Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective March 30, 2010 (Posted December 21, 2009)

Medical Policy Revision
Intensity Modulated Radiation Therapy( IMRT) of Abdomen and Pelvis New policy issued. BCBSNC will not provide coverage for Intensity Modulated Radiation Therapy (IMRT) of the abdomen and pelvis. IMRT is considered investigational for the treatment of tumors: of the upper abdomen, including but not limited to stomach, hepatobiliary tract, and pancreas; of the lower abdomen, including but not limited to anorectal locations; and of the pelvis, including but not limited to gynecologic (e.g., cervical, endometrial) locations. Notification given 12/21/09. Effective date 3/30/10.
Intensity Modulated Radiation Therapy( IMRT) of Breast and Lung New policy issued. BCBSNC will not provide coverage for intensity modulated radiation therapy (IMRT) of the breast or lung. IMRT of the breast is considered investigational, including, but not limited to its use as a technique of partial breast irradiation or as an alternative to whole breast irradiation after breast-conserving surgery. IMRT of the lung is considered investigational, including, but not limited to, its use as a technique of dose escalation in the treatment of lung cancer. Notification given 12/21/09. Effective date 3/30/10.
Intensity Modulated Radiation Therapy( IMRT) of Head and Neck New policy issued. Intensity Modulated Radiation Therapy (IMRT) may be considered medically necessary for the treatment of head and neck cancers. Notification given 12/21/09. Effective date 3/30/10.
Intensity Modulated Radiation Therapy( IMRT) of the Prostate New policy issued. Intensity-modulated radiation therapy (IMRT) may be considered medically necessary in the treatment of localized prostate cancer at radiation doses of 75 to 80 Gy. Notification 12/21/09. Effective date 3/30/10.
Noninvasive Respiratory Assist Devices Notification of new policy entitled Noninvasive Respiratory Assist Devices. THIS POLICY IS NOT EFFECTIVE UNTIL MARCH 30, 2010. Prior to March 30, 2010 refer to policy number OTH8138, Sleep Apnea and Breathing Related Sleep Disorders in Adults. The policy entitled Sleep Apnea and Breathing Related Sleep Disorders in Adults has been separated into three policies and will be archived on March 30, 2010. Notification given December 21, 2009. Effective date March 30, 2010.
Sleep Apnea: Diagnosis and Medical Management Notification of new policy entitled Sleep Apnea: Diagnosis and Medical Management. THIS POLICY IS NOT EFFECTIVE UNTIL MARCH 30, 2010. Prior to March 30, 2010 refer to policy number OTH8138, Sleep Apnea and Breathing Related Sleep Disorders in Adults. The policy entitled Sleep Apnea and Breathing Related Sleep Disorders in Adults has been separated into three policies and will be archived on March 30, 2010. Notification given December 21, 2009. Effective date March 30, 2010.
Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome Notification of new policy entitled Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome. THIS POLICY IS NOT EFFECTIVE UNTIL MARCH 30, 2010. Prior to MARCH 30, 2010 refer to policy number OTH8138, Sleep Apnea and Breathing Related Sleep Disorders in Adults. The policy entitled Sleep Apnea and Breathing Related Sleep Disorders in Adults has been separated into three policies and will be archived on MARCH 30, 2010. Notification given December 21, 2009. Effective date March 30, 2010.