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Policy notifications posted as of November 23, 2011

December 1, 2011

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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 23, 2011.

Policy effective date

Policy No.

Notification title

Notification
issue date

November 16, 2011

03.00.32

Modifier 52 Reduced Services

August 18, 2011

December 9, 2011

00.01.47a

Inpatient Hospital Readmission

November 9, 2011

December 9, 2011

05.00.43d

Seat Lift Mechanisms

November 9, 2011

December 22, 2011

05.00.14f

High Frequency Chest Wall Oscillation Devices

November 22, 2011

December 23, 2011

00.01.25m

PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services

November 23, 2011

January 1, 2012

07.03.14e

Intraoperative Neurophysiological Monitoring (INM)

October 3, 2011

January 10, 2012

05.00.56e

Hospital Beds and Accessories

October 14, 2011

January 11, 2012

08.01.04

Preventive Immunization

October 13, 2011

January 24, 2012

08.00.62d

Abatacept (Orencia?) for injection for intravenous use

October 26, 2011

January 24, 2012

11.08.15m

Reconstructive Breast Surgery

October 26, 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.

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