Coverage Updates

All products

October 30, 2020  

60-Day Notifications

The following changes are effective for dates of service on or after January 1, 2021, for Tufts Medicare Preferred HMO and Tufts Health Plan Senior Care Options (SCO):

Prior Authorization
Tufts Health Plan will require prior authorization for FoundationOne® CDx (0037U), ThyroSeq® (0026U), hyperbaric oxygen therapy (G0277 and 99183) and dorsal column neurostimulator insertion (63650, 63655, 63663, 63685 and 95972). These changes are documented in the Tufts Medicare Preferred HMO Prior Authorization and Inpatient Notification List and the Tufts Health Plan SCO Prior Authorization List.

Other Coverage Updates

Prior Authorization
TecartusTM
Tufts Health Plan requires prior authorization for Tecartus (brexucabtagene autoleucel) for all products. For more information, refer to the Medical Necessity Guidelines for Modified T-Cell Therapies.

Hypoglossal Nerve Stimulation
Tufts Health Plan requires prior authorization for hypoglossal nerve stimulation for Commercial products (including Tufts Health Freedom Plan) and Tufts Health Public Plans products. For more information, refer to the Medical Necessity Guidelines for Hypoglossal Nerve Stimulation for Treatment of Moderate to Severe Obstructive Sleep Apnea.

Limitations
Bariatric Surgery
Adjustable gastric banding in adolescents is now considered a limitation for all products. For more information, refer to the Medical Necessity Guidelines for Bariatric Surgery.