Medical Policy Updates
Notification of Policy Revisions Effective January 6, 2005 (Posted October 28, 2004)
|Breast Surgeries||Specialty Matched Consultant Advisory Panel review - 8/27/04. Under Benefits Application; added "Breast surgeries included in this policy may require prior plan approval." Under Section II - Mastectomy for Gynecomastia; Expanded "Description" section, under "When it is Covered" pulled obesity out of #3 and added as a separate entity with guidelines -"If gynecomastia is caused by obesity (BMI>30), it is documented to have failed to respond to conservative measures which must include participation in a clinically supervised, comprehensive weight loss and exercise program for at least 6 months, AND......." Under Section III - Reduction Mammaplasty; "Policy Guidelines", Table I: Schnur Sliding Scale, added "from each breast" to the end of "Threshold of breast tissue to be removed (in grams). Under Section V - Insertion and Removal of Breast Implants; removed "MRI has not been established as a screening modality for breast cancer even in the presence of breast implants." based on MRI of The Breast policy #RAD5105. Reference sources added. Notification given 10/28/04. Effective date 1/6/05.|
|Correlated Audioelectric Cardiography||
New policy issued. Correlated audioelectric cardiography is considered investigational.
Reference added. Notification 10/28/2004. Effective 1/6/2005.
New policy issued. External defibrillators are considered investigational.
References added. Notification 10/28/2004. Effective 1/6/2005.
|Screening for Vertebral Fracture with Dual X-Ray Absorptiometry (DEXA)||
New policy issued. Screening for vertebral fractures with dual x-ray absorptiometry is considered investigational.
Reference added. Notification 10/28/2004. Effective 01/06/2005.
|Vacuum Assisted Closure of Wounds||Specialty Matched Consultant Advisory Panelreview. Additional information added and criteria changes made regarding acute and subacute wounds. Removed codes K0538, K0539,and K0540 from the policy. They were deleted 1/1/04. Notification given 10/28/04. Effective date of policy is 1/6/2005.|