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||07/23/2012||The following procedure/CPT/HCPCS codes are included in this policy: 33930, 33933, 33935, 33960 - 33961|
|1.0||03/08/2012||Added a new link to the new, current policy version and moved the previous link into the "previous" section.|
|1.1||04/05/2013||Added a new link to the 90-day notice effective August 1, 2013.|
|1.2||07/31/2013||Replaced the 90-day notice policy version with the new clean version and moved the previous version into the "previous" section.|
|1.3||02/14/2014||Added a link to the 90-day notice version of this policy.|
|1.4||06/01/2014||Replaced the link to the 90-day policy version with a link to the new policy version and moved the previous link into the "previous" section.|
|1.5||01/26/2015||Added the January 2015 policy to the current section. Moved the June 2014 policy to the previous section.|
|1.6||01/26/2016||Added a link to the clean, current policy and moved the expired policy into the “previous” section.|
|1.7||04/11/2017||Added a link to the clean, current policy and moved the expired policy into the “previous” section.|
|1.8||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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