All policies are posted prior to their effective date. Below is a listing of
the policy notifications that we have posted to our website as of August 31,
2012.
Policy effective date
Policy No.
Notification title
Notification
issue date
August 29, 2012
11.08.04g
Selective Photothermolysis Using Pulsed-Dye Lasers
July 30, 2012
September 1, 2012
00.03.02m
Diagnostic Radiology Services Included in Capitation
June 1, 2012
September 15, 2012
00.03.07c
Laboratory Services for Members Enrolled in Health Maintenance Organization
(HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
August 15, 2012
September 15, 2012
00.01.25p
PPO Network Rules for Provision of Specialty Services for Durable Medical
Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative
Services
August 15, 2012
September 18, 2012
11.03.01c
Repair of Cleft Lip and/or Cleft Palate
June 21, 2012
September 28, 2012
06.02.17c
Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus
?
IBD sgi Diagnostic
TM Test
August 29, 2012
September 28, 2012
11.01.07a
Cataract Surgery
August 29, 2012
September 28, 2012
08.01.04b
Preventive Immunization
August 29, 2012
September 28, 2012
08.00.08e
Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin
?)
August 29, 2012
September 28, 2012
08.00.44k
Zoledronic Acid (Zometa
?, Reclast
?)
August 29, 2012
October 1, 2012
09.00.28b
Magnetic Resonance Spectroscopy (MRS)
August 31, 2012
October 1, 2012
12.01.01o
Experimental/Investigational Services
June 29, 2012
October 3, 2012
07.13.05f
Photodynamic Therapy (PDT) Using Verteporfin (Visudyne
?)
July 3, 2012
October 30, 2012
11.14.07i
Intra-articular Injection of Hyaluronan for the
Treatment of Osteoarthritis
August 1, 2012
To view the policy notifications, visit our
Medical Policy website, select
Accept and Go to Medical Policy Online, and click on the
Policy
Notifications box. You can also view policy notifications using the
NaviNet
? web portal by selecting
Reference Tools from the
Plan Transactions menu, then
Medical Policy. Once these policies are in
effect, they will be available by using the Search box on the Medical Policy
homepage. Be sure to check back often, as the site is updated frequently.
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