Clinical policy bulletins

Changes to Review Schedule

Please note that the attached document sets forth the anticipated schedule for review of the specified Clinical Policy Bulletin (CPB) in the ordinary course. This schedule is subject to change based on various factors, including but not limited to intervening clinical developments and available resources. Aetna does not hereby commit to review any specific CPB by a specific date, and expressly reserves the right to change any CPB without notice. Aetna does not hereby assume any obligation to update information presented in this document, so information contained herein may be out of date at any given time.

The CPB review dates below are the anticipated start dates of the CPB review process for each CPB listed. The "reviewed" date appearing on the CPB is the date the review is completed.

January 08 (1 - 46) January 22 (47 - 112) February 12 (113 - 170) February 26 (171 - 212) March 12 (213 - 255) March 26 (256 - 298) April 23 (299 - 343)

May 14 (344 - 377) May 28 (378 - 411) June 11 (412 - 446) June 25 (447 - 485) July 09 (486 - 523) July 23 (524 - 558) August 13 (559 - 591)

August 27 (592 - 625) September 10 (626 - 659) September 24 (660 - 690) October 08 (691 - 721) October 22 (722 - 753) November 12 (754 – 772)

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Anticipated CPB Review Date: January 08

001 - Transrectal Ultrasound
002 - Oxygen
003 - Apnea Monitors for Infants
004 - Obstructive Sleep Apnea
005 - Septoplasty and Rhinoplasty
007 - Erectile Dysfunction
008 - Color-Flow Doppler Echocardiography in Adults
009 - Orthopedic Casts, Braces and Splints
010 - Continuous Passive Motion (CPM) Machines
011 - Electrical Stimulation for Pain
013 - Cochlear Implants and Auditory Brainstem Implants
016 - Back Pain - Invasive Procedures
017 - Breast Reduction Surgery and Gynecomastia Surgery
019 - Holter Monitors
020 - Injectable Medications
021 - Cardiac Rehabilitation
022 - Calcitriol/Paricalcitol Injection (see also CPB 020 Injectable Medication Coverage)
023 - Corneal Remodeling
024 - Interleukin-2 (Aldesleukin, Proleukin, IL-2)
025 - Automated Ambulatory Blood Pressure Monitoring
027 - Implantable Vas Deferens Ligation Clip (Vasclip)
028 - Temporomandibular Disorders (TMD) and Temporomandibular Joint Syndrome (TMJ) Dysfunction, Diagnosis and Treatment
029 - Thermography
031 - Cosmetic Surgery
032 - Pulmonary Rehabilitation
034 - Aural Rehabilitation
035 - Influenza Vaccine
037 - Pneumococcal Vaccine
038 - Allergy Testing and Allergy Immunotherapy
039 - Weight Reduction Medications and Programs
046 - Routine Foot Care

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Anticipated CPB Review Date: January 22

047 - Prenatal Care Provided by Primary Care Physicians
048 - Hepatitis A Vaccine
049 - Nutritional Counseling
050 - Varicose Veins
055 - Hematopoietic Colony-Stimulating Factors (CSFs)
059 - Peak Flow Meters
061 - Nutritional Support
062 - Burn Treatment -- Burn Garments and Associated Physical and Occupational Therapies
065 - Nebulizers
067 - Chest Physiotherapy and Airway Clearance Devices
069 - Lymphedema Treatments
070 - Diabetes Programs and Supplies
071 - Positron Emission Tomography
073 - Cardiac Event Monitors
078 - Learning Disabilities, Dyslexia, & Vision
079 - Benign Prostatic Hypertrophy (BPH) Treatments
082 - Dental Services and Oral and Maxillofacial Surgery:  Coverage Under Medical Plans
083 - Stereotactic Radiosurgery
084 - Ptosis Surgery
088 - Antepartum Fetal Surveillance
091 - Endometrial Ablation
093 - Open Air, Low Field Strength, and Standing MRI Units
094 - Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV)
095 - Orthognathic Surgery
097 - External Breast Prosthesis for Post-Mastectomy Patients
100 - Cryoablation
105 - Breast MRI
106 - Fetal Echocardiograms
107 - Chiropractic Services
111 - Indocyanine Green Angiography
112 - Surface Scanning and Macro Electromyography

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Anticipated CPB Review Date: February 12

