Medical policies

Evidence Based Guidelines - Alphabetical Index

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A   top

Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER-2 Positive Malignanciess
Ambulatory Blood Pressure Monitoring
Apnea Monitor for Use in the Home
Arthroscopic Debridement and Lavage as Treatment of Knee Osteoarthritis
Auditory Brain Stem Implant
Automated Nerve Conduction Tests

B   top

Bevacizumab in Advanced Adenocarcinoma of the Pancreas
BCR-ABL1 Testing for Diagnosis, Monitoring, and Drug Resistance Mutation Detection in Chronic Myelogenous Leukemia
Biochemical Markers of Alzheimer's Disease
Biventricular Pacemakers/Cardiac Resynchronization Therapy for Heart Failure
Blood Glucose Monitors for Use in the Home
Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone

C   top

Cardiac Rehabilitation
Charged Particle Radiotherapy
Cryoablation of Prostate Cancer

D   top

Deep Brain Stimulation
Diabetic Retinopathy Telescreening
Diagnosis and Treatment of Sacroiliac Joint Pain
Donor Lymphocyte Infusion

E   top

Endobronchial Brachytherapy
Endoscopic Radiofrequency Ablation or Cryoablation for Barrett's Esophagus
Endovascular Stent Grafts for Abdominal Aortic Aneurysm
Endovascular Stent Grafts for Thoracic Aortic Aneurysm

Erythropoiesis-Stimulating Agents (ESAs)
External Insulin Pumps

F   top

Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
Fecal Calprotectin Test

G   top

Genetic Testing for Alpha Thalassemia
Genetic Testing for CHARGE Syndrome
Genetic Testing for Duchenne and Becker Muscular Dystrophy
Genetic Testing for Facioscapulohumeral Muscular Dystrophy
Genetic Testing for Nonsyndromic Hearing Loss
Genetic Testing for PTEN Hamartoma Tumor Syndrome
Glaucoma, Evaluation by Ophthalmic Techniques

H   top

Hip Resurfacing
Homocysteine Testing in Cardiac Disease Risk Assessment
Human Leukocyte Antigen (HLA) Testing for Celiac Disease

I   top

Implantable Infusion Pumps
Inhaled Nitric Oxide
Interventions for Progressive Scoliosis
Intravitreal Angiogenesis Inhibitors for Choroidal and Retinal Vascular Conditions
Intraoperative Radiation Therapy
Intraoperative Neurophysiologic Monitoring (sensory-evoked potentials, motor-evoked potentials, EEG monitoring)
Intrauterine Ablation or Resection of the Endometrium

J   top

None

K   top

KRAS and BRAF Mutation Analysis in Cancer

L   top

Laboratory Testing for HIV Tropism
Laser Assisted Tonsillectomy

M   top

Maternal and Fetal Diagnostics
Maze Procedure for Atrial Fibrillation or Flutter
Monitored Anesthesia Care (MAC)
Monoclonal Antibodies for Non-Hodgkin Lymphoma and Acute Myeloid Leukemia

N   top



O   top

Ocriplasmin for Symptomatic Vitreomacular Adhesion

P   top

Paraspinal Surface Electromyography
Pertuzumab for Treatment of HER2-Positive Malignancies
Pharmacogenomic and Metabolite Markers for Treatment with Thiopurines
Photodynamic Therapy for Treatment of Specific Cancers
Photodynamic Therapy Ocular
Prostate Cancer Treatment with Brachytherapy
Prothrombin Time Monitoring In The Home
Psychoanalysis
Pulmonary Rehabilitation

Q   top

Quantitative Sensory Testing

R   top

Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma

S   top

Screening for Vertebral Fracture with Dual X-Ray Absorptiometry (DEXA)
Septoplasty
Serum Biomarker Human Epididymis Protein 4 (HE4)

T   top

TENS (Transcutaneous Electrical Nerve Stimulator)
Therapeutic Apheresis
Thermography
Total Body Photography
Transmyocardial Revascularization (TMR)
Trastuzumab

U   top

Ultrafiltration in Decompensated Heart Failure
Uterine Artery Occlusion in the Treatment of Uterine Fibroids

V   top

Ventricular Assist Devices and Total Artificial Hearts
Vertical Expandable Prosthetic Titanium Rib

W   top

None

X   top

None

Y   top

None

Z   top

None

 

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