Connection supplemental articles and policies – January 2014

Supplemental articles

Payment policies

Revised policies – effective March 1, 2014
The following polices have been updated; details about the changes are indicated on the policies.

  • Autism Services Payment Policy – Updated the list of codes in the policy.
  • Clinical Trials Payment Policy – Updated the description of reimbursed services for commercial members and the list of codes in the policy.
  • Infertility/Assisted Reproductive Technology Services Payment Policy – Updated list of reimbursed codes.
  • Laboratory and Pathology Payment Policy – Updated discussion about urine drug tests and added discussion about modifier 26 with automated lab codes.
  • Palliative Care Consultation Payment Policy – Updated the list of codes in the policy.
  • Vaccine Payment Policy – Updated discussion of codes in the policy.


New policy – effective March 1, 2014

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What’s new

Sarika Aggarwal photoDr. Aggarwal named FCHP’s Chief Medical Officer

Sarika Aggarwal, M.D., has accepted the position of FCHP’s Chief Medical Officer. She had been serving as Interim Chief since August 2013, working closely with leadership across the health plan to drive and support the successful execution of FCHP’s strategic goals.

Previously, Dr. Aggarwal was FCHP’s Vice President of NaviCare® Clinical Programs. She brings extensive and valuable experience to her new role, including being the Lead Physician at Shrewsbury Primary Care, the Medical Director in the Office of Clinical Integration at UMass Memorial, and an assistant professor of medicine at UMass Medical School.

FCHP President & CEO Patrick Hughes notes, “Dr. Aggarwal is a well-respected leader and valuable contributor, and FCHP is fortunate to have her in this role.”

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Let’s connect

Choosing Wisely logoTesting Wisely – Age-appropriate screening

In this latest article in our ongoing “Testing Wisely” series, we are highlighting two preventive tests that are mentioned in the Choosing Wisely® campaign (see 

As you may recall, Choosing Wisely is an initiative of the ABIM Foundation that aims to raise awareness about the overuse of certain tests and to help physicians and patients engage in conversation and promote partnership in making effective care choices that are based on each patient’s individual situation.

As we continue to review actual utilization in our networks against the recommendations, it appears that some preventive services are being used outside of the recommended guidelines. We reviewed the utilization of colonoscopies and prostate–specific antigen (PSA) testing for individuals over the age of 75.

Both of these preventive tests are mentioned in the Choosing Wisely campaign. Also, the United States Preventive Services Taskforce (USPSTF) recommends against the use of both tests for individuals over the age of 75. However, our review of the last three years of utilization showed that over 1,200 of our members over the age of 75 underwent routine colonoscopies. Additionally, our review revealed that over 600 of our male members over the age of 75 had PSA testing performed.

There may be medical reasons why these tests were ordered outside of the guidelines. Nonetheless, the delivery of such services outside of the recommended parameters suggests at least some opportunity for further discussion between physicians and patients.

At Fallon Community Health Plan, we appreciate the efforts of the Choosing Wisely campaign to promote better stewardship of finite health care resources. It’s our hope that the utilization information provided in our Testing Wisely series will prompt further discussion and help to decrease duplicative and/or unnecessary testing. 

Listed below are links to Choosing Wisely patient materials that you can use when discussing colonoscopies and PSA testing with your patients.

Colonoscopy: When you need it—when you don't (pdf)
American Gastroenterological Association: Five Things Physicians and Patients Should Question

American Academy of Family Physicians: Fifteen Things Physicians and Patients Should Question

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