113 - Botulinum Toxin
115 - Varicella and Herpes Zoster Vaccines
116 - Frenulectomy for Ankyloglossia
124 - General Anesthesia and I.V. Sedation for Oral and Maxillofacial Surgery and Dental Services
126 - Contact Lens and Eyeglasses
127 - Home Uterine Activity Monitoring
130 - Computerized Corneal Topography
131 - Hemophiliacs, Clotting Factor
132 - Biofeedback
134 - Bone Mass Measurements
135 - Acupuncture
136 - Skilled Home Private Duty Nursing Care
140 - Genetic Testing
142 - Breast Implants/Removal
145 - Alpha 1-Antitrypsin Inhibitor Therapy
147 - Reflex Sympathetic Dystrophy: Diagnostic Tests
151 - Hippotherapy
153 - Thalamotomy
155 - Ribavirin (Virazole)
157 - Obesity Surgery
158 - Neuropsychological Testing (NPT)
160 - Lung Volume Reduction Surgery
161 - Infusion Pumps
163 - Transmyocardial Laser Revascularization (TMLR)
165 - Cardiac Catheter Ablation Procedures
166 - Fetal Fibronectin and Salivary Estriol Testing for Preterm Labor
168 - Tumor Scintigraphy
169 - Outpatient Medical Self Care Programs
170 - Growth Hormone (GH), Growth Hormone Releasing Hormone (GHRH), and Growth Hormone Antagonists

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Anticipated CPB Review Date: February 26

171 - Extremity MRI
172 - Hyperbaric Oxygen Therapy (HBOT)
173 - Prothrombin Time Home / International Normalization Ratio (INR) Testing Systems
174 - Pool Therapy, Aquatic Therapy or Hydrotherapy
175 - High-Frequency Pulsed Electromagnetic Stimulation
177 - Urea Breath Testing for H. Pylori Infection
179 - Viscosupplementation for Osteoarthritis
180 - Vertebral Axial Decompression Therapy
181 - Evoked Potential Studies
182 - Ventricular Remodeling Operation (Batista Procedure)
184 - Prostaglandin Infusion Therapy for Pulmonary Hypertension
185 - Breast Reconstructive Surgery
188 - Total Body Photography and Dermoscopy/Dermatoscopy
189 - Genetic Counseling
190 - Stem Cells for Bone Marrow Transplant
191 - Vagus Nerve Stimulation
194 - Dorsal Column Stimulation
195 - Erythropoietin and Darbepoetin Therapy
198 - Work Hardening Programs
199 - Ultrasound for Pregnancy
200 - Coumadin (Warfarin) to Heparin Conversion Before and After Elective Surgery
201 - Skilled Home Health Care Nursing Services
202 - Magnetic Resonance Spectroscopy (MRS)
204 - Spinal Manipulation Under Anesthesia
205 - Phototherapy and Photochemotherapy (PUVA) for Skin Conditions
206 - Intravenous Immunoglobulins (IVIG)
207 - Prolotherapy
208 - Deep Brain Stimulation
210 - Phonophoresis
211 - Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair
212 - Metrecom Skeletal Analysis System

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Anticipated CPB Review Date: March 12

213 - Gastroesophageal Reflux Disease (GERD): Treatment Devices
214 - Cognitive Rehabilitation
215 - Lyme Disease and other Tick-Borne Diseases
218 - Home Health Aides
220 - Ilizarov Method for Distraction Osteosynthesis
221 - Quantitative EEG (Brain Mapping)
223 - Urinary Incontinence Treatments
225 - Maze Procedure
226 - Hospitalization for the Initiation of Ketogenic Diet for the Treatment of Intractable Seizures
227 - BRCA Testing, Prophylactic Mastectomy, Tamoxifen, and Prophylactic Oophorectomy for Persons at Risk for Breast and Ovarian Cancer
228 - CT Angiography and Calcium Scoring for Evaluating Coronary Artery Disease
229 - Iontophoresis
231 - Grenz Ray Therapy for Skin Disorders
232 - Back Pain - Non Invasive Treatments
234 - Chelation Therapy
235 - Plantar Fasciitis Treatments
236 - MRI and CT of the Spine
237 - Chronic Pain Programs
238 - Chronic Vertigo
240 - Antineoplaston Therapy and Sodium Phenylbutyrate
241 - Extracorporeal Photochemotherapy (Photopheresis)
243 - Speech Therapy
244 - Wound Care
245 - Tumor Chemosensitivity and Chemoresistance Assays
247 - Autologous Chondrocyte Implantation
248 - Fiberoptic Endoscopic Evaluation of Swallowing (FEES) / Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)
249 - Inflammatory Bowel Disease: Serologic Markers and Pharmacogenomic and Metabolic Assessment of Thiopurine Therapy
250 - Occupational Therapy Services
251 - Dermabrasion, Chemical Peels, and Acne Surgery
253 - Injections for Vocal Cord Paralysis
255 - Inpatient Admission Prior to Surgery (Preop Days)

