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Policy notifications posted as of November 30, 2012

November 30, 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 November 30, 2012.

Policy effective date

Policy No.

Notification title

Notification issue date

November 15, 2012

06.02.14e

In Vitro Chemosensitivity and Chemoresistance Assays

October 16, 2012

November 26, 2012

08.00.95b

Personalized Vaccines (e.g., Provenge)

October 26, 2012

December 7, 2012

11.05.17

Implantable Miniature Telescope (IMT) for the Treatment of End-Stage Age-Related Macular Degeneration (AMD)

November 7, 2012

December 12, 2012

11.00.06d

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

September 13, 2012

December 21, 2012

05.00.62e

Injectable Dermal Fillers

November 21, 2012

December 21, 2012

11.15.24

Migraine Deactivation Surgery

November 21, 2012

December 31, 2012

06.02.39

Measurement of Serum Antibodies to Infliximab

November 30, 2012

January 1, 2013

00.03.01j

Podiatry Services Included in Capitation for Pennsylvania Based Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

October 3, 2012

January 9, 2013

11.01.01g

Otoplasty

October 10, 2012

February 5, 2013

00.01.44e

Never Events and Preventable Adverse Events

November 7, 2012

February 25, 2013

07.08.03

Medical and Surgical Treatment of Temporomandibular Joint Disorder

November 27, 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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