Medical Policy Updates

Table Of Contents

Blue Cross and Blue Shield of North Carolina Medical Policy Update for December 11, 2012

Medical Guidelines Reason for Update
Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover Reference added. Title changed to "Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover." Policy statement added that bone turnover markers are considered investigational in the management of conditions associated with high bone turnover. Medical Director review.
BRAF Gene Mutation Testing to Select Melanoma Patients for BRAF Inhibitor Therapy Description section updated. "When Covered" section revised to state: "Testing for the BRAF V600E mutation in tumor tissue of patients with stage IIIC or IV melanoma may be considered medically necessary to select patients for treatment with FDA-approved BRAF inhibitors." Policy Guidelines updated. New statement added to Policy Guidelines: "Currently only vemurafenib has FDA approval for treatment of advanced melanoma." Added CPT code 81406 to Billing/Coding section. References updated. Medical Director review 11/2012.
Bundling Guidelines Revision to Topics of Frequent Interest. Section regarding Balloon Sinuplasty deleted. Refer to corporate medical policy titled "Balloon Sinuplasty for Treatment of Chronic Sinusitis" for information on this procedure.
Congenital Heart Defect, Repair Devices Description section updated. References updated. Policy Guidelines updated. Medical Director review 11/2012.
Electrical Stimulation for the Treatment of Arthritis Reference update added. No change to policy statement.
Electroencephalograms In the When Covered section, #5. Removed criteria related to medical necessity when the patient is in ICU. Added #6. Video EEG monitoring is considered medically necessary for patients with altered levels of consciousness who are at risk of subclinical seizures based upon: a.Suspected clinical diagnosis of encephalitis, meningitis, stroke, intracranial hemorrhage, subarachnoid hemorrhage, or traumatic brain injury; OR b. Clinical findings of elevated intracranial pressure or cerebral edema.” Under the When Not Covered section, #3 added "when performed outside the neonatal, pediatric, or adult ICU" for clarification. Medical Director review 12/2/12.
Facet Joint Denervation Description section revised. Added "Non-pulsed" to When Covered section. Senior Medical Director review 11/27/12.
Foot Care Services Policy Archived. Reviewed by Senior Medical Director 11/20/12.
Minimally Invasive Hip and Knee Arthroplasty Medical policy archived. Medical Director review 11/2012.
NOTCH3 Genotyping for Diagnosis of CADASIL New policy developed. NOTCH3 testing for the diagnosis of CADASIL is considered investigational. Medical Director review 8/2012. Notification given 9/4/2012 for effective date of 12/11/2012.
Sensory Integration Therapy Reference added. Medical Director review. No change to Policy Statement.
Sleep Apnea: Diagnosis and Medical Management Added a related policy and a related guideline. Added "A nasal expiratory positive airway pressure (EPAP) device is considered investigational" to the When Not Covered Section. Specialty Matched Consultant Advisory Panel review 8/15/12. Notification given 9/4/12 for policy effective date of 12/11/12.
Vertebral Axial Decompression (VAD-X) References updated. No changes to Policy Statement.