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Policy notifications posted as of December 21, 2012

December 28, 2012

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 December 21, 2012. []Policy effective date[] []Policy No.[] []Notification title[] []Notification issue date[] 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 1, 2013 11.05.16 Aqueous Shunts, Canaloplasty, and Viscocanalostomy for the Treatment of Glaucoma December 3, 2012 January 2, 2013 11.06.07a Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome December 3, 2012 January 4, 2013 07.10.06 Intracytoplasmic Sperm Injection and Assisted Embryo Hatching December 5, 2012 January 9, 2013 11.01.01g Otoplasty October 10, 2012 January 16, 2013 11.08.20j Wound Care: Bioengineered Skin Substitutes December 17, 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 March 5, 2013 11.14.26 Surgical Treatments of Athletic Pubalgia December 5, 2012 To view the policy notifications, visit our []Medical Policy[] webiste, 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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