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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 00.01.55 New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of- Service (HMO-POS) Radiology Network Rules and Limited Circumstances August 2, 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.amerihealth.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.

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