Medical Policy Updates
Blue Cross and Blue Shield of North Carolina Medical Policy Update for July 1, 2011
| Medical Guidelines | Reason for Update |
|---|---|
| Bioengineered skin and tissue | Added new code to "Billing/Coding" section: C9365. Added new product to "Not Covered" section: Oasis Ultra Tri-Layer Matrix |
| Cellular immunotherapy for prostate cancers | Added new HCPCS code, "Q2043" to "Billing/Coding" section and removed deleted code "C9273". |
| Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors | Removed statement under the "When Not Covered" section that indicated "Except as noted above for treatment of certain testicular tumors, tandem or sequential autologous hematopoietic stem-cell transplantation is considered investigational to treat germ-cell tumors of any stage." Medical Director review 6/13/2011. Reference added. |
| Macular Drusen, Photocoagulation | Added CPT 67299 to Billing /Coding section and removed CPT 0017T which was deleted 12/31/10. Reference added. No change in policy statement. Policy Archived 6/2011. Medical director review. |
| Ocular Photoscreening | No changes to policy statement. Reference added. Policy Archived 6/2011. Medical director review 6/2011. |
| Rehabilitative Therapies | Added new 2011 HCPCS codes G9041-G9044. Added new information under policy guidelines "Some BCBSNC benefit plans may contain a unique benefit design structure. For treatment visits beyond 20, additional documentation of medical information including specific short term and long term goals, measureable objectives, a reasonable estimate of when the goals will be reached, and the frequency and duration of treatment may be required. See Billing/Coding section for medical record documentation requirements. Under “When Not Covered" section, added item #3 under General "The service is primarily intended for the convenience of the patient, the patient's caretaker, or the provider." Under "When Covered" section added C. Outpatient, Office or Home Therapy services: All of the following criteria must be met: Services are individualized, specific, and consistent with symptoms or confirmed diagnosis of illness or injury under treatment and there is documentation outlining quantifiable, attainable treatment goals; AND Services are expected to result in a significant and measurable improvement in functional capabilities within a reasonable and clearly defined period of time; AND Services are delivered by a qualified and appropriately licensed provider; AND Services require the judgment, knowledge, and skill of a qualified provider; AND Goals of therapy are required and must be signed by a MD/DO/NP/PA prior to the start of treatment; AND Progress toward therapy goals must be documented and goals should be re-evaluated if no quantifiable progress has been achieved within a reasonable and clearly defined period of time." Specialty Matched Consultant Advisory Panel 3/2011. Medical director review 6/2011. |
| Retinal Prosthesis | New policy implemented. Retinal Prostheses are considered investigational. BCBSNC does not provide coverage for investigational services or procedures. Medical director review 6/2011. |
| Semi implantable and fully implantable middle ear hearing aid | Policy name changed from Semi-Implantable Middle Ear Hearing Aid to Semi-Implantable and Fully Implantable Middle Ear Hearing Aid. Description section updated to include information related to Fully Implantable Middle Ear Hearing Aids. Policy Statement revised to read: Semi-implantable and fully implantable middle ear hearing aids are considered investigational. Rationale in the Policy Guidelines section and References updated. |
| Surgery for morbid obesity | Policy updated. New indication for "Sleeve gastrectomy" added to the list in Item III in the When Surgery for Morbid Obesity Is Covered section. The reference to sleeve gastrectomy, item 2.f. in the Not Covered section, was deleted. |
| Vagus nerve stimulation | Specialty Matched Consultant Advisory Panel review 5/25/2011. "Description" section revised. No change to policy statement. |
| Vertebroplasty, Kyphoplasty, and Sacroplasty Percutaneous | Specialty Matched Consultant Advisory Panel review 5/25/2011. Revised "Description" section. Added "including use in sacral insufficiency fractures due to osteoporosis and spinal lesions due to metastatic malignancies or multiple myeloma." to the "When Not Covered" statement regarding, "Percutaneous Sacroplasty is considered investigational for all indications". Updated "Policy Guidelines" section. References added. |
| Evidence Based Guidelines | |
| Phototherapeutic Keratectomy | Guideline Archived 6/2011. Medical director review 6/2011 |