To view the current medical policy, please click the link below:
To view the full list of active HMSA Specialty Medical Drug Policies, please click here.
As of 10/1/2015, please click here for previous expired versions of this policy.
To view previous expired versions of this policy prior to 10/1/15, please click on the links below:
|Rev#:||Date:||Nature of Change:|
|0.5||08/06/2012||The following procedure/CPT/HCPCS codes are included in this policy: 90283, 90284, J1459, J1559, J1599, J1561, J1562, J1566, J1568, J1569, J1572|
|1.0||09/06/2011||Moved the link of the previous policy version to the "previous versions" section and added a new link to the current policy version of this policy.|
|1.1||10/09/2012||Added a link to the 90-day notice version of this policy, effective February 1, 2013.|
|1.2||02/04/2013||Removed the link to the 90-day notice version, added a clean, current link and moved the previous version of the policy into the "previous" section.|
|1.3||11/14/2013||Added a link to the 90-day notice version.|
|1.4||03/03/2014||Replaced the link to the 90-day notice version with a link to the current version and moved the previous version into the "previous" section.|
|1.5||12/31/2014||Added a link to the 90-day notice version of this policy.|
|1.6||02/27/2015||Replaced the link to the 90-day notice version with a link to the current version and moved the previous version into the "previous" section.|
|1.7||06/30/2015||Added link to new 90-day notice. Effective 10/1/15.|
|1.9||12/28/2017||Added a link to the clean, current policy effective 12/1/17. Added a link to the CVS website archive page.|
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