Medical Policy Updates

Notification of Policy Revisions Effective August 26, 2004 (Posted June 24,2004)

Medical Policy	Revision
Growth Hormone	Specialty Matched Consultant Advisory Panel review. Added the name "Zorbtive" to Description of Procedure or Service and to the Policy Key Words section. Added new indication of "Short Bowel Syndrome." under section When Growth Hormone (GH) is Covered. Corrected statement under Policy Guidelines section from "Chronic renal insufficiency is defined as a serum creatinine of less than 30 mg/dl" to "Chronic renal insufficiency is defined as a serum creatinine of greater than 1.5mg/dL". References added. Notification date 6/24/04. Effective date 8/26/04.
Intravascular Ultrasound Imaging (IVUS)	Specialty Matched Consultant Advisory Panel review. Coverage criteria broadened. Added statement "Intravascular ultrasound imaging of any artery other than coronary is considered investigational. BCBSNC does not cover investigational procedures". References added. Notification date 6/24/04. Effective date 8/26/04.

Medical Policy

Revision

Growth Hormone

Specialty Matched Consultant Advisory Panel review. Added the name "Zorbtive" to Description of Procedure or Service and to the Policy Key Words section. Added new indication of "Short Bowel Syndrome." under section When Growth Hormone (GH) is Covered. Corrected statement under Policy Guidelines section from "Chronic renal insufficiency is defined as a serum creatinine of less than 30 mg/dl" to "Chronic renal insufficiency is defined as a serum creatinine of greater than 1.5mg/dL". References added. Notification date 6/24/04. Effective date 8/26/04.

Intravascular Ultrasound Imaging (IVUS)

Specialty Matched Consultant Advisory Panel review. Coverage criteria broadened. Added statement "Intravascular ultrasound imaging of any artery other than coronary is considered investigational. BCBSNC does not cover investigational procedures". References added. Notification date 6/24/04. Effective date 8/26/04.