Original Effective Date:
Current Effective Date:
To view the current medical policy, please click the link below:
To view previous versions of this policy that are now expired, please click on the links below:
|Rev#:||Date:||Nature of Change:|
|0.5||08/07/2012||The following procedure/CPT/HCPCS codes are included in this policy: 44132, 44133, 44135, 44136, 44715, 44720, 44721|
|1.0||02/13/2012||Added a new link to the new current policy version and moved the previously existing link down to the "previous" section.|
|1.1||04/05/2013||Added a new link to the 90-day notice version effective August 1, 2013.|
|1.2||07/31/2013||Replaced the link to the 90-day notice with a clean, current version and moved the previous version into the "previous" section.|
|1.3||02/14/2014||Added a link to the new, current version and moved the previous link into the previous section.|
|1.4||07/06/2015||Added a link to the new, current version and moved the previous link into the previous section.|
|1.5||07/06/2015||Added a link to the clean, current policy (eff 4/28/2017) and moved the expired policy into the “previous” section.|
|1.6||10/15/2018||Added a new link to the clean, current policy (effective 09/28/2018) and moved the expired policy into the “previous” section.|
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