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 December 21,
2012.
[
]Policy effective date[]
[
]Policy No.[]
[
]Notification title[]
[
]Notification issue date[]
December 21, 2012
05.00.62e
Injectable Dermal Fillers
November 21, 2012
December 21, 2012
11.15.24
Migraine Deactivation Surgery
November 21, 2012
December 31, 2012
06.02.39
Measurement of Serum Antibodies to Infliximab
November 30, 2012
January 1, 2013
00.03.01j
Podiatry Services Included in Capitation for
Pennsylvania Based Health Maintenance
Organization (HMO) or Health Maintenance
Organization Point-of-Service (HMO-POS) Products
October 3, 2012
January 1, 2013
11.05.16
Aqueous Shunts, Canaloplasty, and
Viscocanalostomy for the Treatment of Glaucoma
December 3, 2012
January 2, 2013
11.06.07a
Ovarian and Internal Iliac Vein Embolization as
Treatment for Pelvic Congestion Syndrome
December 3, 2012
January 4, 2013
07.10.06
Intracytoplasmic Sperm Injection and Assisted
Embryo Hatching
December 5, 2012
January 9, 2013
11.01.01g
Otoplasty
October 10, 2012
January 16, 2013
11.08.20j
Wound Care: Bioengineered Skin Substitutes
December 17, 2012
February 5, 2013
00.01.44e
Never Events and Preventable Adverse Events
November 7, 2012
February 25, 2013
07.08.03
Medical and Surgical Treatment of
Temporomandibular Joint Disorder
November 27, 2012
March 5, 2013
11.14.26
Surgical Treatments of Athletic Pubalgia
December 5, 2012
To view the policy notifications, visit our [
]Medical Policy[] webiste,
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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]NaviNet[]?[] is a registered trademark of
NaviNet, Inc,.[
]