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Learn more about how Medical Policies are developedOpen a PDF and about Experimental & Investigational Procedures.

Showing 226– 250 of 294 Results
Title Last Updated Category
Positron Emission Tomography (PET), Oncologic Applications (FDG PET, FDG SPECT) Open a PDF 6.01.29 2019-08-15 Radiology (x-rays) & Imaging
Magnetic Resonance Imaging (MRI) of the Breast (Breast MRI, CAD MRI) Open a PDF 6.01.35 2020-06-11 Radiology (x-rays) & Imaging
Monitored Anesthesia Care (MAC) Open a PDF 7.03.02 2020-06-11 Anesthesiology
Intensity Modulated Radiation Therapy (IMRT) Open a PDF 6.01.24 2020-06-11 Radiation Treatment
Implantable Bone Conduction Hearing Aids, Bone Anchored Hearing Aid (BAHA®), OBC bone anchored hearing aid system, Ponto Pro Open a PDF 7.01.77 2020-06-11 Ear, Nose & Throat (Otorhinolaryngology)
Immunizations/Vaccines (e.g., Hepatitis A, Hepatitis B, Human Papillomavirus [HPV, Cervarix, Gardasil], Meningococcal, Pneumoccal [Pneumovax 23, Prevnar], Rotavirus [Rotarix], Varicella [Varivax], Varicella Zoster [Zostavax]) Open a PDF 2.01.42 2020-06-11 Vaccines (Immunizations)
Intrastromal Corneal Ring Segments (ICRS) for Keratoconus (e.g., INTACS) Open a PDF 9.01.13 2020-06-11 Eyes (Ophthalmology)
Hyperthermia as a Cancer Treatment: Extracorporeal Whole Body, Intraperitoneal, Local, Regional, Whole Body Open a PDF 2.01.25 2020-06-11 Cancer Treatment (Oncology)
Hyperbaric Oxygen Therapy (HBOT): Systemic or Topical, Topical Oxygen Wound Therapy (TOWT) Open a PDF 2.01.07 2020-06-11 Miscellaneous
Non-Invasive Helicobacter Pylori (H Pylori) Testing: HpSA, Urea Breath Test Open a PDF 2.02.02 2020-06-11 Lab Tests (pathology)
Genetic Testing for Familial Alzheimer's Disease Open a PDF 2.02.16 2020-06-11 Genetic Disease (Inherited Disease)
Cryosurgical Tumor Ablation Open a PDF 7.01.03 2020-06-11 Cancer Treatment (Oncology)
Cochlear Implants and Auditory Brainstem Implants: Advanced Bionics® HiResolution Bionic Ear System (HiRes 90k), Cochlear® Nucleus 5, Med El® Maestro (Sonata or Pulsar), Nucleus 24® Auditory Brainstem Implant System, Nucleus® Hybrid™ L24 Cochlear Implant Open a PDF 7.01.26 2020-06-11 Ear, Nose & Throat (Otorhinolaryngology)
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 2020-06-11 Urinary System (Genitourinary)
Bioimpedance Devices for Detection and Management of Lymphedema, bioelectrical impedance spectroscopy Open a PDF 2.01.52 2020-06-11 Miscellaneous
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 2020-06-11 Skin (Dermatology)
Home Automatic External Defibrillator (AEDs) and Wearable Defibrillator Vests (WCDs): HeartStart, LIFECOR Open a PDF 1.01.42 2020-06-11 Heart & Blood Vessels (Cardiovascular)
Wheelchairs and Power Operated Vehicles (POVs) (e.g., Scooters) Open a PDF 1.01.16 2020-07-17 Durable Medical Equipment & Supplies
Speech/Language Pathology and Therapy (e.g., Fast ForWord, Lee Silverman Voice Therapy [LSVT-LOUD™], Voice Therapy) Open a PDF 8.01.13 2020-07-17 Therapy & Rehabilitation
Sex Specific Services, Gender dysphoria, Gender Identity Disorder, GID, transgender, transsexualism Open a PDF 11.01.26 2020-07-17 Behavioral Health (Psychology)
Patient Lifts (e.g., Hoyer, Saralift), Seat Lift Chair Mechanisms and Ceiling Lifts Open a PDF 1.01.08 2020-07-17 Home Care
Positive Airway Pressure Devices: CPAP, BiPAP, APAP, DPAP, C-FLex Open a PDF 1.01.06 2020-07-17 Durable Medical Equipment & Supplies
Periodontal Scaling and Root Planing Open a PDF 13.01.04 2020-07-17 Dental
Periodontal Maintenance Open a PDF 13.01.05 2020-07-17 Dental
Occupational Therapy (OT): Constraint Induced Movement Therapy (CIMT), Gait Analysis, Sensory Integration Therapy, SIT Open a PDF 8.01.17 2020-07-17 Therapy & Rehabilitation
Showing 226– 250 of 294 Results

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