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Policy notifications posted as of June 28, 2013

July 1, 2013

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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 28, 2013.

Policy effective date

Policy No.

Notification title

Notification issue date

February 13, 2013

07.13.14

The Argus? II Retinal Prosthesis

June 17, 2013

July 17, 2013

00.06.02g

Preventive Care Services

June 17, 2013

July 19, 2013

05.00.53e

Airway-Clearance Devices for Use in the Home Setting

June 19, 2013

July 19, 2013

07.10.04b

Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor

June 19, 2013

July 19, 2013

11.11.05e

Circumcision

June 19, 2013

July 24, 2013

05.00.72b

Upper Limb Prostheses

June 24, 2013

July 24, 2013

11.14.21c

Microprocessor-Controlled Prostheses for Lower-Extremity Amputees

June 24, 2013

August 6, 2013

11.14.07j

Intra-articular Injection of Hyaluronan for the Treatment of Osteoarthritis

May 8, 2013

September 1, 2013

07.03.05o

Sleep Disorder Testing

June 3, 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.

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