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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 27, 2013.
Policy effective date
Policy No.
Notification title
Notification issue date
September 27, 2013
08.01.12
Repository Corticotropin (H.P. Acthar
® Gel Injection)
August 28, 2013
September 27, 2013
09.00.15f
Mammography and Computer-Aided Detection (CAD)
System for Mammography
August 28, 2013
September 27, 2013
11.08.08f
Chemical Peels
August 28, 2013
October 1, 2013
05.00.38f
Negative-Pressure Wound Therapy (NPWT) Systems
July 3, 2013
October 1, 2013
05.00.70a
Mechanical Stretching Devices for the Treatment of
Joint Stiffness or Contractures
August 29, 2013
October 1, 2013
06.02.10k
Genetic Testing for Inherited Susceptibility to Colon
Cancer and Microsatellite Instability Testing (Familial
Adenomatous Polyposis and Lynch Syndrome)
August 20, 2013
October 1, 2013
06.02.35e
Genetic Testing
August 20, 2013
October 1, 2013
07.03.07i
Evaluation and Management of Autism Spectrum
Disorders (ASD)
August 12, 2013
October 1, 2013
07.03.14i
Intraoperative Neurophysiological Monitoring (INM)
July 3, 2013
October 1, 2013
07.03.22
Repetitive Transcranial Magnetic Stimulation (rTMS)
August 29, 2013
October 1, 2013
07.13.12c
Instrument-based Vision Screening
August 29, 2013
October 1, 2013
11.14.22b
Lumbar Interspinous Process Decompression
August 29, 2013
October 1, 2013
11.17.01e
Bulking Agents for the Treatment of Stress Urinary Incontinence (SUI) due to
Intrinsic Sphincter Deficiency (ISD) and for the Treatment of Vesicoureteral
Reflux (VUR)
August 29, 2013
October 11, 2013
08.00.26r
Botulinum Toxin Agents
September 11, 2013
November 1, 2013
11.00.10o
Multiple Surgical Reduction Guidelines
August 2, 2013
November 27, 2013
07.10.05a
Noncontraceptive Use of the Levonorgestrel-
Releasing Intrauterine System
August 28, 2013
December 10, 2013
05.00.73a
Neuromuscular Electrical Stimulators (NMES) and
Functional Electrical Stimulators (FES)
September 11, 2013
December 10, 2013
11.01.06a
Bone-Anchored (Osseointegrated) Hearing Aids
and Implantable Middle Ear Hearing Aids
September 11, 2013
December 26, 2013
06.03.04h
Apheresis Therapy
September 27, 2013
December 26, 2013
11.01.02j
Cochlear Implant
September 27, 2013
To view the policy notifications, go to www.ibx.com/medpolicy, 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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