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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
Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation
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
Transcatheter Aortic Valve Replacement
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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