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Anticipated CPB Review Date: March 26

256 - Sensory and Auditory Integration Therapy
259 - Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
262 - External Counterpulsation (ECP)
263 - Gait Analysis and Electrodynogram
264 - Multiple Sclerosis
265 - Surgical Treatments to Control Drooling (Sialorrhea)
266 - Cholecystokinin Cholescintigraphy
267 - Ornish Cardiac Treatment Program
268 - Liver Neoplasms - Treatment Approaches
269 - Breast Biopsy Procedures
270 - Proton Beam and Neutron Beam Radiotherapy
271 - Wheelchairs
272 - Pectus Excavatum and Poland's Syndrome Surgical Correction
274 - Cryosurgical and Radiofrequency Ablation of Hepatic Lesions
276 - Angioplasty and Stenting of Extra-Cranial and Intra-Cranial Arteries
278 - Hyperthermia in Cancer Therapy
279 - Magnetic Source Imaging/Magnetoencephalography
282 - Down Syndrome Screening By Ultrasonographic Assessment Of Fetal Nuchal Thickening (NT) / Nuchal Translucency Testing
284 - Melodic Intonation Therapy for Persistent Aphasia
285 - Plasmapheresis/Plasma Exchange/Therapeutic Apheresis
287 - Total Hip Implants
288 - Stereotactic Cingulotomy
289 - Grid Monitoring: Presurgical Evaluation for Patients with Intractable Seizures
290 - Scalp Cooling (Hypothermia) To Prevent Hair Loss During Chemotherapy
291 - Hemodialysis for the Treatment of Schizophrenia
292 - Transcatheter Closure of Septal Defects
293 - Corneal Graft with Amniotic Membrane Transplantation
294 - Pedobarography
295 - Peripheral Atherectomy
297 - Cryoanalgesia and Therapeutic Cold
298 - Non-invasive Negative Pressure Ventilation: Body Ventilators and Poncho Wrap

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Anticipated CPB Review Date: April 23

299 - Tilt Table Testing
300 - Hair Analysis
302 - Electrical Stimulation (Salitron System) for Xerostomia
304 - Fibroid Treatment
305 - Videostroboscopy
306 - Dexamethasone Suppression Test in Psychiatry
307 - Parkinson's Disease, Surgical Treatment
310 - Thoracoscopic Sympathectomy
313 - Herceptin (Trastuzumab)
314 - Rituximab (Rituxan)
315 - Enbrel™ (Etanercept)
316 - HIV Drug Susceptibility and Resistance Tests
317 - Ultra Rapid Detoxification (UROD)
318 - Synagis (Palivizumab) for Prevention of Respiratory Syncytial Virus (RSV) Infections
319 - RET Proto-Oncogene Testing
321 - Visual Perceptual Training
322 - Electroencephalographic (EEG) Video Monitoring
323 - Preconceptional Sex Selection Techniques
325 - Physical Therapy Services
327 - Infertility
329 - Home Births
330 - Multiple Sleep Latency Test (MSLT)
332 - Neonatal Hyperbilirubinemia
334 - Negative Pressure Wound Therapy
336 - Acoustic Pharyngometers and SNAP™ Testing System
337 - BreastAlert™ Differential Temperature Sensor
339 - Pulse Oximeter for Home Use
340 - Antibody Screening Tests for Neurologic Diseases
341 - Remicade (infliximab)
342 - Intestinal Rehabilitation Programs
343 - Bone Growth Stimulators

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Anticipated CPB Review Date: May 14

