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Recent Updates

February 2007

Topic Status Date

January 2007

Policies, Procedures, Guidelines & Forms
    
Coverage Positions/Criteria: Pharmacy
 New 02/22/2007
Coverage Positions/Criteria: Medical
 Revised 02/22/2007
• Abdominoplasty and Panniculectomy
Revised 02/22/2007
• Acne Procedures
Revised 02/22/2007
• Inpatient Acute Rehabilitation
Revised 02/22/2007
• Arthroscopic Lavage and Debridement of the Knee for the Treatment of Osteoarthritis and Other Knee Conditions
Revised 02/22/2007
• Autologous Skeletal Myoblast Transplant/Autologous Cell Therapy for Damaged Myocardium
Revised 02/22/2007
• Breast Implant Removal
Revised 02/22/2007
• Breast Reconstruction Following Mastectomy or Lumpectomy
Revised 02/22/2007
• Cardiopulmonary Exercise Testing (CPET)
Revised 02/22/2007
• Cerebral Perfusion Analysis Using Computed Tomography
Revised 02/22/2007
• Chemical Hair Analysis
Revised 02/22/2007
• Circulating Tumor Cells Testing
Revised 02/22/2007
• Correlated Audioelectric Cardiography
Revised 02/22/2007
• Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Management of Respiratory Disorders
Revised 02/22/2007
• External Insulin Pumps
Revised 02/22/2007
• Mammary Ductoscopy (MD)
Revised 02/22/2007
• Foot Care Services
Revised 02/22/2007
• Genetic Disease Screening Panels
Revised 02/22/2007
• Genetic testing for Gaucher Disease
Revised 02/22/2007
• Genetic Testing for Hereditary Hemochromatosis
Revised 02/22/2007
• Histamine Desensitization Therapy
Revised 02/22/2007
• Hysteroscopic tubal Sterilization ESSURE®
Revised 02/22/2007
• Outpatient Acute Rehabilitation
Revised 02/22/2007
• Intestinal and Multivisceral Transplant: Adult and Pediatric
Revised 02/22/2007
• Intradiscal Electrothermal Therapy (IDET™)
Revised 02/22/2007
• Magnetic Resonance Cholangiopancreatography (MRCP)
Revised 02/22/2007
• Mammary Ductal Lavage (DL)
Revised 02/22/2007
• Paranasal Sinus Ultrasound
Revised 02/22/2007
• Photodynamic Therapy for Cancer
Revised 02/22/2007
• Photodynamic Therapy for Dermatologic Conditions
Revised 02/22/2007
• Pressure Reducing Surfaces
Revised 02/22/2007
• Prophylactic Mastectomy
Revised 02/22/2007
• Prophylactic Oophorectomy With or Without Hysterectomy
Revised 02/22/2007
• Radiofrequency Ablation (RFA) of Pulmonary Tumors
Revised 02/22/2007
• Recurrent Pregnancy Loss: Diagnosis and Treatment
Revised 02/22/2007
• Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome Treatment
Revised 02/22/2007
• Sensory and Auditory Integration Therapy-Facilitated Communication
Revised 02/22/2007
• Stem-Cell Transplant for Acute Myelogenous Leukemia
Revised 02/22/2007
• Total Ankle Arthroplasty/Replacement
Revised 02/22/2007
• Transcatheter Arterial Chemoemolization (TACE)
Revised 02/22/2007
• Wheelchairs/Power-Operated Vehicles
Revised 02/22/2007
• Postoperative Continuous Local Delivery of Analgesia
Revised 02/22/2007
• Magnetic Resonance Angiography (MRA)
Revised 02/22/2007
Coverage Positions/Criteria: Medical
 New 01/22/2007
• Genetic Expression Profiles for Detection of Heart Transplantation Rejection (e.g., AlloMap)
Revised 02/22/2007
• Stem-Cell Transplant for Sickle Cell Disease
Revised 02/22/2007
Coverage Positions/Criteria: Pharmacy
 Revised 02/22/2007
• Fentanyl Transdermal System (Duragesic®)
Revised 02/22/2007
• Apomorphine (Apokyn™)
Revised 02/22/2007
• Oral Transmucosal Fentanyl Citrate (Actiq®)
Revised 02/22/2007
• Oral Phosphodiesterase-5 Inibitors
Revised 02/22/2007
• Voriconazole (Vfend®)
Revised 02/22/2007
• Oral Phosphodiesterase-5 Inibitors
Revised 02 1/22/2007
• Mecasermin Rinfabate (Ipolex®)
Revised 01/22/2007
• Mecasermin (Increlex®)
Revised 01/22/2007
Coverage Positions/Criteria: Pharmacy
 New 02/22/2007
• Fentanyl Buccal Tablet (Fentora®)
New 02/22/2007
• Choriogonadotropin alfa (Ovidrel®)
New 02/22/2007
• Alprostadil (Caverject®, Edex®, Muse®)
New 02/22/2007
Topic Status Date
  • December 2006
  • November 2006
  • October 2006
  • September 2006
  • August 2006
  • July 2006
  • June 2006
  • May 2006
  • April 2006
  • March 2006
  • February 2006
  • January 2006
  • 2005 Recent Updates Archive

