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 June 22, 2012.
Policy effective date
Policy No.
Notification title
Notification issue date
June 6, 2012
11.06.09a
Labiaplasty
May 7, 2012
June 8, 2012
02.01.02a
Private Duty Nursing
May 9, 2012
July 1, 2012
09.00.32i
Diagnostic and Therapeutic Radiopharmaceutical
Agents
May 30, 2012
July 18, 2012
07.00.01f
Biofeedback Therapy
June 18, 2012
July 20, 2012
06.02.36
PathfinderTG[
]?[]
June 20, 2012
July 20, 2012
11.08.05g
Application and Removal of Tattoos
June 20, 2012
August 8, 2012
11.02.01i
Treatment of Varicose Veins of the Lower Extremities and Perforator Vein
Incompetence
May 10, 2012
August 21, 2012
08.00.68d
Ibandronate Sodium (Boniva[
]?[]) for Intravenous Injection
May 23, 2012
September 1, 2012
00.03.02l
Diagnostic Radiology Services Included in Capitation
June 1, 2012
September 18, 2012
11.03.01c
Repair of Cleft Lip and/or Cleft Palate
June 21, 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.
[
]NaviNet []?[] is a registered trademark of
NaviNet, Inc.[
]