Medical Policy Updates

Notification of Policy Revisions Effective March 12, 2007 (Posted January 3, 2007)

Medical Policy	Revision
Allergy Immunotherapy (Desensitization)	Description section revised. Under "When Covered", second paragraph now reads: "Rapid desensitization (a.k.a., Rush Immunotherapy or Cluster Immunotherapy) is covered for patients with Hymenoptera sensitivity (e.g., wasps, hornets, bees, fire ants) (a.k.a., Stinging insect hypersensitivity)."; third paragraph (previously second bullet), now reads "Although not considered allergy immunotherapy, drug desensitization is considered medically necessary when there is no alternative medication or therapy available to treat a life-threatening condition....." Further explanation re: drug desensitization follows. "When not Covered" section, now has two main topics: Allergy Immunotherapy and allergy treatments. Allergy Immunotherapy is not covered for the following indications because it is considered investigational: Chronic urticaria, Atopic dermatitis, Angioedema, Food allergy, Migraine headaches, Non-allergic vasomotor rhinitis, Intrinsic (non-allergic) asthma; Allergy treatments non covered because they are considered investigational treatments now lists the 5 bullets that were previously under Allergy immunotherapy not covered. The fifth bullet now reads "Low dose immunotherapy also known as the "Rinkel" technique also known as serial dilution endpoint titration therapy for ragweed pollen hay fever; Also added the following as investigational allergy treatments: Enzyme-Potentiated Desensitization, Acupuncture for allergies, Homeopathy for allergies and Rhinophototherapy. Under "Policy Guidelines" added "Evidence-based clinical practice guidelines support the use of allergy immunotherapy for the management of allergic rhinitis, allergic asthma and stinging insect hypersensitivity." New 2007 CPT code 0168T added to Billing/Coding section. Reference sources and definitions added. Notification given 1/3/07. Effective date 3/12/07.
Posterior Tibial Nerve Stimulation for Voiding Dysfunction	Notification of new policy. BCBSNC will not provide coverage for posterior tibial nerve stimulation for urinary dysfunction, including but not limited to urinary frequency, urgency, incontinence and retention, because it is considered investigational. BCBSNC does not cover investigational services. Notification given 1/3/07. Effective date 3/12/07.

Medical Policy

Revision

Allergy Immunotherapy (Desensitization)

Description section revised. Under "When Covered", second paragraph now reads: "Rapid desensitization (a.k.a., Rush Immunotherapy or Cluster Immunotherapy) is covered for patients with Hymenoptera sensitivity (e.g., wasps, hornets, bees, fire ants) (a.k.a., Stinging insect hypersensitivity)."; third paragraph (previously second bullet), now reads "Although not considered allergy immunotherapy, drug desensitization is considered medically necessary when there is no alternative medication or therapy available to treat a life-threatening condition....." Further explanation re: drug desensitization follows. "When not Covered" section, now has two main topics: Allergy Immunotherapy and allergy treatments. Allergy Immunotherapy is not covered for the following indications because it is considered investigational: Chronic urticaria, Atopic dermatitis, Angioedema, Food allergy, Migraine headaches, Non-allergic vasomotor rhinitis, Intrinsic (non-allergic) asthma; Allergy treatments non covered because they are considered investigational treatments now lists the 5 bullets that were previously under Allergy immunotherapy not covered. The fifth bullet now reads "Low dose immunotherapy also known as the "Rinkel" technique also known as serial dilution endpoint titration therapy for ragweed pollen hay fever; Also added the following as investigational allergy treatments: Enzyme-Potentiated Desensitization, Acupuncture for allergies, Homeopathy for allergies and Rhinophototherapy. Under "Policy Guidelines" added "Evidence-based clinical practice guidelines support the use of allergy immunotherapy for the management of allergic rhinitis, allergic asthma and stinging insect hypersensitivity." New 2007 CPT code 0168T added to Billing/Coding section. Reference sources and definitions added. Notification given 1/3/07. Effective date 3/12/07.

Posterior Tibial Nerve Stimulation for Voiding Dysfunction

Notification of new policy. BCBSNC will not provide coverage for posterior tibial nerve stimulation for urinary dysfunction, including but not limited to urinary frequency, urgency, incontinence and retention, because it is considered investigational. BCBSNC does not cover investigational services. Notification given 1/3/07. Effective date 3/12/07.