Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective October 14, 2004 (Posted July 29, 2004)

Medical Policy Revision
Artificial Intervertebral Disc New policy implemented. Artificial Intervertebral Disc is considered investigational. Reviewed by Specialty Matched Consultant Advisory Panel 6/22/04. Notification given 7/29/04. Effective date 10/14/04.
Corotid Artery Angioplasty/Stenting (CAS) New policy implemented. Carotid Artery Angioplasty/Stenting is considered investigational. Reviewed by Specialty Matched Consultant Advisory Panel 6/22/04. Notification given 7/29/04. Effective date 10/14/04.
Spinal Cord Stimulation Specialty Matched Consultant Advisory Panel review 6/22/2004. Description updated. In the section When Spinal Cord Stimulation is Covered, added the word "neuropathic in the first sentence. Under section When Spinal Cord Stimulation is not covered added statement "Spinal Cord Simulation is investigational as treatment of critical limb ischemia. BCBSNC does not provide coverage for investigational procedures". Updated Benefit Application and Billing Coding section format for consistency. Deleted HCPCS code E0754 and CPT codes 61862 and 61875 as they do not apply to this policy. References added. Notification given 7/29/2004. Effective date 10/14/2004.
Electrical Stimulator, Neuromuscular Combined policies on Therapeutic Electrical Stimulation (TES) and Functional Neuromuscular Stimulation (FNS) and added section related to Neuromuscular Electrical Stimulation (NMES) for disuse atrophy. Therapeutic Electrical Stimulator (TES), Functional Neuromuscular Stimulation (FNS), and Neuromuscular Electrical Stimulation (NMES) for disuse atrophy are considered investigational. Specialty Matched Consultant Advisory Panel review 6/22/2004. References added. Notification given 7/29/2004. Effective date 10/14/2004.
TENS (Transcutaneous Electrical Nerve Stimulator) Specialty Matched Consultant Advisory Panel review 6/22/2004. Removed statement from When Transcutaneous Electrical Nerve Stimulation is covered indicating "When covered, it will be on the basis of individual consideration." Benefit Application section format updated for consistency. References added. Notification given 7/29/2004. Effective 10/14/2004.