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 August 19,
2011.
Policy effective date
Notification title
Notification
issue date
August 19, 2011
08.00.92b Coagulation Factors for Hemophilia
July 20, 2011
August 19, 2011
07.00.03i Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy
July 20, 2011
August 19, 2011
08.01.00 Hydroxyprogesterone Caproate Injection as a Technique to Reduce the
Risk of Preterm Birth
in High-Risk Pregnancies
July 20, 2011
August 19, 2011
11.15.23 Transforaminal Epidural Nerve Block Injections
July 20, 2011
August 22, 2011
11.06.09 Labiaplasty
July 22, 2011
August 24, 2011
09.00.36f First-Trimester Prenatal Screening for Fetal Aneuploidy
May 26, 2011
August 31, 2011
11.01.06 Bone-Anchored (Osseointegrated) Hearing Aids,
Implantable Bone-Conduction Hearing Aids, and Semi-Implantable Hearing Aids
June 1, 2011
September 1, 2011
00.01.52 Always Bundled Procedure Codes
June 3, 2011
September 1, 2011
11.05.02f Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and
Canthoplasty/Canthopexy
June 3, 2011
September 1, 2011
10.02.02e Chiropractic Spinal and Extraspinal Manipulation Therapy
June 1, 2011
September 1, 2011
00.01.47 Inpatient Hospital Readmission
August 2, 2011
September 1, 2011
10.03.01b Physical Medicine and Rehabilitation Services
June 1, 2011
September 1, 2011
11.08.13e Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or
Platysmaplasty
August 1, 2011
September 1, 2011
11.02.01h Treatment of Varicose Veins of the Lower Extremities and Perforator
Vein Incompetence
June 8, 2011
September 2, 2011
05.00.72 Upper-Limb Prostheses
August 3, 2011
September 14, 2011
07.10.04a Parenterally Administered Terbutaline Sulfate for the Prevention or
Treatment of Pre-Term Labor
August 15, 2011
October 1, 2011
00.03.07 Laboratory Services for Members Enrolled in
Health Maintenance Organization (HMO) or Health Maintenance Organization
Point-of-Service (HMO-POS) Products
July 1, 2011
October 1, 2011
11.08.20h Wound Care: Bioengineered Skin Substitutes
July 1, 2011
October 4, 2011
08.00.44i Zoledronic Acid (Zometa?, Reclast?)
July 6, 2011
October 5, 2011
11.08.06f Abdominoplasty and/or Panniculectomy
July 7, 2011
October 27, 2011
00.10.18g Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
July 29, 2011
November 16, 2011
03.00.32 Modifier 52 Reduced Services
August 18, 2011
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 Materials and Reports
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.