Claims Xten Optimization

Date: 05/26/23

Dear Provider,

Thank you for your continued partnership with Absolute Total Care. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of new policies Absolute Total Care will be implementing effective 8/1/2023.

Policy Name	Policy Description	Lines of Business
Claims Xten Optimization – NCD Alignment	Adding prepay reviews for several national coverage determinations (NCDs) to be in accordance with CMS guidelines for correct coding.	Medicare
NCD 20.8.3	Single Chamber and Dual Chamber Permanent Cardiac Pacemakers	Medicare
NCD 150.3	Bone (Mineral) Density Studies	Medicare
NCD 220.13	Percutaneous Image-Guided Breast Biopsy	Medicare
NCD 210.1	Prostate Cancer Screening Tests	Medicare
NCD 210.10, 210.10Y	Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs	Medicare
NCD 210.6	Screening for Hepatitis B Virus HBV Infection	Medicare
210.7, 210.7Y	Screening for the Human Immunodeficiency Virus HIV Infection	Medicare
190.21	Glycated Hemoglobin Glycated Protein	Medicare
20.4,20.4Z	Implantable Cardiac Defibrillators	Medicare
210.1Y, 210.1Z	Prostate Screening Cancer	Medicare

If you have questions about this or any of our other policies, please don’t hesitate to reach out to Provider Services.