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Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective January 29, 2007 (Posted November 27, 2006)

Medical Policy Revision
Lymphedema Pumps-Sequential Pneumatic Compression Device Under When Covered section, #3-A four week trial of conservative medical therapies will be required. Under When Not Covered section-added "Two-phase lymph preparation and drainage therapy devices (e.g., Flexitouch® Lymphedema System) are not covered. The devices are considered investiga¬tional and BCBSNC does not cover investigational services." Policy guidelines added. Policy status changed to "Active policy, no longer scheduled for routine literature review." Notification given 11/27/06. Effective date 1/29/07.