Medical Policy Updates

Notification of Policy Revisions Effective November 3, 2005 (Posted September 1, 2005)

Medical Policy	Revision
Fetal Surgery for Malformations	Temporary tracheal occlusion as a treatment of congenital diaphragmatic hernia is considered investigational-removed from "When covered" section to "When not covered" section with explanation. Explanation re: investigational status of fetal surgery for myelomeningocele or aqueductal stenosis added to "When not covered" section. Reference sources added. Specialty Matched Consultant Advisory Panel review -8/25/05. Notification given 9/1/05. Effective date 11/3/05.
Uterine Artery Occlusion in the Treatment of Uterine Fibroids	Policy name changed from "Uterine Artery Embolization to Treat Uterine Fibroids, Transcatheter Approach" to "Uterine Artery Occlusion in the Treatment of Uterine Fibroids". Under "When not covered" added "Laparoscopic occlusion of the uterine arteries using bipolar coagulation is considered investigational." Rationale for this statement placed under "Policy Guidelines". Reference sources added. Specialty Matched Consultant Advisory Panel review - 8/25/05. Following review, policy status changed to "Active policy, no longer scheduled for routine literature review". Notification given 9/1/05. Effective date 11/3/05.

Medical Policy

Revision

Fetal Surgery for Malformations

Temporary tracheal occlusion as a treatment of congenital diaphragmatic hernia is considered investigational-removed from "When covered" section to "When not covered" section with explanation. Explanation re: investigational status of fetal surgery for myelomeningocele or aqueductal stenosis added to "When not covered" section. Reference sources added. Specialty Matched Consultant Advisory Panel review -8/25/05. Notification given 9/1/05. Effective date 11/3/05.

Uterine Artery Occlusion in the Treatment of Uterine Fibroids

Policy name changed from "Uterine Artery Embolization to Treat Uterine Fibroids, Transcatheter Approach" to "Uterine Artery Occlusion in the Treatment of Uterine Fibroids". Under "When not covered" added "Laparoscopic occlusion of the uterine arteries using bipolar coagulation is considered investigational." Rationale for this statement placed under "Policy Guidelines". Reference sources added. Specialty Matched Consultant Advisory Panel review - 8/25/05. Following review, policy status changed to "Active policy, no longer scheduled for routine literature review". Notification given 9/1/05. Effective date 11/3/05.