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Health Care Service Corporation September 2017 Medical Policy Updates

Health Care Service Corporation (HCSC – BCBS IL, TX, OK, NM, MT) posts September 2017 Medical Policy Updates:


Health Care Service Corporation September 2017 Medical Policy Updates »

The following Medical Policies are Pending;

Policy Title Policy Number Release Date
Acne Management THE801.028 10-15-2017
Acoustic Respiratory Management (ARM) MED201.037 10-15-2017
Airway Clearance Devices DME101.027 10-15-2017
Alemtuzumab (Lemtrada) RX501.077 10-15-2017
Back School THE803.024 10-15-2017
Bioimpedance Devices for Detection of Lymphedema MED201.036 10-15-2017
Cardiac Contractility Modulation (CCM) Device MED202.068 10-15-2017
Cervical and Thoracic Spinal Fusion SUR712.041 10-15-2017
Composite Tissue Allotransplantation of the Hand and Face SUR703.052 10-15-2017
Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease MED202.063 10-15-2017
Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors SUR701.018 10-15-2017
Cryosurgical Ablation of Primary or Metastatic Liver Tumors SUR701.032 10-15-2017
Dynamic Cardiomyoplasty SUR707.005 10-15-2017
Electrocardiographic Body Surface Mapping MED202.061 10-15-2017
Electromagnetic Navigation Bronchoscopy (ENB) SUR706.013 10-15-2017
Endobronchial Valves SUR706.015 10-15-2017
Endovascular Grafts (Endoprostheses) for Abdominal Aortic Aneurysms MED202.051 10-15-2017
Extracorporeal Shock Wave Treatment for Musculoskeletal Indications and Soft Tissue Injuries SUR705.018 10-15-2017
Extracranial Carotid Angioplasty or Stenting SUR701.028 10-15-2017
Facet Joint and Sacroiliac Joint Denervation SUR702.017 10-15-2017
Functional Neuromuscular Electrical Stimulation (FNMES) MED201.033 10-15-2017
Home Spirometry DME101.040 10-15-2017
Inhaled Nitric Oxide THE801.038 10-15-2017
Interferential Current Stimulation MED201.041 10-15-2017
Intracellular Micronutrient Analysis MED207.088 10-15-2017
Intravitreal Angiogenesis Inhibitors for Choroidal Vascular Conditions OTH903.020 10-15-2017
Intravitreal Corticosteroid Implants OTH903.024 01-01-2018
Isolated Facet Joint Fusion SUR712.032 10-15-2017
Isolated Limb Perfusion/Infusion for Malignant Melanoma SUR701.010 01-01-2018
Lower Limb Prosthetics, Including Microprocessor Prosthetics DME104.012 10-15-2017
Melanoma Vaccines MED203.010 10-15-2017
Microwave Thermotherapy for Primary Breast Cancer SUR701.020 10-15-2017
Navigated Transcranial Magnetic Stimulation (nTMS) MED205.037 10-15-2017
Non-Invasive Measurement of Central Blood Pressure (cBP) MED202.070 10-15-2017
Optical Coherence Tomography of the Breast RAD601.053 10-15-2017
Orthopedic Applications of Stem-Cell Therapy SUR703.051 10-15-2017
Patient-Specific Cutting Guides and Custom Knee Implants SUR705.037 10-15-2017
Prostatic Urethral Lift (PUL) for the treatment of Benign Prostatic Hyperplasia (BPH) SUR710.023 10-15-2017
Quantitative Sensory Testing MED205.030 10-15-2017
Radiostereometric Analysis for Assessment of Orthopedic Implant Position RAD601.054 10-15-2017
Reslizumab (CINQAIR) RX501.083 10-15-2017
Risk Stratification Tests for Determining Arrhythmias (Signal-Averaged Electrocardiography [SAECG] and Microvolt T-Wave Alternans [MTWA]) MED202.006 10-15-2017
Serum Holotranscobalamin (holo-TC) as a Marker of Vitamin B12 (Cobalamin) Status MED207.138 10-15-2017
Sodium Phenylbutyrate RX501.057 10-15-2017
Speech Generating Devices (SGD) DME104.009 10-15-2017
Suprachoroidal Delivery of a Pharmacologic Agent OTH903.035 10-15-2017
Surface Scanning Electromyography (EMG) (SEMG), Paraspinal Surface EMG, and Spinoscopy MED205.006 10-15-2017
Transcatheter Mitral Valve Repair SUR707.025 10-15-2017
Transcatheter Pulmonary Valve Implantation SUR707.029 10-15-2017
Transciliary Fistulization for the Treatment of Glaucoma SUR713.033 10-15-2017
Ultrasonographic Evaluation of Skin Lesions RAD602.017 10-15-2017
Visual Evoked Potential Testing for Glaucoma OTH903.033 10-15-2017
Xolair (Omalizumab) RX501.058 10-15-2017


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