Medical Policy Updates

Notification of Policy Revisions Effective October 16, 2012 (Posted July 10, 2012)

Medical Policy	Revision
Biofeedback "Notification"	Under "When Not Covered" section added as investigational: autism, Raynaud's disease, back pain, muscle re-education or muscle tension, hypertension, asthma, anxiety disorders, insomnia, sleep bruxism, tinnitus, movement disorders, Bell's palsy, motor function after stroke, injury or lower limb surgery, orthostatic hypotension with spinal cord injury, and temporomandibular joint dysfunction (TMJD) for consistency with BCBSA. Policy guidelines extensively revised. Deleted the statement "Limitations and Exclusions for investigational services for use of Biofeedback with Attention Deficit Disorder" from Benefits Application section. Specialty Matched Consultant Advisory Panel review meeting 3/21/12. References added. Notification given 7/10/12 for effective date 10/16/12. Reviewed with medical director.
Corneal Collagen Cross-linking "Notification"	New policy issued. Corneal collagen cross-linking is considered investigational. BCBSNC does not provide coverage for investigational services or procedures. Medical director review 6/2012. Specialty Matched Consultant Advisory Panel review meeting 6/20/12. Notification given 7/10/12. Effective date 10/16/2012.

Medical Policy

Revision

Biofeedback "Notification"

Under "When Not Covered" section added as investigational: autism, Raynaud's disease, back pain, muscle re-education or muscle tension, hypertension, asthma, anxiety disorders, insomnia, sleep bruxism, tinnitus, movement disorders, Bell's palsy, motor function after stroke, injury or lower limb surgery, orthostatic hypotension with spinal cord injury, and temporomandibular joint dysfunction (TMJD) for consistency with BCBSA. Policy guidelines extensively revised. Deleted the statement "Limitations and Exclusions for investigational services for use of Biofeedback with Attention Deficit Disorder" from Benefits Application section. Specialty Matched Consultant Advisory Panel review meeting 3/21/12. References added. Notification given 7/10/12 for effective date 10/16/12. Reviewed with medical director.

Corneal Collagen Cross-linking "Notification"

New policy issued. Corneal collagen cross-linking is considered investigational. BCBSNC does not provide coverage for investigational services or procedures. Medical director review 6/2012. Specialty Matched Consultant Advisory Panel review meeting 6/20/12. Notification given 7/10/12. Effective date 10/16/2012.