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Policy notifications posted as of October 26, 2012

November 1, 2012

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 26, 2012. Policy effective date Policy No. Notification title Notification issue date October 26, 2012 06.02.24f Preimplantation Genetic testing September 26, 2012 October 26, 2012 07.13.06g Scanning Computerized Opthalmic Diagnostic Imaging (SCODI) September 26, 2012 October 30, 2012 11.14.07i Intra-articular Injection of Hyaluronan for the Treatment of Osteoarthritis August 1, 2012 November 9, 2012 02.01.01b Home Health Care Services October 10, 2012 November 9, 2012 11.11.01d Evaluation and Treatment of Erectile Dysfunction (ED) October 10, 2012 November 9, 2012 06.02.31c Genetic Testing for Congenital Long QT Syndrome October 10, 2012 November 9, 2012 11.06.04g Uterine Artery Embolization October 10, 2012 November 9, 2012 07.02.10b End-Diastolic Pneumatic Compression Therapy October 10, 2012 November 15, 2012 06.02.14e In Vitro Chemosensitivity and Chemoresistance Assays October 16, 2012 November 26, 2012 08.00.95b Personalized Vaccines (e.g., Provenge) October 26, 2012 December 12, 2012 11.00.06d Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults September 13, 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 November 3, 2012 January 9, 2013 11.01.01g Otoplasty October 10, 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.

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