    • December 2006

    Policies, Procedures, Guidelines & Forms
    		    
    Coverage Positions/Criteria: Pharmacy
    		 New 01/22/2007
    Coverage Positions/Criteria: Medical
    		 Revised 01/22/2007
    • Genetic Testing for Susceptibility to Breast and Ovarian Cancer (BRCA1 & BRCA2
    		Revised 01/22/2007
    • Cineradiography/Videofluroscopy for Non-Cardiac Conditions
    		Revised 01/22/2007
    • Coronary Intravascular Ultasound (IVUS)
    		Revised 01/22/2007
    • Implantable Cardioverter Defibrillator
    		Revised 01/22/2007
    • Cineradiography/Videofluroscopy for Non-Cardiac Conditions
    		Revised 01/22/2007
    • Bariatric Surgery)
    		Revised 01/22/2007
    • Donor Leukocyte Infusion
    		 Revised 01/22/2007
    • Recombinant Hyuman Bone Morphogenetic Potein for Use in one Repair)
    		Revised 01/22/2007
    • Hospital Beds and Accessories
    		 Revised 01/22/2007
    • Vestibular Rehabilitation and Particle Repositioning Maneuvers
    		Revised 01/22/2007
    • Genetic Testing for Cystic Fibrosis
    		 Revised 01/22/2007
    • Genetic Testing for Susceptibility to Colorectal Cancer
    		Revised 01/22/2007
    • Nutritional Counseling
    		 Revised 01/22/2007
    • Endometrial Ablation
    		Revised 01/22/2007
    • Photodynamic therapy for Ocular Conditions
    		 Revised 01/22/2007
    • Light Therapy for Seasonal Affective Disorder (SAD)
    		Revised 01/22/2007
    • Apheresis for Hypercholesterolemia
    		 Revised 01/22/2007
    • Uterine Artery Embolization
    		Revised 01/22/2007
    • Home Blood Glucose Monitors
    		 Revised 01/22/2007
    • Genotyping for Thiopurine Methyltransferase (TPMT) Deficiency in Individuals with Inflammatory Bowel Disease (IBD)
    		Revised 01/22/2007
    • Home Blood Glucose Monitors
    		 Revised 01/22/2007
    • Hyperhidrosis Treatments
    		Revised 01/22/2007
    • Wearable Cardioverter Defibrillator and Automatic External Defibrillator
    		 Revised 01/22/2007
    Coverage Positions/Criteria: Pharmacy
    		 Revised 01/22/2007
    • Follitropin Therapy
    		Revised 01/22/2007
    • Menotropin Therapy
    		Revised 01/22/2007
    • human Chorionic Gonadotropin Therapy
    		Revised 01/22/2007
    • Bortezomib (Velcade®
    		Revised 01/22/2007
    • Interferon Alfacon-1 (Infergen®)
    		Revised 01/22/2007
    • Bortezomib (Velcade®
    		Revised 01/22/2007
    • Lutropin alfa (Luveris®)
    		Revised 01/22/2007
    • Bortezomib (Velcade®
    		Revised 01/22/2007
    • Bevacizumab (Avastin®)
    		Revised 01/22/2007
    • Rebetol® (ribavirin) and Introl®A (interferon alfa-2b) Combination Therapy (Rebetron®)
    		Revised 01/22/2007
    • Inteferon alfa-2b (Intron®)
    		Revised 01/22/2007
    • Interferon alfa-2a (Roferon®A)
    		Revised 01/22/2007
    • Inteferon alfa-n3 (Alferon® N)
    		Revised 01/22/2007
    Topic Status Date
    Policies, Procedures, Guidelines & Forms
    		    
