Medical Policies

Evidence Based Guidelines - Categorical Index

Administrative | Drugs | Home Health/Durable Medical Equipment | Medical | Mental Health/Chemical Dependency | OB−GYN Reproduction | Radiology | Surgery | Therapy | Other Treatments

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Administrative

NONE

Erythropoiesis-Stimulating Agents (ESAs)
Trastuzumab
Treatment for Age Related Macular Degeneration

Home Health/Durable Medical Equipment

Apnea Monitor for Use in the Home
Blood Glucose Monitors for Use in the Home
External Insulin Pumps
Implantable Infusion Pumps
Photodynamic Therapy Ocular
Prothrombin Time Monitoring In The Home
Therapeutic Apheresis
Water Induced Thermotherapy for Treatment of Benign Prostatic Hypertrophy

Ambulatory Blood Pressure Monitoring
Androstanediol Glucuronide Test for Hirsutism
Anti-CCP Testing for Rheumatoid Arthritis
Arthroscopic Debridement and Lavage as Treatment of Knee Osteoarthritis
Bevacizumab in Advanced Adenocarcinoma of the Pancreas
Biochemical Markers of Alzheimer's Disease
Cytochrome p450 Genotyping
Cardiac Rehabilitation
Dermatologic Applications of Photodynamic Therapy
Diagnosis and Treatment of Sacroiliac Joint Pain
Donor Leukocyte Infusion
Endoscopic Radiofrequency Ablation for Barreett's Esophagus
Homocysteine Testing in Cardiac Disease Risk Assessment
Human Papillomavirus (HPV) Vaccine
Intra Articular Hyaluronan Injections for Osteoarthritis of the Knee
Intravenous Anesthetics for the Treatment of Chronic Pain
KRAS Mutation Analysis in Cancer
Laboratory Testing for HIV Tropism
Mechanical Embolectomy for Treatment of Acute Stroke
Monitored Anesthesia Care (MAC)
Monoclonal Antibodies for Non-Hodgkin Lymphoma and Acute Myeloid Leukemia
Novel Lipid Risk Factors in Risk Assessment of Cardiovasculaar Disease
Pharmacogenomic and Metabolite Markers for Treatment with Thiopurines
Photodynamic Therapy for Treatment of Specific Cancers
Photodynamic Therapy Ocular
Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
Serologic Diagnosis of Celiac Disease
Serum Biomarker Human Epididymis Protein 4 (HE4)
Therapeutic Apheresis
Thermotherapy, Transpupillary
Total Body Photography
Ultrafiltration in Decompensated Heart Failure

Mental Health/Chemical Dependency

OB-GYN Reproduction

Intrauterine Ablation or Resection of the Endometrium
Maternal and Fetal Diagnostics
Uterine Artery Occlusion in the Treatment of Uterine Fibroids

Charged Particle Radiotherapy
Dynamic Spinal Visualization
Endobronchial Brachytherapy
Intraoperative Radiation Therapy
Prostate Cancer Treatment with Brachytherapy
Transrectal Ultrasound
Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia
Transurethral Radiofrequency Needle Ablation of the Prostate
Screening for Vertebral Fracture with Dual X-Ray Absorptiometry (DEXA)

Auditory Brain Stem Implant
Biventricular Pacemakers for CHF
Balloon Dilatation of the Prostatic Urethra
Bone Allotransplantation
Colon Cancer Screening
Cryosurgery Ablation of the Prostate
Deep Brain Stimulation
Free Vascularized Fibular Graft for Avascular Necrosis
Ilizarov Bone Lengthening Procedure
Laser Assisted Tonsillectomy
Maze Procedure for Atrial Fibrillation or Flutter
Partial Left Ventriculectomy
Septoplasty
TENS (Transcutaneous Electrical Nerve Stimulator)
Tissue Pressure Measurement
Transmyocardial Revascularization (TMR)
Ventricular Assist Devices and Total Artificial Hearts

Interventions for Progressive Scoliosis
Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia

Other Treatments

Diabetic Retinopathy Telescreening
External Breast Reconstruction (Prosthesis)
Glaucoma, Evaluation by Ophthalmic Techniques
Pulmonary Rehabilitation