Medical Policy Updates

Notification of Policy Revisions Effective January 15, 2013 (Posted October 16, 2012)

Medical Policy	Revision
Autologous Fat Grafting to the Breast "Notification"	New policy developed. The use of autologous fat grafting and adipose-derived stem cells for augmentation or reconstruction of the breast is considered investigational. Ninety day notice given 10/16/2012 for effective date of 01/15/2013.
Dopamine Transporter Imaging with Single Photon Emission Computed Tomography "Notification"	New policy issued. Dopamine transporter imaging with single photon emission computed tomography (DAT-SPECT) is investigational for all indications, including but not limited to, aiding in the diagnosis of patients with clinically uncertain parkinsonian syndromes, essential tremor, or dementia with Lewy bodies, and for the monitoring of disease progression. Notification given 10/16/2012 for effective date of 01/15/2013. Medical Director review 8-2012

Medical Policy

Revision

Autologous Fat Grafting to the Breast "Notification"

New policy developed. The use of autologous fat grafting and adipose-derived stem cells for augmentation or reconstruction of the breast is considered investigational. Ninety day notice given 10/16/2012 for effective date of 01/15/2013.

Dopamine Transporter Imaging with Single Photon Emission Computed Tomography "Notification"

New policy issued. Dopamine transporter imaging with single photon emission computed tomography (DAT-SPECT) is investigational for all indications, including but not limited to, aiding in the diagnosis of patients with clinically uncertain parkinsonian syndromes, essential tremor, or dementia with Lewy bodies, and for the monitoring of disease progression. Notification given 10/16/2012 for effective date of 01/15/2013. Medical Director review 8-2012