Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective January 1, 2013 (Posted October 1, 2012)

Medical Policy Revision
Cardiovascular Disease Risk Tests "Notification" Evidence Based Guideline converted to Corporate Medical Policy. Policy re-titled from "Novel Lipid Risk Factors in Risk Assessment of Cardiovascular Disease" to "Cardiovascular Disease Risk Tests." Measurement of cardiovascular risk factors, (i.e., apolipoprotein B, apolipoprotein A-I, apolipoprotein E, LDL subclass, HDL subclass, lipoprotein[a], long chain fatty acids,) is considered investigational as an adjunct to LDL cholesterol in the risk assessment and management of cardiovascular disease. References updated. Desciption and Policy Guidelines sections updated. Medical Director review 8/2012. Notification given 10/1/12 for effective date 1/1/2013.
Implantable Cardioverter Defibrillator "Notification" New policy developed to separate information regarding Internal Cardioverter Defibrillators (ICD) from the External Defibrillator policy. BCBSNC will provide coverage for implantable cardioverter defibrillators when it is determined to be medically necessary because the medical criteria and guidelines are met. Information regarding subcutaneous ICD added to policy. The use of a subcutaneous ICD is considered investigational for all indications. Medical Director review 9/2012. Policy notified on 10/1/2012 for effective date of 1/1/2013.
Measurement of Serum Antibodies to Infliximab "Notification" New policy. Measurement of antibodies to infliximab in a patient receiving treatment with infliximab, either alone or as a combination test which includes the measurement of serum infliximab levels, is considered investigational. Medical director review 9/18/2012. Notification given10/1/12. Policy effective 1/1/13.
Urinary Tumor Markers for Bladder Cancer "Notification" Policy status changed from covered to investigational. Description section revised. Policy statement changed from "BCBSNC will provide coverage for Urinary Tumor Markers for Bladder Cancer when it is determined to be medically necessary because the medical criteria and guidelines shown below are met." to "Urinary Tumor Markers for Bladder Cancer are considered investigational for all applications. BCBSNC does not provide coverage for investigational services or procedures." Policy Guidelines updated. Senior Medical Director review 8/29/2012. Notification given 10/1/2012. Policy effective date 1/1/2013.