344 - Optic Nerve and Retinal Imaging Methods
345 - Implantable Hormone Pellets
346 - Low-Molecular-Weight Heparins
347 - Transcervical Balloon Tuboplasty
348 - Recurrent Pregnancy Loss
349 - Alzheimer’s Disease: Diagnosis
351 - Flow Cytometry, DNA Ploidy, and S-phase Fraction
352 - Tumor Markers
353 - Transcranial Doppler Ultrasonography
354 - YAG Laser Capsulotomy
355 - Extracorporeal Immunoadsorption (Prosorba column)
356 - Meningococcal Vaccine
357 - Quantitative Sensory Testing (QST) / Current Perception Threshold (CPT) Testing
358 - Prenatal Diagnosis of Genetic Diseases
361 - Metastron® (Strontium-89) Injection
362 - Neurosurgical Management of Spasticity
363 - Cold Laser Therapy
364 - Allograft Transplants of the Lower Extremity
365 - Pancreaticoduodenectomy (Whipple Resection) for Zollinger-Ellison Syndrome
366 - Gold Weight Eyelid Implants
367 - Home Cholesterol Monitors
368 - Obstetrical Hypertension Programs
369 - Chronic Fatigue Syndrome, Diagnosis
370 - Phototherapy for Seasonal Affective Disorder
371 - Brachytherapy
372 - Warm-Up® Therapy/Noncontact Normothermic Wound Therapy
373 - Crit-Line In-Line Monitor
374 - Trigeminal Neuralgia - Surgical Treatment
375 - Photodynamic Therapy for Cancer
376 - Single Photon Emission Computed Tomography (SPECT)
377 - Dendritic Cell Immunotherapy

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Anticipated CPB Review Date: May 28

378 - NeuroControl Freehand System
379 - Cranial Remodeling Bands and Helmets
380 - Lung Cancer Screening
381 - Cardiac Disease Risk Tests
382 - Intravascular Ultrasound
383 - Mohs Micrographic Surgery
384 - Magnetic Resonance Cholangiopancreatography
386 - Breast Transillumination and Electrical Impedance Scanning (EIS)
387 - Magnetic Resonance Neurography
388 - Complementary and Alternative Medicine
389 - Silicone for Hypertrophic Scars and Keloids
390 - Smell and Taste Disorders - Diagnostic Procedures and Services
392 - Metabolic and Environmental Profiling for Kidney Stone Risk
393 - Vitrectomy Face Support
394 - Surgery for Intractable Epilepsy
395 - Ethanol Injection Sclerotherapy for Thyroglossal Duct Cyst
396 - Electrogastrography / Colonic Motility Studies
397 - Knee Ligament Arthrometer Testing
398 - Idiopathic Scoliosis Treatments
399 - Myoelectric Prosthesis
400 - Ernest Eagle’s Syndrome (Stylomandibular Ligament Pain): Treatment with Radiofrequency Thermoneurolysis
401 - Selective Peripheral Denervation (Bertrand Procedure) for Spasmodic Torticollis
402 - Polio Vaccine
403 - Bone-anchored Hearing Aid
404 - Interferons
405 - Mechanical Stretching Devices for Contracture and Joint Stiffness
406 - Tinnitus Treatments
407 - Ross Pulmonary Autograft for Aortic Valve Replacement
409 - Macular / Foveal Translocation
410 - Hepatitis B Vaccine
411 - Bone Graft Substitutes and Adjuncts

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Anticipated CPB Review Date: June 11

412 - Therabite® Jaw Motion Rehabilitation System
413 - Percutaneous Embolization of Varicocele
414 - AcuTect/Scintigraphic Imaging for Detection/Localization of Lower Limb Deep Vein Thrombosis
415 - Optic Nerve Decompression Surgery
416 - Sural Nerve Graft During Radical Retropubic Prostatectomy
417 - Amnioinfusion
418 - Myringotomy and Tympanostomy Tube
419 - Graves' Ophthalmopathy: Surgical Procedures
420 - Balloon Dacryocystoplasty/Dacryoplasty for Nasolacrimal Duct Obstruction
421 - Breast Pumps
422 - Vitiligo
423 - Alopecia Areata
425 - Ambulatory Electroencephalography for the Diagnosis and Management of Epilepsy
426 - Attention Deficit/Hyperactivity Disorder
427 - Carbon Dioxide Laser for Actinic Lesions of the Skin
428 - Carbogen Inhalation Therapy for the Treatment of Sudden Hearing Loss
429 - Bathroom and Toilet Equipment and Supplies
430 - Pressure Reducing Support Surfaces
431 - Bedwetting Alarm for Nocturnal Enuresis
432 - Computerized Motion Diagnostic Imaging
433 - Chlamydia Trachomatis - Screening and Diagnosis
434 - Therapeutic Chairs
435 - Viscocanalostomy
437 - Speech Generating Devices
438 - Obsolete or Unreliable Pathology and Laboratory Diagnostic Tests
441 - Ovarian Vein Embolization for Pelvic Congestion Syndrome
442 - Enzyme-replacement Therapy for Lipidoses and Mucopolysaccharidoses
443 - Cervical Cancer Screening
444 - Early Intervention Programs
445 - Electroconvulsive Therapy
446 - Endoscopic Ultrasonography

