Medical Policy Updates

Table Of Contents

Blue Cross and Blue Shield of North Carolina Medical Policy Update for January 10, 2012

Medical Guidelines Reason for Update
Analysis of Proteomic Patterns for Early Detection of Cancer Title updated from "Analysis of Proteomic Patterns in Serum to Identify Ovarian Cancer" to "Analysis of Proteomic Patterns for Early Detection of Cancer". "Description" section updated. The "When Not Covered" section updated to indicate; "Analysis of proteomic patterns in serum for screening and detection of cancer is not covered. It is considered investigational. BCBSNC does not cover investigational services. "Policy Guidelines" updated to indicate; "The use of proteomic pattern analysis for the early detection of cancer is currently in clinical trials and testing is not commercially available." No change to policy intent. Specialty Matched Consultant Advisory Panel review 11/30/11.
Anesthesia Services Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy statement.
Computerized 2-Lead Resting Electrocardiogram (Multifunction Cardiogram) References updated. No changes to Policy Statement.
Electrodiagnostic Studies Specialty Matched Consultant Advisory Panel meeting "Description" revised. "Policy Guidelines" reformatted. Added the following CPT codes to the "Billing/Coding" section: 95885, 95886, 95887, 95938, and 95939.
Electroencephalograms Specialty Matched Consultant Advisory Panel review 11/30/2011. "Description" section revised. The "When Covered" and When Not Covered" sections revised to only discuss "Twenty-four hour ambulatory cassette recorded EEGs" and "Video/EEG monitoring". Removed the reference in the "Policy Guidelines" section that requires "a qualified medical practitioner has witnessed and documented the seizure." References added.
H-Wave Electrical Stimulation Specialty Matched Consultant Advisory Panel review 11/30/11. No change to policy intent.
Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases Specialty Matched Consultant Advisory Panel review 11/30/11. No change to policy statement. References added.
Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy statement. References added.
Hematopoietic Stem-Cell Transplantation for CLL and SLL Specialty Matched Consultant Advisory Panel review 11/30/2011. "Description" section revised. No change to policy statement.
Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma Specialty Matched Consultant Advisory Panel review 11/30/2011. No changes to policy.
Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy statement. "Policy Guidelines" updated.
Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy statement.
Hematopoietic Stem-Cell Transplantation for Multiple Myeloma "Description" section revised. Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy intent.
Hematopoietic Stem-Cell Transplant for Non-Hodgkin Lymphomas Specialty Matched Consultant Advisory Panel review 11/30/2011. "Description" section revised. No change to policy intent. Reference added.
Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis "Waldenstrom Macroglobulinemia" removed from policy name and throughout policy as appropriate. This topic is discussed in a separate policy entitled Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia. Specialty Matched Consultant Advisory Panel review 11/30/2011.
Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy intent. "Policy Guidelines" updated.
Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to policy.
Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia Specialty Matched Consultant Advisory Panel review 11/30/11. No change to policy intent.
Percutaneous Electrical Nerve Stimulation (PENS) or Neuromodulation Therapy Specialty Matched Consultant Advisory Panel review 11/30/11. No change to policy intent.
Spinal Cord Stimulation Specialty Matched Consultant Advisory Panel review 11/30/11. "Description" section revised. No change to policy statement.
Spinal Manipulation under Anesthesia Specialty Matched Consultant Advisory Panel review 11/30/11. No changes to policy.
Evidence Based Guidelines
Intravenous Anesthetics for the Treatment of Chronic Pain Removed the word "neuropathic" from policy title and throughout as appropriate. Specialty Matched Consultant Advisory Panel review 11/30/11. No changes to guideline intent.
Monitored Anesthesia Care (MAC) Specialty Matched Consultant Advisory Panel review 11/30/2011. No change to guideline.
Photodynamic Therapy for Treatment of Specific Cancers "Description" revised. Specialty Matched Consultant Advisory Panel review August 2011. No change to guideline intent. References added.