Medical Policy Updates

Notification of Policy Revisions Effective July 20, 2009 (Posted April 13, 2009)

Medical Policy	Revision
Microwave Thermotherapy for Primary Breast Cancer	New policy adopted. Reviewed with Senior Medical Director 3/16/09. BCBSNC will not provide coverage for focused microwave phase array thermotherapy for the treatment of breast cancer because it is considered investigational. BCBSNC does not cover investigational services. Notice given 4/13/09. Policy effective date 7/20/09.
Percutaneous Electrical Nerve Stimulation (PENS) or Neuromodulation Therapy	Policy from archive. Original name of policy, "Percutaneous Electrical Nerve Stimulation" has been changed to "Percutaneous Electrical Nerve Stimulation (PENS) and Neuromodulation Therapy". Senior Medical Director Review 3/16/09. "Description" section updated. "Policy" statement indicates; "BCBSNC will not provide coverage for Percutaneous Electrical Nerve Stimulation (PENS) or Percutaneous Neuromodulation Therapy (PNT) because they are considered investigational." References added. Notification date 4/13/09. Effective date of policy 7/20/09.

Medical Policy

Revision

Microwave Thermotherapy for Primary Breast Cancer

New policy adopted. Reviewed with Senior Medical Director 3/16/09. BCBSNC will not provide coverage for focused microwave phase array thermotherapy for the treatment of breast cancer because it is considered investigational. BCBSNC does not cover investigational services. Notice given 4/13/09. Policy effective date 7/20/09.

Percutaneous Electrical Nerve Stimulation (PENS) or Neuromodulation Therapy

Policy from archive. Original name of policy, "Percutaneous Electrical Nerve Stimulation" has been changed to "Percutaneous Electrical Nerve Stimulation (PENS) and Neuromodulation Therapy". Senior Medical Director Review 3/16/09. "Description" section updated. "Policy" statement indicates; "BCBSNC will not provide coverage for Percutaneous Electrical Nerve Stimulation (PENS) or Percutaneous Neuromodulation Therapy (PNT) because they are considered investigational." References added. Notification date 4/13/09. Effective date of policy 7/20/09.