Medical Policies - Univera Providers


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Showing 26– 50 of 292 Results
Title Last Updated Category
Behavioral Health Treatment of Family and Couples (Couples Therapy, Family Therapy) Open a PDF 3.01.05 2019-04-30 Behavioral Health (Psychology)
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)
Bioengineered Tissue Products (Affinity™, AlloDerm®, AlloMax™, AlloSkin™, AlloWrap™, AmnioBand™, Amnioexcel®, AmnioMatrix®, Apligraf®, Artacent™ Wound, ArthroFlex™, Artificial skin, Avaulta Plus™, Biobrane®, Biobrane l®, Bioengineered skin, Biologic tissue, Biovance®, Clarix® Flo, Collamend, Conexa™, Cygnus Solo™, Cygnus Matrix™, Cygnus Max™, Cymetra®, Cytal™ Burn Matrix, Cytal™ Wound Matrix, DermACELL AWM™, DermaMatrix, DermaPure™, DermaSpan™, Dermavest™, Endoform Dermal Template™, ENDURAgen™, Epicel®, EpiCord™, EpiFix, Excellagen®, E-Z Derm™, FlexHD®, GammaGraft, Grafix® CORE, Grafix® PRIME, GraftJacket®, GraftJacket® Xpress, Graftskin, Guardian, hMatrix®, Hyalomatrix®, Integra™, Integra™ Bilayer Wound® Matrix, Integra™ Dermal Regeneration Matrix®, Integra™ Flowable Wound® Matrix, InteguPly™, Interfyl™, Laserskin, MariGen, Mediskin®, Miroderm®, Neoform, Neox®, Neox 1K, Neox® Flo, NuShield™, OASIS® Wound Matrix, OASIS® Burn Matrix, OASIS® Ultra, Omnigraft™, Orcel™, Orthoadapt, PalinGen® - Membrane, Hydromembrane, Flow, and SportFlow, Pelvicol, Pelvisoft, Permacol™, Primatrix, PuraPly, Restore, Revitalon™, Skin substitute, StrataGraft, Strattice™, SurgiMend®, TenSIX™, TheraSkin®, Tissuemend, TransCyte™, TranZgraft, TruSkin™, Veritas® Collagen Matrix, XCM Biological Tissue Matrix.) Open a PDF 7.01.35 2019-08-15 Skin (Dermatology)
Biofeedback, EMG Biofeedback Open a PDF 2.01.09 2018-11-19 Alternative Medicine
Bioimpedance Devices for Detection and Management of Lymphedema, bioelectrical impedance spectroscopy Open a PDF 2.01.52 2019-06-14 Miscellaneous
Blepharoplasty/Eyelid Surgery with or without Levator Muscle Advancement(Pseudoptosis Surgery, Ptosis Surgery, Brow Lift) Open a PDF 7.01.55 2019-06-04 Cosmetic / Reconstructive Surgery
Blood Pressure Monitoring, Automated, Ambulatory Open a PDF 1.01.04 2019-01-18 Heart & Blood Vessels (Cardiovascular)
Bone Densitometry/Bone Density Studies: DEXA Scan, Dual Photon Absorptiometry (DPA), Morphometric X-ray Absorptiometry, Single Photon Absorbtiometry (SPA), Ultrasound Measurement of the Heel Open a PDF 6-01-05 2019-10-15 Radiology (x-rays) & Imaging
Bone Growth Stimulators (e.g., Electrical, Osteogenic, Sonic Accelerated Fracture Healing System - SAFHS, Ultrasonic) Open a PDF 7.01.40 2019-04-30 Bone & Joints (Orthopedic)
Bone Growth Stimulators for the Appendicular Skeleton Open a PDF 1.01.53 2019-04-30 Bone & Joints (Orthopedic)
Brachytherapy after Breast Conserving Surgery, as Boost with Whole Breast Irradiation or Alone as Accelerated Partial Breast Irradiation: Accelerated Partial Breast Irradiation, APBI, Axxent, MammoSite Open a PDF 6.01.30 2019-01-02 Radiation Treatment
Brachytherapy or Radioactive Seed Implantation for Prostate Cancer Open a PDF 6.01.16 2018-11-19 Radiation Treatment
Breast Pumps Open a PDF 1.01.39 2019-06-04 Durable Medical Equipment & Supplies
Breast Reconstruction Surgery Open a PDF 10.01.01 2019-10-15 Cosmetic / Reconstructive Surgery
Bronchial Thermoplasty (e.g., Alair® System) Open a PDF 7.01.88 2019-02-06 Lungs (Respiratory)
Bulking Agents for Treatment of Urinary or Fecal Incontinence (Bovine Collagen, Carbon Coated Beads, Coaptite®, Contigen®, Durasphere, GAX, Macroplastique®, Microballoons, Solesta, Teflon® Injections, Uryx®) Open a PDF 7.01.22 2018-06-14 Urinary System (Genitourinary)
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
Cardiac Rehabilitation Open a PDF 8.01.14 2019-08-12 Therapy & Rehabilitation
Cardiac Resynchronization Therapy (Biventricular Pacemakers) for the Treatment of Heart Failure (Bioimpedance, Dual Chamber Pacemaker) Open a PDF 7.01.58 2019-09-19 Heart & Blood Vessels (Cardiovascular)
Cardiovascular Disease Risk Assessment - Laboratory Evaluation of Lipids: Apolipoprotein A-1, B, and E, Lipoprotein (a) Enzyme Immunoassay Open a PDF 2.02.29 2019-01-18 Lab Tests (pathology)
Cervical Cancer Screening and Human Papilloma Virus (HPV) Testing (e.g., Cervista™, Cobas® HPV test, DNA with PAP, HPV, HPV DNA testing, Human Papillomavirus, HC 2, Hybrid Capture 2, Pap/ Papanicolaou smear: Direct visualization, Monolayer, Optical; FocalPoint™, MonoPrep Pap Test (MPPT), PapSure®, Speculite®, Speculoscopy, SurePath, ThinPrep®) Open a PDF 2.02.04 2019-04-30 Women's Health (Obstetrics & Gynecology)
Cervical Traction Devices (e.g., HomeTrac Deluxe, Saunders Cervical HomeTrac, Hydraulic, Over-The-Door, Pneumatic Cervical, Pronex) Open a PDF 1.01.47 2019-06-04 Durable Medical Equipment & Supplies
CGMS, Continuous glucose monitor, DexCom STS, Freestyle Navigator, Interstitial glucose monitoring, MiniMed CGMS® System Gold™, MiniMed Guardian® Real-Time, MiniMed Paradigm Revel® Real-Time system, DexCom G5®,Wrist glucose monitor, Continuous subcutaneous insulin infusion, CSII, Insulin pump therapy Open a PDF 1.01.30 2019-10-15 Diabetes (Endocrinology)
Chelation Therapy (e.g., EDTA, Endrate, Desferal, BAL in oil, Cuprimine, Depen, Zinecard, Exjade, Post-chelator Challenge Urinary Metal Testing. Post-provocation Urinary Metal Testing) Open a PDF 8.01.03 2018-11-19 Blood Disorders (Hematology)
Chiropractic Care Open a PDF 10.01.02 2019-04-30 Chiropractic
Showing 26– 50 of 292 Results

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