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Policy notifications posted as of March 26, 2012

March 29, 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 March 26, 2012.

Policy effective date Policy no. Notification title Notification issue date March 20, 2012 11.08.03h Lipectomy and Liposuction December 21, 2011 March 21, 2012 10.01.01i Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Programs January 18, 2012 March 30, 2012 07.00.14d Cold Laser Therapy February 29, 2012 March 30, 2012 07.03.05l Sleep Disorder Testing February 29, 2012 April 4, 2012 11.17.06h Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH) January 5, 2012 April 4, 2012 10.06.01e Speech Therapy January 5, 2012 April 4, 2012 07.13.07e Corneal Pachymetry Using Ultrasound January 5, 2012 April 4, 2012 10.04.01j Pulmonary Rehabilitation January 5, 2012 April 4, 2012 11.08.12g Surgery for Gynecomastia January 5, 2012 April 4, 2012 05.00.09e Bone Growth Stimulators January 5, 2012 April 4, 2012 05.00.37d Compression Garments January 5, 2012 April 5, 2012 07.03.09h Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG) January 6, 2012 April 5, 2012 07.03.18g Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies January 6, 2012 April 5, 2012 07.03.20 Surface Electromyelogram March 6, 2012 June 1, 2012 09.00.46f High-Technology Diagnostic Radiology Services March 2, 2012

To view the policy notifications, go to the 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 website. Be sure to check back often, as the site is updated frequently.

Be sure to check back often, as the site is updated frequently.

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