Medical Policy Updates

Table Of Contents

Blue Cross and Blue Shield of North Carolina Medical Policy Update for December 07, 2010

Medical Guidelines Reason for Update
Capsule Endoscopy, Wireless Added the statement to Benefits Application section: "This procedure may require prior review." Medical Director review 9/8/10.
Cryosurgical Ablation of Primary or Metastatic Liver Tumors New policy. Cryosurgical ablation of either primary or metastatic tumors in the liver is investigational. Reviewed with Medical Director 7/21/2010. Notice given 8/31/2010. Policy effective 12/7/2010
Dermatoscopy Senior Medical Director review. Description section and Policy Guidelines section extensively revised. References updated. Policy Statement changed to state "BCBSNC will not provide coverage for Dermatoscopy because it is considered investigational as a technique to evaluate or serially monitor pigmented skin lesions or as a technique to define peripheral margins of basal cell carcinomas. BCBSNC does not cover investigational services or procedures." Under section "When Dermatoscopy is not covered", the not medically necessary statement was removed and the following statements were added: "Dermatoscopy, using either direct inspection, digitization of images, or computer-assisted analysis, is considered investigational as a technique to evaluate or serially monitor pigmented skin lesions. Dermatoscopy as a technique to define peripheral margins of basal cell carcinomas is investigational."
Electrogastrography, Cutaneous Policy status changed to "active policy, no longer scheduled for routine literature review." Description section revised. Medical Director review 9/8/10.
Functional Capacity Assessment and Work Hardening Specialty Matched Consultant Advisory Panel Review 10/2010. Under "When Not Covered" section removed the statements: 1)Functional capacity assessment is not eligible for benefits for workers compensation related evaluations and 2)Functional Capacity Assessment is not eligible for benefits when done solely for occupational evaluation. No change to policy statement. No change to criteria.
Gait Analysis Specialty Matched Consultant Advisory Panel review 10/2010. Policy statement added under When Covered section: Comprehensive gait analysis may be considered medically necessary as an aid in surgical planning in patients with gait disorders associated with cerebral palsy. References added.
Inflammatory Bowel Disease (IBD) Serology Description section revised. Policy statement restated, but intent is unchanged. Medical Director review 10/6/10. Policy archived 12/7/10.
Pancreas Transplant Description section revised. Information regarding eligible candidates for transplant moved from the When Covered section to the Policy Guidelines section. No change in policy statement. Medical Director review 11/12/10.
Power Operated Vehicle (Scooter) Specialty Matched Consultant Advisory Panel review 10/2010. No change to policy statement.
Small Bowel, Small Bowel with Liver, or Multivisceral Transplant Description section revised. Medical coverage criteria in the When Covered and When Not Covered sections was reformatted. General criteria for transplant candidates moved to the Policy Guidelines section. References updated. Medical Director review 11/12/10.
Speech Generating Devices Specialty Matched Consultant Advisory Panel review 10/2010. No change to policy statement.
Evidence Based Guidelines
Colon Cancer Screening Status changed to "Active guideline, no longer scheduled for routine literature review." Medical Director review 9/8/10.
Human Papillomavirus (HPV) Vaccine Added information regarding use of Gardasil in males from the "Description" section to the "Evidenced Based Guideline" section for clarity. Reviewed by medical director.