    Coverage Positions/Criteria: Pharmacy
    		 New 12/19/2006
    Coverage Positions/Criteria: Medical
    		 Revised 12/19/2006
    • Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
    		Revised 12/19/2006
    • Prolotherapy
    		Revised 12/19/2006
    • Spiral Computed Tomography for Lung Cancer Sceening
    		Revised 12/19/2006
    • Computed Tomography to Detect Coronary Artery Calcification
    		Revised 12/19/2006
    • Antiretroviral Resistance Testing (ART)
    		Revised 12/19/2006
    • Monitoring Thiopurine Metabolite Levels in Inflammatory Bowel Disease (IBD)
    		Revised 12/19/2006
    • Amniotic Membrane Transplant for the Treatment of Ocular Conditions
    		Revised 12/19/2006
    • Endoscopic Anti-Reflux Procedures
    		Revised 12/19/2006
    • Transmyocardial Revascularization (TMR) and Percutaneous Myocardial Revascularization (PMR)
    		Revised 12/19/2006
    • Defecography
    		Revised 12/19/2006
    • Magnetoencephalography (MEG)
    		Revised 12/19/2006
    • Computed Tomography for Whole-Body Screening
    		Revised 12/19/2006
    • Proton Beam Therapy for Ocular Melanoma, Ocular Hemangiomas and Macular Degeration
    		Revised 12/19/2006
    • Genetic Testing for Congenital, Profound Deafness
    		Revised 12/19/2006
    • Genetic Testing for Factor V Leiden Thrombophilia
    		Revised 12/19/2006
    • Bionicare® Bio System™
    		Revised 12/19/2006
    • Image-Guided Sinus Surgery
    		Revised 12/19/2006
    • Titanium Rib Implants  -  Vertical Expandable Prosthetic Titanium Rib (VEPTR)
    		Revised 12/19/2006
    • Electrical Impedance Scanning (EIS) and Transilluminatioof the Breast)
    		Revised 12/19/2006
    • Stem-Cell Transplant for Non-Hodgkin's Lumphoma
    		Revised 12/19/2006
    • Stem-Cell Transplant for Non-Hodgkin's Lymphoma:  Pediatric (Obsolete as of 12/15/2006)
    		Revised 12/19/2006
    • Home Traction Devices: Cervical and Lumbar
    		Revised 12/19/2006
    • Gender Reassignment Surgery
    		Revised 12/19/2006
    • Chiropractic Care
    		Revised 12/19/2006
    • Current Perception Threshold (CPT) Testing
    		Revised 12/19/2006
    • Computerized Dynamic Posturography (CDP)
    		Revised 12/19/2006
    • Genetic Testing for Myotonic Dystrophy Type 1
    		Revised 12/19/2006
    • Sensory Stimulation for Patients in Coma or Persistent Vegetative State
    		Revised 12/19/2006
    • Magnetic Resonance (MR)-Guided Thermal Ablation of Fibroids
    		Revised 12/19/2006
    • Adrenal-to-Brain and Fetal Mesencephalic Transplantation for Parkinson's Disease
    		Revised 12/19/2006
    • Spinal Manipulation Under Anesthesia (SMUA) for the Treatment of Chronic Back Pain
    		Revised 12/19/2006
    • Lumbar Fusion for Spinal Instability and Degerative Disc Conditions
    		Revised 12/19/2006
    • Computed Tomography Angiography (CTA)
    		Revised 12/19/2006
    • Stem-Cell Transplant for Chronic Lymphocytic Leukemia
    		Revised 12/19/2006
    • Pediatric Intensive Feeding Programs
    		Revised 12/19/2006
    • Noninvasive Negative Pressure Ventilators
    		Revised 12/19/2006
    • Microwave Ablation for the Treatment of atrial Fibrillation (Obsolete as of 12/15/2006)
    		Revised 12/19/2006
    • Radiofrequency Catheter Ablation for Cardiac Arrhythmias (Obsolete as of 12/15/2006)
    		Revised 12/19/2006
    Coverage Positions/Criteria: Medical
    		 New 12/19/2006
    • Transcatheter Ablation of Arrhythomogenic Foci in the Pulmonary Veins for the Treatment of Artrial Fibrillation
    		New 12/19/2006
    Coverage Positions/Criteria: Pharmacy
    		 Revised 12/19/2006
    • imatinib (Gleevec®)
    		Revised 12/19/2006
    • sodium oxybate (Xyrem®)
    		Revised 12/19/2006
    • Ganirelix
    		Revised 12/19/2006
    • cetrorelix (Cetrotide®)
    		Revised 12/19/2006
    • trastuzumab (Herceptin®)
    		Revised 12/19/2006
    Coverage Positions/Criteria: Pharmacy
    		 New 12/19/2006
    • leuprolide (Lupron®, Lupron Depot®, Lupron Depot-PED®, Eligard®, Viadur®)
    		New 12/19/2006
    Topic Status Date

