View Medical Policies

Showing 1– 20 of 295 Results
Title Last Updated Category
Early Intervention Services Open a PDF 10.01.09 2018-11-26 Children's Health (Pediatrics)
Coverage for Dependents with Disabilities Open a PDF 10.01.08 2019-08-12 Miscellaneous
Out of Area/Out of Network Services Open a PDF 11.01.14 2019-08-12 Miscellaneous
Positron Emission Tomography (PET), Oncologic Applications (FDG PET, FDG SPECT) Open a PDF 6.01.29 2019-08-15 Radiology (x-rays) & Imaging
Total Hip Resurfacing, Metal-on-Metal Open a PDF 7.01.74 2019-08-15 Bone & Joints (Orthopedic)
Wireless Capsule Endoscopy/Imaging for Examination of the Gastrointestinal (GI) Tract: AGILE Patency Capsule, Given® Capsule Camera, PillCam SB, PillCam ESO Open a PDF 6.01.27 2019-08-15 Digestive System (Gastroenterology)
Whole Exome and Whole Genome Sequencing for the Diagnosis of Genetic Disorders Open a PDF 2.02.46 2019-08-15 Genetic Disease (Inherited Disease)
Radiofrequency Facet Denervation Open a PDF 7.01.42 2019-08-15 Bone & Joints (Orthopedic)
Prostate Cancer Screening, Detection and Monitoring (e.g., Digital Rectal Exam - DRE, PCA3Plus, Prostate Specific Antigen - PSA, Prostatic Acid Phosphatase - Male PAP Test) Open a PDF 10.01.05 2019-08-15 Urinary System (Genitourinary)
Neuromuscular Electrical Stimulation (FNS, NMES, TES, VitalStim®) Open a PDF 1.01.48 2019-08-15 Durable Medical Equipment & Supplies
Autologous Chrondrocyte Implantation (e.g., Carticel®, Matrix-induced ACI, MACI, Minced cartilage, Neocartilage, Scaffold-induced ACI) Open a PDF 7.01.38 2019-08-15 Bone & Joints (Orthopedic)
Placental and Umbilical Cord Blood as a Source of Stem Cells Open a PDF 7.01.48 2019-08-22 Transplants
Cardiac Computed Tomographic Angiography (Calcium Scoring, Cardiac/Coronary CTA, Coronary Artery CTA, CT Angiography) Open a PDF 6.01.34 2019-08-22 Radiology (x-rays) & Imaging
Intramuscular Brachytherapy, Endovascular Radiation Open a PDF 6.01.15 2019-08-22 Radiation Treatment
Selective Internal Radiation Therapy (SIRT) for Hepatic Tumors (SIR-Spheres, Theraspheres) Open a PDF 7.01.69 2019-08-22 Radiation Treatment
Anticoagulation Testing Open a PDF 2.02.40 2019-08-22 Lab Tests (pathology)
Biochemical Markers of Bone Turnover (e.g., Collagen Cross Links, Cross Laps, ITCP, N-telopeptides, NTx, Pyrilinks) Open a PDF 2.02.18 2019-08-22 Lab Tests (pathology)
Proteomics-Based Testing for the Evaluation of Ovarian (Adnexal) Masses: Ova1™ Open a PDF 2.02.43 2019-08-22 Lab Tests (pathology)
Screening for Vitamin D Deficiency Open a PDF 2.02.45 2019-08-22 Lab Tests (pathology)
Urinary Tumor Markers for Bladder Cancer: AccuDx, BTA Stat™, Fibrin/Fibrinogen Degradation Products (FDP), ImmunoCyt, Nuclear Matrix Protein (NMP-22), Urinary Bladder Cancer Antigen (UBC Rapid Test) Open a PDF 2.02.12 2019-08-22 Lab Tests (pathology)
Showing 1– 20 of 295 Results