Medical Policy Updates

Notification of Policy Revisions Effective December 23, 2004 (Posted October 14, 2004)

Medical Policy	Revision
Allergy Testing	Specialty Matched Consultant Advisory Panel review 7/23/04. Under "When Covered": 1.a added "Rarely are more than 40 percutaneous tests required in a three year period."; 1.b added "Rarely are more than 20 intracutaneous tests required in a three year period."; added photo–patch test and double–blind food challenge test; added "or for consideration of Xolair administration in patients with moderate to severe asthma." to #5. Under "When Not Covered", added Conjunctival Challenge Testing as investigational. Sources added. Notice given 10/14/04. Effective date 12/23/ 04.
Sleep Apnea and Breathing Related Sleep Disorders in Adults	Specialty Matched Consultant Advisory Panel review – 6/21/04. Multiple updates and clarifications. Under Section I – "When not Covered" – B. Unattended (unsupervised) sleep studies are considered investigational. Under Section II – "When Covered" – A. Medical Management, good faith effort at CPAP compliance added; B. Surgical Management, clinically significant UARS included; "When not Covered" – C. Additional non-covered surgical procedures listed, including RFVTR (Somnoplasty) of nasal turbinates, the Repose System, injection snoreplasty, CAPSO. Section I – "Billing/Coding" – removed deleted CPT code 99508. Section II – "Billing/Coding" – added the following HCPCS codes: A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, E0470, E0471, E0472, E0561, E0562, S2080; Removed CPT codes 42825, 42826; Removed the following deleted HCPCS codes: K0183–K0189, K0268, K0531, K0532, K0533, K0534. Sources added. Notification given 10/14/04. Effective date 12/23/04.

Medical Policy

Revision

Allergy Testing

Specialty Matched Consultant Advisory Panel review 7/23/04. Under "When Covered": 1.a added "Rarely are more than 40 percutaneous tests required in a three year period."; 1.b added "Rarely are more than 20 intracutaneous tests required in a three year period."; added photo–patch test and double–blind food challenge test; added "or for consideration of Xolair administration in patients with moderate to severe asthma." to #5. Under "When Not Covered", added Conjunctival Challenge Testing as investigational. Sources added. Notice given 10/14/04. Effective date 12/23/ 04.

Sleep Apnea and Breathing Related Sleep Disorders in Adults

Specialty Matched Consultant Advisory Panel review – 6/21/04. Multiple updates and clarifications. Under Section I – "When not Covered" – B. Unattended (unsupervised) sleep studies are considered investigational. Under Section II – "When Covered" – A. Medical Management, good faith effort at CPAP compliance added; B. Surgical Management, clinically significant UARS included; "When not Covered" – C. Additional non-covered surgical procedures listed, including RFVTR (Somnoplasty) of nasal turbinates, the Repose System, injection snoreplasty, CAPSO. Section I – "Billing/Coding" – removed deleted CPT code 99508. Section II – "Billing/Coding" – added the following HCPCS codes: A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, E0470, E0471, E0472, E0561, E0562, S2080; Removed CPT codes 42825, 42826; Removed the following deleted HCPCS codes: K0183–K0189, K0268, K0531, K0532, K0533, K0534. Sources added. Notification given 10/14/04. Effective date 12/23/04.