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Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective June 10, 2014 (Posted April 1, 2014)

Medical Policy Revision
Epiretinal Radiation Therapy for Age-Related Macular Degeneration "Notification" Added investigational indication to "When Not Covered" section regarding stereotactic radiation therapy: Sterotactic radiation therapy for the treatment of choroidal neovascularization is considered investigational. Updated Policy Guidelines section. Reference added. Medical director review 3/2014. Notification 4/1/14 for effective date 6/10/14.
Infliximab (Remicade) "Notification" Specialty Matched Consultant Advisory Panel review meeting 2/25/2014. Renumbered quantity limitations under Policy Guidelines section. Under "When Covered" section 1.g.: added neurosarcoid to diagnosis reference; under 2.contraindications list:added "any active infections" for c. and "demyelinating disease" for d. Under "When Not Covered" section added (JIA) juvenile idiopathic arthritis to (JRA) juvenile rheumatoid arthritis reference as these terms are synonomous. Medical director review. Policy noticed on 4/1/14 for effective date 6/10/14.