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Anticipated CPB Review Date: June 25

447 - Complex Regional Pain Syndrome (CRPS) / Reflex Sympathetic Dystrophy (RSD) Treatments
449 - Fetal Surgery In Utero
450 - Fluidized Therapy (Fluidotherapy)
451 - Foot Orthotics
452 - Noninvasive Positive Pressure Ventilation
453 - Cervical Traction Devices
456 - Pillows and Cushions
457 - Punctal Plugs and Punctoplasty for Dry Eyes
458 - Peripheral Vascular Rehabilitation Programs
459 - Seat Lifts and Patient Lifts
462 - Dihydroergotamine (DHE) Therapy for Intractable Migraine or Cluster Headache
464 - Serum Marker Screening for Down Syndrome
465 - Mifepristone (RU 486)
466 - Clinical Trials, Coverage of Routine Patient Care Costs
467 - Vestibular Autorotation Test (VAT)
468 - Terbutaline Pump for Preterm Labor
469 - Transcranial Magnetic Stimulation and Cranial Electrical Stimulation
471 - Tuberculosis Testing
472 - Thoracic Electrical Bioimpedance for Cardiac Output Monitoring
473 - Vaccines for Travel
474 - Total Body Plethysmography
475 - Coblation Non-thermal Volumetric Tissue Reduction
476 - Influenza Rapid Diagnostic Tests
477 - Balloon Valvuloplasty
479 - Respiratory Devices: Incentive Spirometers and Intermittent Positive Pressure Breathing Machines
480 - Tourette Syndrome
481 - Tables and Boards
482 - Compression Garments for the Legs
483 - Anthrax Vaccine
484 - Glaucoma, Surgical Treatments
485 - Autonomic Testing / Sudomotor Tests

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Anticipated CPB Review Date: July 09

489 - Vision Therapy
490 - Transpupillary Thermal Therapy
491 - Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions
492 - Radiofrequency Tumor Ablation
493 - Kidney Transplantation
494 - High Dose Chemotherapy and Bone Marrow or Peripheral Stem Cell Transplant for Non-Hodgkin's Lymphoma
495 - High Dose Chemotherapy Bone Marrow or Peripheral Stem Cell Transplant for Hodgkin's Disease
496 - High Dose Chemotherapy Bone Marrow or Peripheral Stem Cell Transplant for Neuroblastoma
497 - High Dose Chemotherapy Bone Marrow or Peripheral Stem Cell Transplant for Multiple Myeloma
500 - Intermittent Pneumatic Compression Devices for the Legs
501 - Gonadotropin-Releasing Hormone Analogs (Lupron/Zoladex) and Antagonists (Plenaxis)
502 - Nerve Conduction Velocity Studies
503 - Suction Pumps
504 - Hyperhidrosis (Hyperhydrosis)
505 - Ambulatory Assist Devices: Walkers, Canes, and Crutches
507 - Breast Cancer: High-Dose Chemotherapy with Autologous Stem Cell Support
508 - Cataract Removal Surgery
509 - Contact Dissolution for the Treatment of Gallstones
510 - Progestins
511 - Eating Disorders (Anorexia and Bulimia)
512 - Premenstrual Syndrome/Premenstrual Dysphoric Disorder
514 - Meniere's Disease Surgery
515 - Thyrogen (Thyrotropin Alfa)
516 - Colorectal Cancer Screening
517 - Breast Ductal Lavage and Fiberoptic Ductoscopy
518 - Nitric Oxide, Inhalational (INO)
520 - Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI
521 - Prostate Cancer Screening
522 - Pulsed Irrigation Evacuation (PIE)
523 - Car-Ride Simulators for Infantile Colic

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Anticipated CPB Review Date: July 23