    November 2006

    Policies, Procedures, Guidelines & Forms
    		    
    Coverage Positions/Criteria: Pharmacy
    		 New 11/28/2006
    Coverage Positions/Criteria: Medical
    		 Revised 11/28/2006
    • Actinic Keratosis Treatments
    		Revised 11/28/2006
    • Adoptive Immunotherapy
    		Revised 11/28/2006
    • Amnioinfusion
    		Revised 11/28/2006
    • Attention-Deficit/Hyperactivity Disorder: Assessment and Treatment
    		Revised 11/28/2006
    • Balloon Valvuloplasty
    		Revised 11/28/2006
    • Biofeedback Therapy for Vulvodynia
    		Revised 11/28/2006
    • Coronary Artery Brachytherapy
    		Revised 11/28/2006
    • Deep Brain Stimulation for Dystonia
    		Revised 11/28/2006
    • Genetic Testing for Retinoblastoma
    		Revised 11/28/2006
    • Genetic Testing for RET Proto-oncogene Germline Point Mutations
    		Revised 11/28/2006
    • Gold Weight Eyelid Implants
    		Revised 11/28/2006
    • Home Dialysis and Associated Technologies
    		Revised 11/28/2006
    • Injections for Unilateral Vocal Cord Paralysis (UVCP)
    		Revised 11/28/2006
    • Intracranial Electroencephalography (IEEG)
    		Revised 11/28/2006
    • Lung Volume Reduction Surgery (LVRS)
    		Revised 11/28/2006
    • Magnetic Resonance Spectroscopy (MRS)
    		Revised 11/28/2006
    • Malignant Melanoma Surveillance Technologies
    		Revised 11/28/2006
    • Meniett™ Device
    		Revised 11/28/2006
    • Minimally Invasive Total Hip Arthroplasty
    		Revised 11/28/2006
    • Monoclonal Antibody (MAb) Imaging or Radioimmunoscintigraphy
    		Revised 11/28/2006
    • Myoelectric Prostheses
    		Revised 11/28/2006
    • Occupational Therapy
    		Revised 11/28/2006
    • Prostate-Specific Antigen (PSA) Screening for Prostate Cancer
    		Revised 11/28/2006
    • Provant® Wound Closure System
    		Revised 11/28/2006
    • Quantitative Electroencephalography (QEEG)
    		Revised 11/28/2006
    • Radiofrequency Ablation (RFA) of Renal Masses
    		Revised 11/28/2006
    • Robotic Surgical Systems
    		Revised 11/28/2006
    • Spinal Ultrasound
    		Revised 11/28/2006
    • Stem-Cell Transplant for Amyloidosis
    		Revised 11/28/2006
    • Stem-Cell Transplant for Chronic Myelogenous Leukemia
    		Revised 11/28/2006
    • Stem-Cell Transplant for Chronic Myelomonocytic Leukemia (CMML) and Juvenile Myelomonocytic Leukemia (JMML)
    		Revised 11/28/2006
    • Tinnitus Instruments, Devices and Retraining Therapy
    		Revised 11/28/2006
    • Total Artificial Heart
    		Revised 11/28/2006
    • Transcatheter Closure of Septal Defects
    		Revised 11/28/2006
    • Transcranial Doppler (TCD) Ultrasonography
    		Revised 11/28/2006
    • Transplant Donor Charges
    		Revised 11/28/2006
    • Tumor In Vitro Chemosensitivity and Chemoresistance Assays
    		Revised 11/28/2006
    • Varicose Vein Treatments
    		Revised 11/28/2006
    • Video Electroencephalographic (V-EEG) Monitoring
    		Revised 11/28/2006
    • Vision Therapy/Orthoptics
    		Revised 11/28/2006
    Coverage Positions/Criteria: Pharmacy
    		 Revised 11/28/2006
    • Bevacizumab (Avastin®)
    		Revised 11/28/2006
    • Dolasetron (Anzemet®), Granisetron (Kytril®), Ondansetron (Zofran®)
    		Revised 11/28/2006
    • Peginterferon Alfa-2a (PegaSys®)
    		Revised 11/28/2006
    • Peginterferon Alfa-2b (PEG Intron®)
    		Revised 11/28/2006

