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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 August 29, 2013.
Policy effective date
Policy No.
Notification title
Notification issue date
September 1, 2013
07.03.05o
Sleep Disorder Testing
June 3, 2013
September 13, 2013
08.00.77b
Human Papillomavirus (HPV) Vaccine(s)
August 14, 2013
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 (CAD) Detection 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 due to Intrinsic Sphincter Deficiency
(ISD) and for the Treatment of Vesicoureteral Reflux (VUR)
August 29, 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
To view the policy notifications, visit our Medical Policy portal, 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.