524 - Zometa (Zoledronic Acid)
525 - Screening for Lipid Disorders
526 - Surgical Dressings (Wound Care Supplies)
527 - Intragastric Hypothermia
528 - Androgens and Anabolic Steroids
529 - Transabdominal Cerclage
530 - Transvaginal Ultrasonography for Ovarian and Endometrial Cancer Screening
531 - Balloon-Expandable Venous Stents
532 - Scrotal Ultrasonography
533 - Urological Supplies
534 - Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents
535 - Virtual Gastrointestinal Endoscopy
536 - Vitamin B-12 Therapy
538 - Endothelial Cell Photography
539 - Fundus Photography
540 - Heating Devices
541 - Home Dialysis
542 - HIV Testing
543 - Hospital Beds and Accessories
544- I mmune Globulins for Post-exposure Prophylaxis
545 - Electrothermal Arthroscopy
546 - Extracorporeal Membrane Oxygenation (ECMO)
547 - Rosacea
548 - Cardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, and Pacemaker Monitors
549 - Distraction Osteogenesis for Craniofacial Defects
551 - Radiation Treatment of Keloids
552 - Laser Neurolysis
553 - Lead Testing
556 - Medicinal Leech Therapy
557 - Melanoma Vaccine
558 - Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)

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Anticipated CPB Review Date: August 13

559 - Pulsed Dye Laser Treatment
560 - Voice Prosthesis for Voice Rehabilitation Following Total Laryngectomy
561 - Laboratory Testing for Celiac Disease
562 - Biochemical Markers of Bone Remodeling for Osteoporosis
563 - Diabetic Retinopathy Telescreening Systems
564 - Electrocochleogram and Perilymphatic Pressure Measurement
565 - Ankle Orthoses, Ankle-Foot Orthoses (AFOs), and Knee-Ankle-Foot Orthoses (KAFOs)
566 - Strabismus Repair in Adults
567 - Actinic Keratoses Treatment
568 - AngioJet Rheolytic Thrombectomy System
569 - Lumbar Traction Devices
570 - Chemotherapy Inpatient
571 - Dehydration Testing for Endolymphatic Hydrops (Meniere's Disease)
572 - Home/Ambulatory Spirometry
574 - Female Erectile Devices for the Treatment of Female Sexual Dysfunction (FSD)
575 - Intravenous Iron Therapy
576 - Laminoplasty
577 - Psoriasis: Laser Treatment
578 - Lower Limb Prostheses
579 - T-Wave Alternans
580 - Low Vision Programs
581 - Lung Imaging Fluorescence Endoscopy (LIFE)
582 - Titanium Rib
583 - Eye Movement Desensitization and Reprocessing (EMDR) Therapy
584 - Mammography
585 - Cardioverter-Defibrillators
586 - Heart Transplantation
587 - Pancreas Kidney Transplantation
588 - Capsule Endoscopy
590 - Intensity Modulated Radiation Therapy
591 - Intervertebral Disc Prostheses

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Anticipated CPB Review Date: August 27

592 - Turbinate Somnoplasty: Radiofrequency Ablation of Hypertrophied Nasal Turbinates
593 - Aerosolized Anti-infectives: Treatment for Sinusitis
594 - Visudyne (Verteporfin) Photodynamic Therapy
595 - Kineret (Anakinra)
596 - Liver Transplantation
597 - Heart-Lung Transplant
598 - Lung Transplantation
599 - Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation for Cardiac Diseases
601 - Pancreas Transplantation Alone and Islet Cell Transplantation
602 - Nucleoplasty
603 - Total-Body CT Screening
604 - Infrared Therapy
605 - Intestinal Transplantation
606 - Stem Cell Transplant for Autoimmune Diseases 0607-Intralesional and Intraarticular Anesthetic Pumps
608 - Salivary Hormone Tests
609 - Laser Photocoagulation of Drusen
610 - Biventricular Pacing (Cardiac Resynchronization Therapy)/Combination Resynchronization-Defibrillation Devices for Congestive Heart Failure
611 - Fecal Incontinence Treatments
612 - Implantable Hearing Aids: Vibrant Soundbridge
613 - Stereolithography
614 - Fetal Striatal Transplantation for Huntington's Disease
615 - Sex Reassignment Surgery
616 - Antroduodenal Manometry
617 - High Dose Chemotherapy Bone Marrow or Peripheral Stem Cell Transplant for Testicular Cancer
618 - Brain Natriuretic Peptide Testing
619 - Eye Prosthesis
620 - Facial Prostheses, External
621 - Drug-Eluting Stents
622 - Ocular Blood Flow Tonometer
623 - Safety Items
625 - Dysphagia Therapy

