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Policy notifications posted as of February 28, 2013

March 1, 2013

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 February 28, 2013. Policy effective date Pol No. Notification title Notification issue date 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 March 29, 2013 08.01.05 Carfilzomib (Kyprolis? ) February 27, 2013 March 29, 2013 08.01.09 Omacetaxine mepesuccinate (Synribo®) February 27, 2013 April 1, 2013 05.00.58f Home Oxygen Therapy February 28, 2013 April 2, 2013 11.14.08c Orthognathic Surgery January 2, 2013 April 2, 2013 08.00.81b Bendamustine Hydrochloride (Treanda®) January 2, 2013 April 2, 2013 11.14.03e Meniscal Allograft Transplantation January 2, 2013 April 4, 2013 08.00.25g Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Intended for Home Use January 4, 2013 April 16, 2013 07.02.07g Ambulatory, Real-Time Cardiac Surveillance System January 16, 2013 April 16, 2013 11.05.02g Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy January 16, 2013 April 17, 2013 11.15.09d Denervation of the Spinal Nerves for Chronic Facet Pain January 17, 2013

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., an independent company.


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