Updated Clinical Policies - Effective November 1, 2024

Date: 10/01/24

MHS Health Wisconsin continually adds new or provides updates  to clinical and payment policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members.

View all Clinical and Payment Policies.

The following policies are effective November 1, 2024. 

Policy Number	Policy Name	Policy Description	Line(s) of Business
CP.MP.180	Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea	Added criteria II. regarding drug induced sleep endoscopy (DISE) being medically necessary when completed to evaluate the appropriateness of a hypoglossal nerve stimulation device. Background updated with no clinical significance. CPT code “42975” added.	Medicaid; Medicare
HI.CP.MP.505	Transportation for Care Coordination	Annual review. Updated Description to include “on the island where member resides”. Minor rewording within the criteria. Added “to one of the following” to Section I.A .Separated I.C.3. into Section II.A-M. Section II. changed to III. with the addition of E.-K. as not medically necessary. Background updated. References reviewed and updated.	Medicaid; Medicare

Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the policies listed above or any our Clinical & Payment Policies, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who your representative is, please email us at WI_Provider_Relations@mhswi.com.