmark Blue Shield has revised coverage criteria for onabotulinumtoxinA (Botox®), AbobotulinumtoxinA (Dysport™), IncobotulinumtoxinA (Xeomin®) and RimabotulinumtoxinB (Myobloc®) to include the following updates: The following indications will be added to onabotulinumtoxinA (Botox): • Benign essential blepharospasm or VII nerve disorders are now included in the blepharospasm indication. • Age limit of 16 years or older is now applied to the cervical dystonia (spasmodic torticollis) indication. • Initial authorization period for chronic migraine prevention will be for six (6) months. • Reauthorization will be granted if headache frequency and hours are reduced by at least 50% from baseline. • Urinary incontinence due to detrusor over activity requires an inadequate response to or intolerant of conservative therapy (e.g., moderation of fluid intake, avoidance of 2 Medical Policy Update December 2020 alcohol, caffeine, and medications such as diuretics, control of chronic cough and constipation, smoking cessation, etc.) and medical therapy with an anticholinergic medication. • Upper and lower limb spasticity in individuals 2-17 years of age is an included indication. • Oro-facial-lingual-masticatory tardive dyskinesia due to dopamine blocking agents in adult individuals • Anismus related to pelvic floor dyssynergia in adult individuals who are refractory to biofeedback training, for a maximum of three (3) treatments during a three (3) month period. • Auriculotemporal syndrome in adults to reduce severe symptoms including food- induced facial flushing and sweating or gustatory hyperhidrosis post-parotidectomy (eg. Frey syndrome. • Benign prostatic hyperplasia in adults who no longer respond to medication and refuse surgical treatment with moderate to severe symptoms of urinary obstruction based on the American Urological Association (AUA) index, mean peak urinary flow rate less than 15 mL/sec with voided volume of at least 150 mL, and an enlarged prostate gland. • Cerebral palsy in individuals with upper and lower limb spasticity; or • Detrusor and sphincter dyssynergia in adults due to multiple sclerosis. • Voice failure after tracheoesophageal puncture and prosthesis placements after total laryngectomy in adult individuals (this is due to persistent focal constrictor hypertonicity/spasm). • Disorders of esophagus – dysphagia in adult individuals due to esophageal motility disorder or nonachalasia esophageal motility disorder (ie, diffuse esophageal spasm, nonspecific esophageal motility disorders, and lower esophageal sphincter dysfunction). • Dysphagia in adult individuals due to cricopharyngeus muscle spasm or pure upper esophageal sphincter dysfunction. • Estropia, congenital in pediatric individuals age 7 months or younger. • Epicondylitis (e.g. tennis elbow) in adult individuals who did not respond to conventional treatment. • Headache, cervicogenic (whiplash headache) in adult individuals with chronic headache, unrelieved by other therapies, secondary to a cervical whiplash injury which restricts range of motion in the neck. • Hand tremors, severe in adult individuals due to Parkinson disease or essential tremor. • Hemifacial spasms (7th cranial nerve palsy) in adult individuals when failure of oral pharmacological therapies such as carbamazepine, baclofen and benzodiazepine. • Epiphora, functional (e.g. excessive tear production) in adult individuals. • Esophageal achalasia (failure in relaxation of the lower esophageal sphincter with swallowing and by a lack of esophageal peristalsis): in individuals 18 years of age or older who have not responded to dilation therapy or who are considered poor surgical candidates. • Exotropia of third nerve palsy – Acute Injury to oculomotor nerve in adult individuals. • Focal spasticity in pediatric individuals age 2 to 17 years of age with cerebral palsy and concurrent equinus gait (tiptoeing). • Granuloma of the vocal cords in adult individuals refractory to conventional surgical and medical therapies. • Anismus related to pelvic floor dyssynergia in adult individuals who are refractory to biofeedback training, for a maximum of three (3) treatments during a three (3) month period. 3 Medical Policy Update December 2020 • Auriculotemporal syndrome in adults to reduce severe symptoms including food- induced facial flushing and sweating or gustatory hyperhidrosis post-parotidectomy (eg. Frey syndrome. • Backache in adults with chronic lower back pain. • Benign prostatic hyperplasia in adults who no longer respond to medication and refuse surgical treatment with moderate to severe symptoms of urinary obstruction based on the American Urological Association (AUA) index, mean peak urinary flow rate less than 15 mL/sec with voided volume of at least 150 mL, and an enlarged prostate gland. • Cerebral palsy in individuals with upper and lower limb spasticity; or • Detrusor and sphincter dyssynergia in adults due to multiple sclerosis. • Voice failure after tracheoesophageal puncture and prosthesis placements after total laryngectomy in adult individuals (this is due to persistent focal constrictor hypertonicity/spasm). • Disorders of esophagus – dysphagia in adult individuals due to esophageal motility disorder or nonachalasia esophageal motility disorder (ie, diffuse esophageal spasm, nonspecific esophageal motility disorders, and lower esophageal sphincter dysfunction). • Dysphagia in adult individuals due to cricopharyngeus muscle spasm or pure upper esophageal sphincter dysfunction. • Estropia, congenital in pediatric individuals age 7 months or younger. • Epicondylitis (e.g. tennis elbow) in adult individuals who did not respond to conventional treatment. • Hand tremors, severe in adult individuals due to Parkinson disease or essential tremor. • Headache, cervicogenic (e.g. whiplash headache) in adult individuals with chronic headache, unrelieved by other therapies, secondary to a cervical whiplash injury which restricts range of motion in the neck. • Hemifacial spasms (7th cranial nerve palsy) in adult individuals when failure of oral pharmacological therapies such as carbamazepine, baclofen and benzodiazepine. • Epiphora, functional (e.g. excessive tear production) in adult individuals. • Esophageal achalasia (failure in relaxation of the lower esophageal sphincter with swallowing and by a lack of esophageal peristalsis): in individuals 18 years of age or older who have not responded to dilation therapy or who are considered poor surgical candidates. • Exotropia of third nerve palsy – Acute Injury to
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