View Medical Policies

Showing 1– 20 of 296 Results
Title Last Updated Category
Abdominoplasty and Panniculectomy (e.g., Belt Lipectomy, Lipectomy, Tummy Tuck) Open a PDF 7.01.53 2020-05-13 Cosmetic / Reconstructive Surgery
Acupuncture, Auricular Electrostimulation (e.g., E-Pulse, P-Stim™) Open a PDF 8.01.20 2020-05-13 Alternative Medicine
Airway Clearance Devices: Oscillatory Devices - ABI Vest, Acapella, Flutter Valve, Lung Flute®, ThAIRapy Vest; Mechanical Percussors and Assisted Cough Devices - Cofflator, Cough-Alator, In-Exsufflator Open a PDF 1.01.15 2021-01-19 Lungs (Respiratory)
Allergen Immunotherapy: Injections, Sublingual Immunotherapy Open a PDF 2.01.11 2020-10-19 Ear, Nose & Throat (Otorhinolaryngology)
Allergy Testing (Allergen Specific IgE, Allergen Specific IgG, Challenge, Cytotoxic, Dipstick, Disk, Intracutaneous, Intradermal, Leukocyte Histamine Release, Mucous Membrane, Paddle, Patch, Percutaneous, Phadiatop, Prick, Provocation-Neutralization, RAST, Rinkel, Scratch, Serial Endpoint Titration, Skin End Point Titration, Skin) Open a PDF 2.01.10 2021-03-16 Ear, Nose & Throat (Otorhinolaryngology)
Allogeneic Hematopoietic Stem Cell Transplantation Open a PDF 7.02.02 2021-01-19 Transplants
Alopecia (e.g., Areata, Androgenic, Scarring), Baldness, Hair Loss Open a PDF 2.01.36 2021-01-07 Cosmetic / Reconstructive Surgery
Ambulance: Air Open a PDF 11.01.06 2020-05-13 Miscellaneous
Ambulance: Land/Ground Open a PDF 10.01.07 2020-05-13 Miscellaneous
Ambulatory Event Monitor (AEM): Ambulatory Electrocardiographic (AECG) Devices, Cardiac Event Detection (CED), CardioNet, Mobile Cardiac Outpatient Telemetry (MCOT), Ziopatch Open a PDF 2.01.03 2021-01-12 Heart & Blood Vessels (Cardiovascular)
Angioplasty of Intracranial Atherosclerotic Stenoses with or without Stenting (e.g., Percutaneous Transluminal Angioplasty, Neurolink® System, Wingspan™ Stent) Open a PDF 7.01.70 2021-03-16 Nervous Systems (Neurology)
Antiprothrombin Antibody Testing Open a PDF 2.02.40 2020-09-02 Lab Tests (pathology)
Applied Behavioral Analysis for Treatment of Autism Spectrum Disorders (ABA), Pervasive Developmental Disorders (PDD) Open a PDF 3.01.11 2021-01-07 Behavioral Health (Psychology)
Aqueous Drainage Devices (Stents and Shunts): Ahmed, Aquaflow, Baerveldt, CyPass, Ex-PRESS, Glaucoma Filtration Device, IOP, iStent, Krupin, Molteno, XEN Open a PDF 9.01.18 2021-04-19 Eyes (Ophthalmology)
Artificial Cervical Intervertebral Discs (e.g., Bryan, Mobi-C, PCM [Porous Coated Motion] Cervical Disc®, Prestige®, ProDisc®, Secure-C) Open a PDF 7.01.80 2021-03-16 Bone & Joints (Orthopedic)
Artificial Hearts Open a PDF 7.01.65 2020-07-17 Heart & Blood Vessels (Cardiovascular)
Artificial Lumbar Intervertebral Disc (Effective 2021-09-01) Open a PDF 7.01.63 05-06-2021 Bone & Joints (Orthopedic)
Artificial Lumbar Intervertebral Disc Open a PDF 7.01.63 2021-03-16 Bone & Joints (Orthopedic)
Assisted Reproductive Technologies (ART) for Infertility): COMET Assay, Hylaluronan Binding Assay (HBA), Sperm DNA Integrity, Sperm Chromatin Structure Assay (SCSA®), Sperm DNA Fragmentation Assay (SDFA™), TUNEL Assay, Artificial or Intrauterine Insemination (AI, IUI), Microsurgical Epididymal Sperm Aspiration (MESA), Microsurgical Testicular Sperm Extraction (MicroTESE), Testicular Sperm Extraction (TESE), Direct Intra-Peritoneal Insemination (DIPI), Gamete Intrafallopian Transfer (GIFT), Intracytoplasmic Sperm Injection (ICSI), In-vitro Fertilization (IVF), Zygote Intrafallopian Transfer (ZIFT) Open a PDF 4.01.05 2021-01-22 Women's Health (Obstetrics & Gynecology)
Auditory Processing Disorder (APD) Testing Open a PDF 2.01.39 2021-01-07 Ear, Nose & Throat (Otorhinolaryngology)
Showing 1– 20 of 296 Results
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