Medical Policies - Univera Providers


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Showing 1– 25 of 292 Results
Title Last Updated Category
CT (Computed Tomography) Perfusion Imaging - Dynamic Perfusion CT, Multimodal CT, Perfusion CT, Xenon-enhanced CT (XeCT) Open a PDF 6.01.37 2018-04-04 Radiology (x-rays) & Imaging
Nuclear Breast Imaging: Breast Specific Gamma Camera, BSGI, Gammagram, Miraluma, Radioimmunoscintigraphy, Scintigraphy, Scintimammography Open a PDF 6.01.02 2018-04-04 Radiology (x-rays) & Imaging
Implantable Cardioverter-Defibrillator (AICD, Automatic ICD, Biventricular ICD, Dual-Chamber ICD, ICD) Open a PDF 7.01.06 2018-04-04 Heart & Blood Vessels (Cardiovascular)
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)
Mammography: Digital Breast Tomosynthesis Open a PDF 6.01.22 2018-09-10 Radiology (x-rays) & Imaging
Measurement of Exhaled Markers of Airway Inflammation in Patients with Asthma: Exhaled Breath Condensate, Exhaled Nitric Oxide, Nioxx Open a PDF 2.01.41 2018-09-10 Lungs (Respiratory)
Physical Therapy (PT) Open a PDF 8.01.12 2018-10-02 Therapy & Rehabilitation
Biofeedback, EMG Biofeedback Open a PDF 2.01.09 2018-11-19 Alternative Medicine
Noninvasive Measurement of Cardiac Bioimpedance: Impedance Cardiography (ICG), Thoracic Electrical Bioimpedance (TEB) Open a PDF 6.01.26 2018-11-19 Heart & Blood Vessels (Cardiovascular)
Brachytherapy or Radioactive Seed Implantation for Prostate Cancer Open a PDF 6.01.16 2018-11-19 Radiation Treatment
Surgical Ventricular Restoration (SVR): DOR Procedure, Surgical Anterioe Endocardial Restoration (SAVER), Ventricular Remodeling Open a PDF 7.01.71 2018-11-19 Heart & Blood Vessels (Cardiovascular)
Genetic Testing for Susceptibility to Hereditary Cancers (PTEN, Cowden Syndrome, TP53, Li Fraumeni Syndrome, BreastNext, CancerNext, OvaNext, MyRisk Hereditary Cancer, Melaris, Prolaris, Panexia) Open a PDF 2.02.44 2018-11-19 Genetic Disease (Inherited Disease)
Gas Permeable Scleral Contact Lens (e.g., Boston Ocular Surface Prosthesis, Prosthetic Replacement of the Ocular Surface Ecosystem [PROSE]) Open a PDF 9.01.17 2018-11-19 Eyes (Ophthalmology)
Fecal Incontinence, Radiofrequency Treatment (Secca procedure) Open a PDF 7.01.66 2018-11-19 Digestive System (Gastroenterology)
Electrothermal Collagen Shrinkage for Orthopedic Conditions, Thermal Capsulorrhaphy Open a PDF 7.01.46 2018-11-19 Bone & Joints (Orthopedic)
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)
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 2018-11-26 Women's Health (Obstetrics & Gynecology)
Female Sterilization (e.g., Adiana®, Essure®, Tubal Ligation) Open a PDF 4.01.07 2018-11-26 Women's Health (Obstetrics & Gynecology)
Home Birth by Certified Nurse Midwives Open a PDF 11.01.23 2018-11-26 Women's Health (Obstetrics & Gynecology)
Intraocular Lens (IOL) Implants (e.g., Accommodating, Aspheric, Crystalens, Dynamic, Monofocal, Multifocal, Pseudoaccommodating) Open a PDF 9.01.14 2018-11-26 Eyes (Ophthalmology)
Refractive Procedures (e.g., Artisan, Astigmatic Keratotomy, Clear Lens Extraction, Photorefractive Keratectomy - PRK, INTACS - Corneal Ring Segments, Intracorneal Inlay, Laser-Assisted Subepithelial Keratomileusis - LASIK, Phakic Intraocular Lens) Open a PDF 9.01.08 2018-11-26 Eyes (Ophthalmology)
Early Intervention Services Open a PDF 10.01.09 2018-11-26 Children's Health (Pediatrics)
Phototherapy/Light Therapy for Seasonal Affective Disorder (SAD) Open a PDF 1.01.24 2018-11-26 Behavioral Health (Psychology)
Allogeneic Hematopoietic Stem Cell Transplantation Open a PDF 7.02.02 2019-01-02 Transplants
Autologous Hematopoietic Stem Cell Transplantation Open a PDF 7.02.03 2019-01-02 Transplants
Showing 1– 25 of 292 Results

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