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 October 30, 2013. Policy effective date Policy No. Notification title Notification issue date November 1, 2013 00.01.55 New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances August 2, 2013 November 1, 2013 11.00.10o Multiple Surgical Reduction Guidelines August 2, 2013 November 27, 2013 07.10.05a Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System August 28, 2013 December 10, 2013 05.00.73a Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) September 11, 2013 December 10, 2013 11.01.06a Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids September 11, 2013 December 26, 2013 06.03.04h Apheresis Therapy September 27, 2013 December 26, 2013 11.01.02j Cochlear Implant September 27, 2013 January 1, 2014 05.00.24j Interstitial Continuous Glucose Monitoring Systems (CGMSs) October 3, 2013 January 1, 2014 05.00.39i Ankle-Foot/Knee-Ankle-Foot Orthosis October 3, 2013 January 1, 2014 07.00.03k Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy October 3, 2013 January 1, 2014 07.00.20e Routine Costs Associated with Qualifying Clinical Trials October 3, 2013 January 1, 2014 07.03.05p Sleep Disorder Testing October 3, 2013 January 1, 2014 07.05.02j Wireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon October 3, 2013 January 1, 2014 08.00.13o Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG) October 3, 2013 January 1, 2014 08.00.78j Self-Administered Drugs October 3, 2013 January 1, 2014 08.00.92e Coagulation Factors for Hemophilia October 3, 2013 January 1, 2014 10.03.01c Physical Medicine, Rehabilitation, and Habilitation Services October 3, 2013 January 1, 2014 11.07.01l Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant) October 3, 2013 January 1, 2014 11.14.24 Manipulation under Anesthesia October 3, 2013 January 7, 2014 07.03.08d Neuropsychological Evaluation/Testing October 9, 2013

To view the policy notifications, visit our Medical Policy page, 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.