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Policy notifications posted as of January 29, 2013

February 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 January 29, 2013.

Policy effective date

Policy No.

Notification title

Notification
issue date

February 1, 2013

11.00.14c

Treatment of Twin-Twin Transfusion Syndrome (TTTS)

January 2, 2013

February 1, 2013

11.14.06f

Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions

January 2, 2013

February 1, 2013

11.14.09e

Osteochondral Autograft Transplantation (OAT) Procedure

January 2, 2013

February 1, 2013

11.14.12c

Osteochondral Allograft Transplantation

January 2, 2013

February 1, 2013

05.00.09f

Electrical Bone Growth Stimulation and Ultrasound Accelerated Fracture Healing System

January 2, 2013

February 5, 2013

00.01.44e

Never Events and Preventable Adverse Events

November 7, 2012

February 13, 2013

08.00.26q

Botulinum Toxin Agents

January 14, 2013

February 15, 2013

08.00.13m

Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)

January 16, 2013

February 15, 2013

08.00.50k

Rituximab (Rituxan®)

January 16, 2013

February 15, 2013

08.00.87a

Pemetrexed (Alimta®)

January 16, 2013

February 15, 2013

11.02.10h

Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms

January 16, 2013

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

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 Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents 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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