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Anticipated CPB Review Date: September 10

0626 - High Dose Chemotherapy and Allogeneic Bone Marrow or Peripheral Stem Cell Transplant for halassemia Major and Sickle Cell Anemia
627 - High Dose Chemotherapy Allogeneic Bone Marrow or Peripheral Stem Cell Transplant for Aplastic Anemia
628 - Spinal Ultrasound
629 - Bunionectomy
630 - Vacuum Assisted Socket System (VASS)
633 - Benign Skin Lesion Removal
634 - Non-myeloablative Bone Marrow/Peripheral Stem Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant)
635 - High Dose Chemotherapy Bone Marrow or Peripheral Stem Cell Transplant for Ovarian Cancer
636 - Hammer Toe Repair
637 - Osteochondral Autografts (Mosaicplasty, OATS)
638 - Donor Lymphocyte Infusion
639 - Autotransfusers
640 - Bone Marrow or Peripheral Stem Cell Transplant for Acute Lymphocytic Leukemia
641 - Adoptive Immunothera 0642-Neuralgia Inducing Cavitational Osteonecrosis (NICO) and Ultrasonograph Bone Densitometer to Detect NICO
643 - DNA Hybridization Assays for Diagnosis of Vaginitis
644 - Smallpox Vaccine
645 - Total Ankle Arthroplasty
646 - Voice Therapy
647 - Histamine Desensitization Therapy for Intractable Headaches
648 - Pervasive Developmental Disorders
649 - Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications
650 - Polymerase Chain Reaction Testing: Selected Indications
651 - Endovascular Repair of Aortic Aneurysms
652 - Therapeutic Phlebotomy
653 - Diphtheria, Tetanus, and Pertussis Vaccines
654 - Ventricular Assist Devices
655 - Adalimumab (Humira)
656 - Phototherapy for Acne
657 - Hysteroscopic Tubal Sterilization: Essure Micro-Insert
658 - Psoriasis: Biological Therapies
659 - Radioimmunotherapy for Non-Hodgkin's Lymphoma: Ibritumomab Tiuxetan (Zevalin) and Tositumomab (Bexxar)

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Anticipated CPB Review Date: September 24

660 - Unicompartmental Knee Arthroplasty
661 - Hip Resurfacing
662 - Antiprothrombin Antibody Testing
663 - Computed Tomography Perfusion Imaging
664 - Signal-Averaged Electrocardiography (SAECG)
665 - Constraint-Induced Movement Therapy
666 - Teriparatide (Forteo)
667 - Esophageal pH Monitoring
668 - Central Auditory Processing Disorder (CAPD)
669 - Subtalar Implant for the Treatment of Flatfoot Deformity
670 - Xolair (Omalizumab)
671 - Enfuvirtide (Fuzeon)
672 - Pamidronate (Aredia)
673 - Arthroscopic Lavage and Debridement for Osteoarthritis of the Knee
674 - High Dose Chemotherapy/Bone Marrow or Peripheral Stem Cell Transplantation for Chronic Myelogenous Leukemia
675 - Bortezomib (Velcade)
676 - Electrical Stimulation for Nausea, Vomiting and Motion Sickness (ReliefBand)
677 - Functional Electrical Stimulation and Neuromuscular Electrical Stimulation
678 - Gastric Pacing / Gastric Electrical Stimulation
679 - Electrical Stimulation for Levator Syndrome
680 - Electrical Stimulation for Chronic Ulcers
681 - Pachymetry of Cornea
682 - Microwave Thermotherapy for Breast Cancer
683 - Oxaliplatin (Eloxatin)
684 - Cetuximab (Erbitux)
685 - Bevacizumab (Avastin)
686 - Oral Brush Biopsy
0687 - Pemetrexed (Alimta)
688 - Intra-oral Appliances for Migraines
689 - Ocular Photoscreening
690 - Noninvasive Tests for Hepatic Fibrosis

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Anticipated CPB Review Date: October 08

