Medical Policy Updates

Notification of Policy Revisions Effective July 21, 2005 (Posted May 19, 2005)

Medical Policy	Revision
Prosthetic Appliances	Under "Policy" section, moved "Active policy, no longer scheduled for routine literature review" from last sentence to beginning of section. Under "When Covered" section, revised 2.e. to read "Lenses (intraocular or contact) and Eyeglasses" and added i., ii., and iii. IOL is covered as a "prosthesis" replacing the natural lens of the eye for either surgically removed or congenitally absent crystalline lens(es) of the eye. For these two indications, one pair of external lens(es) (contacts or lens(es) within a frame) due to a prescription change following surgery is covered. For members who have had a cataract extraction or members with congenitally absent crystalline lens(es) who have not had IOL inserted, contact lens(es) or lens(es) within a frame are covered as prosthetic appliances. The first pair of contact lens(es) or lens(es) within a frame are covered, as well as additional pair of lenses each time the member’s prescription changes. Therapeutic soft (hydrophillic) contact lens(es) (corneal bandage) are considered medically necessary for the treatment of acute or chronic corneal pathology with examples provided. Under "When not Covered" section - added #12. Lens(es) for keratoconus. Notice given 5/19/05. Effective date 7/21/05.

Medical Policy

Revision

Prosthetic Appliances

Under "Policy" section, moved "Active policy, no longer scheduled for routine literature review" from last sentence to beginning of section. Under "When Covered" section, revised 2.e. to read "Lenses (intraocular or contact) and Eyeglasses" and added i., ii., and iii. IOL is covered as a "prosthesis" replacing the natural lens of the eye for either surgically removed or congenitally absent crystalline lens(es) of the eye. For these two indications, one pair of external lens(es) (contacts or lens(es) within a frame) due to a prescription change following surgery is covered. For members who have had a cataract extraction or members with congenitally absent crystalline lens(es) who have not had IOL inserted, contact lens(es) or lens(es) within a frame are covered as prosthetic appliances. The first pair of contact lens(es) or lens(es) within a frame are covered, as well as additional pair of lenses each time the member’s prescription changes. Therapeutic soft (hydrophillic) contact lens(es) (corneal bandage) are considered medically necessary for the treatment of acute or chronic corneal pathology with examples provided. Under "When not Covered" section - added #12. Lens(es) for keratoconus. Notice given 5/19/05. Effective date 7/21/05.