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Policy notifications posted as of September 21, 2012

September 28, 2012

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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 September 21, 2012.

Policy effective date

Policy No.

Notification title

Notification issue date

September 28, 2012

06.02.17c

Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi DiagnosticTM Test

August 29, 2012

September 28, 2012

11.01.07a

Cataract Surgery

August 29, 2012

September 28, 2012

08.01.04b

Preventive Immunization

August 29, 2012

September 28, 2012

08.00.08e

Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®)

August 29, 2012

September 28, 2012

08.00.44k

Zoledronic Acid (Zometa®, Reclast®)

August 29, 2012

October 1, 2012

09.00.28b

Magnetic Resonance Spectroscopy (MRS)

August 31, 2012

October 1, 2012

12.01.01o

Experimental/Investigational Services

June 29, 2012

October 3, 2012

07.13.05f

Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)

July 3, 2012

October 10, 2012

05.00.24i

Interstitial Continuous Glucose Monitoring Systems (CGMSs)

September 10, 2012

October 10, 2012

06.02.32a

Multigene Expression Assays for Predicting Recurrence in Colon Cancer

September 10, 2012

October 10, 2012

12.04.02c

Nonemergency Ambulance Transport Services

September 12, 2012

October 30, 2012

11.14.07i

Intra-articular Injection of Hyaluronan for the Treatment of Osteoarthritis

August 1, 2012

December 12, 2012

11.00.06d

Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults

September 13, 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.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

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