Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective April 1, 2012 (Posted December 30, 2011)

Medical Policy Revision
Facet Joint Denervation "Notification" Specialty Matched Consultant Advisory Panel review 11/30/2011. "Description" section revised. "Chemical denervation" added to the "When Not Covered" section. "All other techniques of facet joint denervation for the treatment of chronic back pain are considered investigational including, but not limited to: Pulsed radiofrequency denervation; Laser; Cryodenervation; and Chemical denervation." "Therapeutic (as opposed to diagnostic) medial branch blocks are considered investigational." "Policy Guidelines" updated. Added the following new 2012 CPT codes to the "Billing/Coding" section: 64633, 64634, 64635, and 64636. Deleted CPT codes: 64622, 64623, 64626, and 64627. Notification given 1/1/2012. Policy effective date 4/1/2012.
Genetic Testing for Familial Alzheimer's Disease "Notification" Policy converted from Evidence Based Guideline to Corporate Medical Policy. Specialty Matched Consultant Advisory Panel review 11/30/2011. "Genetic testing for the diagnosis or risk assessment of Alzheimer's disease is considered investigational. Genetic testing includes, but is not limited to, testing for the apolipoprotein E epsilon 4 allele, presenilin genes, or amyloid precursor gene." Added new CPT code effective 1/1/2012, 81401, to "Billing/Coding" section. Notification given 1/1/2012. Policy effective 4/1/2012.
Genetic Testing for Tamoxifen Treatment "Notification" Evidence based guideline converted to corporate medical policy. "Genotyping to determine cytochrome p450 (CYP2D6) genetic polymorphisms is considered investigational for the purpose of managing treatment with tamoxifen for women at high risk for or with breast cancer." Added new 2012 CPT code, 81226 to "Billing/Coding" section. Notification given 1/1/2012. Policy effective 4/1/2012.
Quantitative Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers "Notification" New policy. "The assessment of HER2 status by quantitative total HER2 protein expression and HER2 homodimer measurement is considered investigational." Medical Director review 12/14/11. Notification given 1/1/2012. Policy effective 4/1/2012.