Coverage Policies

Important! Please note:

Current policies effective through April 30, 2024.

Take me to policies effective May 1, 2024.

Use the index below to search for coverage information on specific medical conditions.

High-Tech Imaging: High-Tech Imaging services are administered by Evolent. For coverage information and authorizations, click here.

Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

Clinical Practice Guidelines for Providers (PDF)

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:



Effective Date: 08/24/2006	Title: Enuresis Treatments
Revision Date: 08/01/2016	Document: BI167:00
CPT Code(s): S8270, J2597
Public Statement
*Effective Date:* a) This policy will apply to all services performed on or after the above revision date which will become the new effective date. b) For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply. · Bed wetting or primary nocturnal enuresis (NE) refers to involuntary loss of urine during sleep in patients who have never stopped bedwetting. Primary NE usually resolves over time. · Bedwetting alarms are not covered.
Medical Statement
1) Nocturnal enuresis alarms are considered convenience items and are not covered. 2) Desmopressin acetate (DDAVP) nasal spray or injection is not covered for enuresis. 3) Desmopressin tablets are covered with no restrictions under the pharmacy benefit. Codes Used In This BI: S8270 Enuresis alarm J2597 Desmopressin Acetate Injection
Application to Products
This policy applies to all QualChoice Health Plans, unless there is indication otherwise or a stated exclusion. Consult individual plan sponsor Summary Plan Description (SPD) for self-insured plans. In the event of a discrepancy between this policy and a self-insured customer’s SPD, the SPD will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.

This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.