CarePartners of Connecticut Medical Necessity Guideline Updates

Providers and office staff can refer to the following chart to review changes and updates to CarePartners of Connecticut’s Medical Necessity Guidelines, which detail coverage and prior authorization criteria.

MNG TitleEffective DateSummary

CarePartners of Connecticut Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines

 

3/1/2025

Prior authorization will be required for the Intracept procedure (basivertebral nerve ablation, CPT codes 64628 and 64629), and CMS’ local coverage determination L39642 will be used for criteria. 

In addition, new prior authorization requirements added for the following: 

  • Deep Brain Stimulation for Essential Tremor and Parkinson Disease (will use CMS criteria NCD 160.24 for codes 61880, 61885, 61886, 61863, 61864, 61867, and 61868)
  • Implantable Neurostimulator – Sacral Nerve (will use CMS criteria LCA A53017 for codes 64590, 64595)

Hypoglossal Nerve Stimulation

 

3/1/2025

 

New MNG outlining our newly developed internal criteria, and prior authorization will be required.