Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective May 11, 2010 (Posted February 02, 2010)

Medical Policy Revision
Electrostimulation and Electromagnetic Therapy for Chronic Wounds MED1127 Notification of new policy. Electrical stimulation and electromagnetic therapy for the treatment of wounds is considered investigational. Electrical stimulation performed by the patient in the home setting for the treatment of wounds is considered investigational. Notification given 2/2/2010. Effective date 5/11/2010.
Intraepidermal Nerve Fiber Density MED1251 NEW POLICY IMPLEMENTED. REVIEWED WITH SENIOR MEDICAL DIRECTOR 11/9/09. "SKIN BIOPSY WITH EPIDERMAL NERVE FIBER DENSITY MEASUREMENT IS CONSIDERED INVESTIGATIONAL. BCBSNC DOES NOT PROVIDE COVERAGE FOR INVESTIGATIONAL SERVICES." NOTICE GIVEN 2/2/2010. POLICY EFFECTIVE DATE 5/11/2010.
Radiofrequency Facet Joint Denervation SUR6578 ADDED SPECIFIC CPT CODES; 64622, 64623, 64626, 64627, 77003 TO "BILLING/CODING" SECTION. NOTICE GIVEN 2/2/10. POLICY EFFECTIVE DATE 5/11/2010.
Ultrasound Accelerated Fracture Healing Device SUR6670 Policy name changed from Sonic Accelerated Fracture Healing System (SAFHS) to Ultrasound Accelerated Fracture Healing Device. Description section extensively revised. When Covered section revised to read: Low-intensity ultrasound treatment may be considered medically necessary when used as an adjunct to conventional management (i.e., closed reduction and cast immobilization) for the treatment of fresh, closed fractures in skeletally mature individuals and as a treatment of fracture nonunions of bones, excluding the skull and vertebra. When Not Covered section revised to read: "Other applications of low-intensity ultrasound treatment are investigational, including but not limited to treatment of delayed unions (defined as a decelerating healing process as determined by serial x-rays), congenital pseudarthroses, open fractures, or stress fractures. This device may not be used concurrently with other noninvasive devices." Information that was previously in the When Covered section was moved to the Policy Guidelines section. Notification given 2/2/10 for effective date of 5/11/10.