691 - Breath Tests of Airway Inflammation: Exhaled Nitric Oxide and Exhaled Breath Condensate pH
692 - Acoustic Heart Sound Recording and Computer Analysis
693 - Octreotide (Sandostatin)
694 - Paranasal Sinus Ultrasound for the Evaluation of Sinusitis
695 - Broth Culture Testing for Interstitial Cystitis
696 - Suit Therapy
697 - Intra-operative Electromyographic Monitoring
698 - Prostate Saturation Biopsy
699 - Dry Hydrotherapy (Hydromassage, Aquamassage, Water Massage)
700 - Rhinomanometry and Acoustic Rhinometry
701 - Macular Disease Treatments
702 - Abdominal Aortic Aneurysm Screening
703 - Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow
704 - Indirect Measurement of Left Ventricular Filling Pressure (LVFP): The VeriCor System
705 - Body Surface Potential Mapping
706 - Anecortave Acetate (Retaane)
707 - Cervicogenic Headache and Occipital Neuralgia: Invasive Procedures
708 - Metatarsal Phalangeal Joint Replacement of the Hallux
709 - Nesiritide (Natrecor)
710 - Actigraphy Testing
711 - Insulin-Like Growth Factor-1 (IGF-1) Analogues: Mecasermin (Increlex) and Mecasermin Rinfabate (Iplex)
712 - Ziconotide (Prialt)
713 - Artificial Retina
714 - Re-breathing of Inert Gas for Measurement of Cardiac Output
715 - Pharmacogenetic Testing
716 - Extracorporeal Shock Wave Lithotripsy for Sialolithiasis (Salivary Stones)
717 - Analysis of Volatile Organic Compounds to Detect Bacteriuria
718 - Defecography / Evacuation Proctography
719 - Retisert (Fluocinolone Acetonide Intra-vitreal Implant)
720 - Abatacept (Orencia)
721 - Intraoperative Radiation Therapy (IORT)

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Anticipated CPB Review Date: October 22

722 - Selective Nerve Root Blocks
723 - Rotavirus Vaccine
724 - Serotonin 3 (5-HT3) Receptor Antagonist Antiemetic Injection Therapy
725 - Post-Herpetic Neuralgia
726 - Cervical Cancer Vaccine: Gardasil
727 - Ibandronate Sodium (Boniva) Injection
728 - Barrett’s Esophagus Surgery
729 - Surgical Decompression for Diabetic Neuropathy
730 - Home Behavioral Healthcare Services
731 - Convection-Enhanced Intraparenchymal Delivery of Drugs to the Brain
732 - Guillain-Barre Syndrome Treatments
733 - Discography
734 - External Ocular Photography
735 - Pulsed Radiofrequency
736 - Femoro-Acetabular Surgery for Hip Impingement Syndrome
737 - Double Balloon Enterosc 0738 - Upper Gastrointestinal Endoscopy
739 - Functional Magnetic Resonance Imaging
740 - Anesthesia Services for Gastrointestinal Endoscopy
741 - Peripheral Ultrafiltration for Acute Decompensated Heart Failure
742 – Intermittent Intravenous Insulin Therapy
743 – Spinal Surgery: Laminectomy and Fusion
744 - Bronchial Thermoplasty
745 - Bell's Palsy
746 - Ultrasound Therapy for Wound Healing
747 - Transanal Endoscopic Microsurgery for Rectal Cancer
748 - Panitumumab (Vectibix)
749 - Anterior Segment Optical Coherence Tomography
750 - Athletic Pubalgia Surgery
751 - Natalizumab (Tysabri)
752 - Obstructive Sleep Apnea in Children
753 - Core Decompression for Avascular Necrosis

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Anticipated CPB Review Date: November 12

754 - Laparoscopic Uterine Nerve Ablation (LUNA) and Presacral Neurectomy (PSN)
755 - Motor Cortex Stimulation
756 - Epiretinal Radiation Therapy
757 - AmniSure ROM (Rupture of Membranes)
758 - Tumor Chemoresistance Assays
759 - Vulvodynia and Vulvar Vestibulitis Treatments
760 - Oral Lesion Identification Systems
761 - Certolizumab Pegol (Cimzia)
762 - Repository Corticotropin Injection (H.P. Acthar Gel)
763 - Homocysteine
764 - Alemtuzumab (Campath)
765 - Age-Related Macular Degeneration Treatments
766 - High Intensity Focused Ultrasound for the Treatment of Prostate Cancer
768 - Romiplostim (Nplate)
769 - Endometrial Cancer Screening and Diagnosis
770 - Rilonacept (Arcalyst)
771 - Procalcitonin
772 - Axial Lumbar Interbody Fusion (AxiaLIF)

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