    Back to top

    October 2006

    Topic Status Date
    Policies, Procedures, Guidelines & Forms
    		    
    Coverage Positions/Criteria: Medical
    		 New 10/26/2006
    Coverage Positions/Criteria: Medical
    		 Revised 10/26/2006
    • Brachytherapy of the Breast
    		Revised 10/26/2006
    • Brachytherapy of the Prostate
    		Revised 10/26/2006
    • Breast Biopsy Procedures including Sentinel Node Biopsy
    		Revised 10/26/2006
    • Cardiovascular Magnetic Resonance (CMR)
    		Revised 10/26/2006
    • Carotid Artery Stenting for Carotid Artery Stenosis
    		Revised 10/26/2006
    • Cochlear and Auditory Brainstem Implants
    		Revised 10/26/2006
    • Cryoablation for Prostate Cancer
    		Revised 10/26/2006
    • Diabetes Self-Management Education
    		Revised 10/26/2006
    • Down Syndrome Screening
    		Revised 10/26/2006
    • Electrical Bioimpedance for the Measurement of Cardiac Output
    		Revised 10/26/2006
    • Embolization for Pelvic Congestion
    		Revised 10/26/2006
    • Endovascular Repair of Abdominal Aortic Aneurysms
    		Revised 10/26/2006
    • Endovascular Repair of Thoracic Aortic Aneurysms
    		Revised 10/26/2006
    • Fecal Lactoferrin
    		Revised 10/26/2006
    • Genetic Testing for Hemoglobinopathies
    		Revised 10/26/2006
    • Genetic Testing for Long QT Syndrome (LQTS)
    		Revised 10/26/2006
    • Genetic Testing for Mitochondrial Disorders
    		Revised 10/26/2006
    • Injectable Bulking Agents for Urinary Conditions
    		Revised 10/26/2006
    • Magnetic Resonance Imaging (MRI), Low-Field
    		Revised 10/26/2006
    • Mammography
    		Revised 10/26/2006
    • Nuclear Imaging including Single-Photon Emission Computed Tomography (SPECT)
    		Revised 10/26/2006
    • Observation Care
    		Revised 10/26/2006
    • Obstructive Sleep Apnea (OSA) Diagnosis and Treatment Services
    		Revised 10/26/2006
    • Orthognathic Surgery
    		Revised 10/26/2006
    • Osteochondral Autograft Transplant (Mosaicplasty/OATS®)
    		Revised 10/26/2006
    • Oxygen for Home Use
    		Revised 10/26/2006
    • Plasma Brain Natriuretic Peptide
    		Revised 10/26/2006
    • Signal-Averaged Electrocardiography (SAECG)
    		Revised 10/26/2006
    • Stem-Cell Transplant for Hodgkin's Disease
    		Revised 10/26/2006
    • Stem-Cell Transplant for Myelodysplastic Syndrome
    		Revised 10/26/2006
    • Stem-Cell Transplant for Neuroblastoma
    		Revised 10/26/2006
    • Surgical Treatment of Gynecomastia