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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 25, 2013.
Policy effective date
Policy No.
Notification title
Notification issue date
November 27, 2013
07.10.05a
Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
August 28, 2013
December 10, 2013
05.00.73a
Neuromuscular Electrical Stimulators (NMES) and
Functional Electrical Stimulators (FES)
September 11, 2013
December 10, 2013
11.01.06a
Bone-Anchored (Osseointegrated) Hearing Aids
and Implantable Middle Ear Hearing Aids
September 11, 2013
December 26, 2013
06.03.04h
Apheresis Therapy
September 27, 2013
December 26, 2013
11.01.02j
Cochlear Implant
September 27, 2013
January 1, 2014
05.00.24j
Interstitial Continuous Glucose Monitoring
Systems (CGMSs)
October 3, 2013
(Revised Nov. 25, 2013)
January 1, 2014
05.00.39i
Ankle-Foot/Knee-Ankle-Foot Orthosis
October 3, 2013
January 1, 2014
07.00.03k
Full-Body Monoplace or Multiplace Chamber
Hyperbaric Oxygen Therapy
October 3, 2013
(Revised Nov. 25, 2013)
January 1, 2014
07.00.20e
Routine Costs Associated with Qualifying
Clinical Trials
October 3, 2013
January 1, 2014
07.03.05p
Sleep Disorder Testing
October 3, 2013
January 1, 2014
07.05.02j
Wireless Capsule Endoscopy (WCE) as a
Diagnostic Technique in Disorders of the Small
Bowel, Esophagus, and Colon
October 3, 2013
January 1, 2014
07.10.05b
Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
November 20, 2013
January 1, 2014
08.00.13o
Immune Globulin Intravenous (IVIG),
Subcutaneous (SCIG)
October 3, 2013
January 1, 2014
08.00.78j
Self-Administered Drugs
October 3, 2013
January 1, 2014
08.00.92e
Coagulation Factors for Hemophilia
October 3, 2013
January 1, 2014
10.03.01c
Physical Medicine, Rehabilitation, and
Habilitation Services
October 3, 2013
January 1, 2014
11.07.01l
Hematopoietic Stem Cell Transplantation
(Bone Marrow Transplant)
October 3, 2013
January 1, 2014
11.14.24
Manipulation under Anesthesia
October 3, 2013
January 7, 2014
07.03.08d
Neuropsychological Evaluation/Testing
October 9, 2013
February 4, 2014
11.08.02f
Reduction Mammoplasty
November 6, 2013
February 5, 2014
05.00.42e
Patient Lifts
November 6, 2013
February 5, 2014
11.14.10k
Percutaneous Vertebroplasty, Kyphoplasty,
and Sacroplasty
November 6, 2013
February 5, 2014
07.00.02g
Intravenous Chelation Therapy
November 7, 2013
February 18, 2014
07.02.03g
Implantable Cardiac Loop Monitor
November 20, 2013
February 19, 2014
11.02.12e
Percutaneous Transluminal Angioplasty (PTA)
Concurrent with or without Stenting of the
Extracranial Carotid Artery or Intracranial Artery
November 20, 2013
February 19, 2014
11.11.01f
Evaluation and Treatment of Erectile
Dysfunction (ED)
November 21, 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.
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