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 July 20, 2011.
Policy effective date
Notification title
Notification
issue date
July 22, 2011
08.00.99 Belimumab (Benlysta?)
June 22, 2011
July 22, 2011
05.00.55g Wheelchair Cushions and Seating
June 22, 2011
July 27, 2011
05.00.70 Mechanical Stretching Devices for the Treatment of Joint Stiffness or
Contractures
April 28, 2011
July 27, 2011
05.00.15k Nebulizers
June 27, 2011
August 5, 2011
08.01.01 Ipilimumab (Yervoy?)
July 6, 2011
August 5, 2011
11.14.10i Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
July 6, 2011
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
Rink 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 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
10.03.01b Physical Medicine and Rehabilitation Services
June 1, 2011
September 1, 2011
11.02.01h Treatment of Varicose Veins of the Lower Extremities
and Perforator Vein Incompetence
June 8, 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
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.