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Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective December 30, 2016 (Posted October 25, 2016)

Medical Policy Revision
Hemodialysis Treatment for ESRD "Notification" New policy developed. BCBSNC will provide coverage for Hemodialysis treatment for ESRD when it is determined to be medically necessary because the medical criteria and guidelines outlined in the policy are met. Notification given 10/25/2016 for policy effective date 12/30/2016.
Implantable Bone Conduction Hearing Aids "Notification" Under Benefits Application section, added statements "This health benefit plan provides coverage for MEDICALLY NECESSARY hearing aids, including implantable bone-anchored hearing aids (BAHA), and related services that are ordered by a DOCTOR or a licensed audiologist for each MEMBER under the age of 22. Benefits are provided for one hearing aid per hearing-impaired ear, and replacement hearing aids when alterations to an existing hearing aid are not adequate to meet the MEMBER'S needs. This benefit is limited to once every 36 months for MEMBERS under age 22. Benefits are also provided for the evaluation, fitting, and adjustments of hearing aids or replacement of hearing aids, and for supplies, including ear molds." Notification given 10/25/2016 for policy effective date 12/30/16.
Surgery for Morbid Obesity "Notification" Under Benefits Application section, added statements "Benefits are provided for surgical treatment of morbid obesity (bariatric surgery) if the individual has received 12 consecutive months of medical management of this condition prior to the surgical procedure. Medical management is defined as participation in non-surgical weight reduction programs that include frequent, e.g., monthly, documentation of weight, dietary regimen, and exercise." Notification given 10/25/2016 for policy effective date 12/30/16.
Varicose Veins, Treatment for "Notification" Under Benefits Application section, added statement "Coverage is provided for endovenous procedures used to support the normal function of your veins, and is limited to one procedure per limb per lifetime. Benefits are also provided for sclerotherapy vein treatment and are limited to three procedures per limb per lifetime." Notification given 10/25/2016 for policy effective date 12/30/16.
Wheelchairs (Manual and Power Operated) "Notification" Policy title change. Removed "Power Operated Vehicle (Scooters)" from the Policy Statement. Under Benefit Application section, added statement "Power Operated Vehicles (Scooters) are considered a convenience item and excluded from coverage." When Covered section extensively updated to include the following under the Wheelchair section: "The wheelchair is appropriate for the member's weight;"; added "medically necessary" language to items I and II; updated item IIa and added item IId - "The request is for Group 1, 2, 3, or 5 power wheelchair, and member meets criteria for specific type of power wheelchair being requested (see below)."; changed items 3 and 4 to IV and V. and moved them below item III. Criteria for Specific Types of Power Wheelchairs section. Added item III medically necessary language for Group PWCs, items 1-6; added item VI. in reference to repairs and replacements. Removed criteria for Power Operated Vehicle (Scooters) When Not Covered section updated to include section for Power Wheelchairs (PWC): non-coverage language for Group 2 Single Power Options PWCs and Group 4 PWCs, and removed criteria and reference to Power Operated Vehicles (Scooter). Coding section and references updated. Policy noticed 10/25/2016 for effective date 12/30/16. Specialty Matched Consultant Advisory Panel review 9/2016. Medical Director review 9/2016.