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Medical policies

Medical Guidelines - Alphabetical Index

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A   top

Ambulance and Medical Transport Services
Antiemetics

B   top

Breast Implant Removal
Breast Reduction (Reduction Mammoplasty)

C   top

Cardiac Rehabilitation
Clinical Trial Services

D   top

Deep Brain Stimulation for Essential Tremor and Parkinson
Dental Services
Dermabrasion
Durable Medical Equipment

E   top

Electrical Stimulators - Osteogenesis
Electrical Stimulators - Spinal Cord
Electrical Stimulators - TENS
Erythropoietin Stimulating Agents (ESAs)
External Infusion Pumps

F   top

None

G   top

None

H   top

None

I   top

Immunosuppressants Medications
Implantable Infusion Pump (Pain Mgmt, Chemotherapy, Baclofen)
Investigational (Experimental) Services
IVIG

J   top

None

K   top

None

L   top

Lung Volume Reduction Surgery

M   top

Morbid Obesity Surgery

N   top

Nebulizer Medications
Neuromuscular Electrical Stimulation
Neuropsychological Testing

O   top

Observation
Oral Anticancer Meds
Orthognathic Surgery
Oxygen and Oxygen Supplements

P   top

Penile Implants
Pneumatic Compression Device
Positive Airway Pressure Therapy For Obstructive Sleep Apnea and Breathing Related Sleep Disorders
Prosthesis
Psychological Evaluations Covered as a Medical Benefit
Pulmonary Rehabilitation

Q   top

None

R   top

Reconstructive Eyelid Surgery
Refractive Surgical Procedures
Rehabilitation Therapy - Inpatient
Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders

S   top

Sacral Nerve Stimulator for Urinary Incontinence and Fecal Incontinence
Skilled Care Services
Speech Language Pathology (SLP) Services
Surgical Treatment of Obstructive Sleep Apnea

T   top

Temporomandibular Joint Surgery &/or Occlusal Splints
Transplants: Stem Cells and Organ


U   top

None

V   top

Vagal Nerve Stimulator (VNS) for Epilepsy
Varicose Vein Treatment
Ventricular Assist Devices
Vertebroplasty & Kyphoplasty

W   top

None

X   top

X-Stop

Y   top

None

Z   top

None

 

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