Added the following statement to the "Description" section; "***Note: This Medical Policy is complex and technical. For questions concerning the technical language and/or specific clinical indications for its use, please consult your physician." Moved "A.2. Patients with hypoglycemic unawareness." into "A.1." in the "When Covered" section. Added "type I diabetes who have" to "B.1." and "severe, symptomatic (generally blood glucose levels less than 50 mg/dl)". Changed "B.2." to indicate; "Patients with type I diabetes who are pregnant whose diabetes is poorly controlled. Poorly controlled type I diabetes includes unexplained hypoglycemic episodes, hypoglycemic unawareness, suspected postprandial hyperglycemia, and recurrent diabetic ketoacidosis." In the "When Not Covered" section removed "A. Glucose sensors and transmitters associated with an integrated insulin pump are not medically necessary unless the patient meets criterion B.1. above AND does not already have an adequately functioning insulin pump." Reviewed by Senior Medical Director 6/24/09. Notice given 8/3/2009. Policy effective date 11/9/2009.

Description section revised. Policy statement changed to read, "BCBSNC will not provide coverage for signal-averaged ECG. It is considered investigational and BCBSNC does not cover investigational services." Criteria in the When Covered section was deleted. Statement in the When it is Not Covered section was revised to read: "Signal- averaged electrocardiography is considered investigational, including, but not limited to, its use as a technique of risk stratification for arrhythmias: after prior myocardial infarction; in patients with cardiomyopathy; in patients with syncope; as an assessment of success after surgery for arrhythmia; in the detection of acute rejection of heart transplants; as an assessment of efficacy of antiarrhythmic drug therapy; or in the assessment of success of pharmacological, mechanical, or surgical interventions to restore coronary artery blood flow." Rationale for change to investigational status added to Policy Guidelines section. References updated. Notification given 8/3/09. Effective date 11/9/09.

New policy adopted from the BCBS Association. Transanal radiofrequency treatment of fecal incontinence is considered investigational. BCBSNC does not cover investigational services. Reviewed by Senior Medical Director 6/23/09. Notice given 8/3/2009. Policy effective date is 11/9/2009.