Covered Benefit: Implant Services CMP Published: Yes No CPG Published: Yes No Definition: Implants cover a wide array of devices; which may be surgically implanted on an inpatient or outpatient basis by physicians ranging from primary care practitioners to specialists. While Neighborhood entrusts its practitioners to provide high quality cost effective care; some implants require more detailed support in order to ensure an effective claims adjudication process. This documentation refers to implants that require specific medical review and contracting considerations. Benefit Packages: RIte Care, Children with Special Health Care Needs, Substitute Care, and Rhody Health Partners. Extended Family Planning is a limited benefit package; only specific contraceptive implants are covered. Coverage Limitations: All implants as defined above require authorization. Exclusions: Dental implants are not covered as dental services are not covered. Implants for cosmetic reasons are not covered Breast implants are not covered except for breast reconstruction post mastectomy Implants for gender reassignment are not covered Non FDA approved implants, or implants for which insufficient evidence of net health outcome improvement exists, are not covered. Coverage Includes: Cochlear implants Pacemakers Defibrillators Neurostimulators Additional implants utilized during surgery that meet general guidelines for coverage noted above. Episodes of care can occur across multiple settings; the following are included in the detailed benefit service category criteria: Office (POS 11) Inpatient (POS 21) Outpatient (POS 22) Ambulatory Surgical Center (POS 24) Table: 1 Configuration: Implant Services
Covered Benefit: Implant Services CMP Published: Yes No CPG Published: Yes No Definition: Implants cover a wide array of devices; which may be surgically implanted on an inpatient or outpatient basis by physicians ranging from primary care practitioners to specialists. While Neighborhood entrusts its practitioners to provide high quality cost effective care; some implants require more detailed support in order to ensure an effective claims adjudication process. This documentation refers to implants that require specific medical review and contracting considerations. Benefit Packages: RIte Care, Children with Special Health Care Needs, Substitute Care, and Rhody Health Partners. Extended Family Planning is a limited benefit package; only specific contraceptive implants are covered. Coverage Limitations: All implants as defined above require authorization. Exclusions: Dental implants are not covered as dental services are not covered. Implants for cosmetic reasons are not covered Breast implants are not covered except for breast reconstruction post mastectomy Implants for gender reassignment are not covered Non FDA approved implants, or implants for which insufficient evidence of net health outcome improvement exists, are not covered. Coverage Includes: Cochlear implants Pacemakers Defibrillators Neurostimulators Additional implants utilized during surgery that meet general guidelines for coverage noted above. Episodes of care can occur across multiple settings; the following are included in the detailed benefit service category criteria: Office (POS 11) Inpatient (POS 21) Outpatient (POS 22) Ambulatory Surgical Center (POS 24) Table: 1 Configuration: Implant Services