Medical Policies


Evidence Based Guidelines - Categorical Index

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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   top

NONE

Drugs   top

Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER-2 Positive Malignancies
Erythropoiesis-Stimulating Agents (ESAs)

Home Health/Durable Medical Equipment   top

Blood Glucose Monitors for Use in the Home
External Insulin Pumps
Implantable Infusion Pumps
Photodynamic Therapy Ocular
Therapeutic Apheresis

Medical   top

Ambulatory Blood Pressure Monitoring
Arthroscopic Debridement and Lavage as Treatment of Knee Osteoarthritis
Automated Nerve Conduction Tests
Bevacizumab in Advanced Adenocarcinoma of the Pancreas
Biochemical Markers of Alzheimer's Disease
Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
Diagnosis and Treatment of Sacroiliac Joint Pain
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
Fecal Calprotectin Test
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 Li-Fraumeni Syndrome
Genetic Testing for Hereditary Hearing Loss
Genetic Testing for PTEN Hamartoma Tumor Syndrome
KRAS and BRAF Mutation Analysis in Cancer
Laboratory Testing for HIV Tropism
Paraspinal Surface Electromyography (EMG)
Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Therapeutic Apheresis
Total Body Photography
Ultrafiltration in Decompensated Heart Failure

Mental Health/Chemical Dependency   top

Psychoanalysis

OB-GYN Reproduction   top

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

Radiology   top

Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer

Surgery   top

Biventricular Pacemakers/Cardiac Resynchronization Therapy for Heart Failure
Cryoablation of Prostate Cancer
Endovascular Stent Graft for Abdominal Aortic Aneurysm
Endovascular Stent Graft for Thoracic Aortic Aneurysm
Hip Resurfacing
Maze Procedure for Atrial Fibrillation or Flutter
Septoplasty
Transmyocardial Revascularization (TMR)
Ventricular Assist Devices and Total Artificial Hearts


Therapy   top

Interventions for Progressive Scoliosis
Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia

Other Treatments   top

Glaucoma, Evaluation by Ophthalmic Techniques

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