Network Bulletin - An important message to health care professionals and facilities
In this Issue Volume 45, September 2011

Medical Policy, Drug Policy and Coverage Determination Guideline (CDG) Updates

Articles:

New

Updated/Revised


Medical Policy, Drug Policy and Coverage Determination Guideline (CDG) Updates

The following table outlines the Medical Policies, Drug Policies and/or Coverage Determination Guidelines (CDGs) recently adopted or revised by UnitedHealthcare. A detailed summary of the policy updates listed below is available for your reference on UnitedHealthcareOnline.com. By accessing the monthly Medical Policy Update Bulletin, you may view new and/or revised policies, along with an overview or summary of changes. The Policy Update Bulletin is published on the first calendar day of every month at UnitedHealthcareOnline.com >Tools& Resources > Policies and Protocols >Medical &Drug Policies and Coverage Determination Guidelines >Medical Policy Update Bulletin.

Note: The appearance of an item or procedure in the table below indicates only that UnitedHealthcare has recently adopted, revised or retired a Medical Policy, Drug Policy or CDG; it does not imply that UnitedHealthcare provides coverage for the items or procedures listed. In the event of an inconsistency or conflict between the information provided in this bulletin and the posted Medical Policy, Drug Policy or CDG, the provisions of the posted policy will prevail. Note that most UnitedHealthcare benefit plan documents exclude from benefit coverage health services identified as investigational or unproven. Physicians and other health care professionals may not seek or collect payment from a UnitedHealthcare member for services not covered by the applicable benefit plan, unless they first obtain the member's written consent, acknowledging that the service is not covered by the benefit plan and that they will be billed directly for the service.

Policy Title Policy Type Effective Date Medical Policy Update Bulletin
NEW
17-Alpha-Hydroxyprogesterone Caproate (17P and Makena™) Drug Policy Oct. 1, 2011 July 2011
August 2011
September 2011
UPDATED/REVISED
Artificial Total Disc Replacement for the Spine - Medical Policy - Oct. 1, 2011 Medical Policy Oct. 1, 2011 September 2011
Botulinum Toxins A and B - Drug Policy - Sep. 1, 2011 Drug Policy Sep. 1, 2011
August 2011
Bronchial Thermoplasty - Medical Policy - Sep. 1, 2011 Medical Policy Sep. 1, 2011 August 2011
Breast Reduction Surgery - CDG - Dec. 1, 2011 CDG Dec. 1, 2011 September 2011
Gastrointestinal Motility Disorders, Diagnosis and Treatment - Medical Policy - Oct. 1, 2011 Medical Policy Oct. 1, 2011 September 2011
Growth Hormone/Growth Stimulation Products - Somatropin and Mecasermin - Drug Policy - Sep. 1, 2011 Drug Policy Sep. 1, 2011 August 2011
Immune Globulin (IVIG) - Drug Policy - Sep. 1, 2011 Drug Policy Sep. 1, 2011 August 2011
Intensive Behavioral Therapy for the Treatment of Autism Spectrum Disorders - Medical Policy - Sep. 1, 2011 Medical Policy Sep. 1, 2011 August 2011
Omnibus Codes - Medical Policy - Oct. 1, 2011 Medical Policy Oct. 1, 2011 September 2011
Preterm Labor: Identification and Treatment - Medical Policy - Oct. 1, 2011 Medical Policy Oct. 1, 2011 August 2011

September 2011
Preventive Care Services - CDG - Aug. 16, 2011 CDG Aug. 16, 2011 August 2011
Rituxan (rituximab) - Drug Policy - Sep. 1, 2011 Drug Policy Sep. 1, 2011 August 2011
Surgical Treatment of Obstructive Sleep Apnea - Medical Policy - Sep. 1, 2011 Medical Policy Sep. 1, 2011 August 2011
Synagis (palivizumab) - Drug Policy - Sep. 1, 2011 Drug Policy Sep. 1, 2011 August 2011
Tysabri (natalizumab) - Drug Policy - Sep. 1, 2011 Drug Policy Sep. 1, 2011 August 2011
Umbilical Cord Blood Harvesting and Storage for Future Use - Medical Policy - Oct. 1, 2011 Medical Policy Oct. 1, 2011 September 2011

Back to top


If you do not contract directly with UnitedHealthcare, and participate in our network through an arrangement in which we "Lease" a network from some other entity, some of the information provided in this communication may not be applicable to you and/or impact you differently. If you have questions regarding any of the information or need to better understand its impact on you, please contact your local Network Account Representative, Physician Advocate or Hospital & Facility Advocate. If you are not sure who your contact is, please visit UnitedHealthcareOnline.com > Contact Us > Network Contacts.

Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oregon, Inc., and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc. or its affiliates.

Questions or Comments? Write to us at: UnitedHealthcare, MN012-S117, P.O. Box 1459, Minneapolis, MN 55440-1459. For more information, visit our Web site unitedhealthcareonline.com or call our telephone self-service system at: 1-877-842-3210.

We respect your right to privacy; visit our Web site to read our Privacy Policy, Security Notice and Notice of Privacy Policy and Practices.

UnitedHealthcare Services, Inc., P.O. Box 1459, Minneapolis, MN 55440-1459.40-1459.

Copyright 2011 UnitedHealth Group Incorporated. All rights reserved.