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

Drugs   top

Abatacept (Orencia®) 
Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER-2 Positive Malignancies
Alemtuzumab (LemtradaTM)
Antiemetic Injection Therapy
Atezolizumab (Tecentriq) for Intravenous Use
Belimumab (Benlysta)
Bevacizumab in Advanced Adenocarcinoma of the Pancreas
Botulinum Toxin Injection
Brentuximab Vedotin (Adcetris)
Cabazitaxel (Jevtana)
Carfilzomib (Kyprolis®)
CAR-T Therapy
Chemotherapy For Malignant Disease
Daratumumab (Darzalex)
Denosumab (ProliaTM, XGEVATM)
Eculizumab (Soliris®)
Edaravone (RadicavaTM)
Elotuzumab (Empliciti)
Enzyme Replacement Therapy for Lysosomal Storage Disorders
Eribulin Mesylate (Halaven)
Erythropoiesis-Stimulating Agents (ESAs)
Eteplirsen for Duchenne Muscular Dystrophy
Golimumab (Simponi Aria)
Goserelin Acetate (Zoladex)
Immunoglobulin Therapy
Infliximab (Remicade)
Inotuzumab (Besponsa)
Interleukin-5 Antagonists
Intravenous Antiobiotic Therapy for Lyme Disease
Ipilimumab (Yervoy)
Melphalan Hydrochloride (Evomela) for Intravenous Use
Monoclonal Antibodies for Non-Hodgkin Lymphoma and Acute Myeloid Leukemia In the Non-Hematopoietic Stem Cell Transplant Setting
Natalizumab Tysabri
New-To-Market Specialty Drug PPA Requirements
Nusinersen (SpinrazaTM)
Ocrelizumab (OcrevusTM)
Paclitaxel (Abraxane)®
PD-1 Inhibitors
Pemetrexed (Alimta)
Pertuzumab for Treatment of Malignancies
Place of Service for Medical Infusions
Pulmonary Hypertension, Drug Management
Repository Corticotropin (H.P. Acthar Gel)
Respiratory Syncytial Virus Prophylaxis
Rituximab for the Treatment of Rheumatoid Arthritis
Siltuximab (Sylvant)
Tocilizumab (Actemra)
Topotecan Hydrochloride (Hycamtin)
Treatment of Hereditary Angioedema
Treatment for Severe Primary IGF-1 Deficiency
Ustekinumab (Stelara)
Vedolizumab (Entyvio)
White Blood Cell Growth Factors
Xolair (Omalizumab)
Zinplava (bezlotoxumab)

Home Health/Durable Medical Equipment   top

Artificial Pancreas Device Systems
Children's Mobility and Positioning Equipment
Continuous Monitoring of Glucose in the Interstitial Fluid
Continuous Passive Motion in the Home Setting
Durable Medical Equipment (DME)
Electrical Stimulation for the Treatment of Arthritis
External Defibrillators
Infusion Therapy in the Home
Interferential Stimulation
Neurostimulation, Electrical
Noninvasive Respiratory Assist Devices
Oscillatory Devices for the Treatment of Respiratory Conditions
Patient Lifts
Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers
Powered Exoskeleton for Ambulation in Patients with Lower Limb Disabilities
Pressure Reducing Support Surfaces
Skilled Nursing Services
Speech Generating Devices
Transtympanic Micropressure Applications as a Treatment of Meniere's Disease
Wheelchairs (Manual and Power Operated)

Medical   top

Allergy Immunotherapy (Desensitization)
Allergy Testing
Ambulance and Medical Transport Services
Ambulatory Event Monitors
Analysis of MGMT Promoter Methylation in Malignant Gliomas
Anesthesia Services
Antiprothrombin Antibody Testing
Aqueous Shunts and Devices for Glaucoma
Assays of Genetic Expression to Determine Prognosis of Breast Cancer
Baroreflex Stimulation Devices
Bioimpedance Devices for Detection of Lymphedema
BRAF Gene Mutation Testing to Select Melanoma or Glioma Patients for Targeted Therapy
Cardiac Hemodynamic Monitoring in the Outpatient Setting
Cardiovascular Disease Risk Tests
Carotid Intimal-Medial Thickness
Carrier Screening for Genetic Disease
Chelation Therapy
Chemoembolization of the Hepatic Artery, Transcatheter Approach
Circulating Tumor DNA for Cancer Management (Liquid Biopsy)
Clinical Trial Services
Common Genetic Variants to Predict Risk of Nonfamilial Breast Cancer
Complementary and Alternative Medicine
Convection-Enhanced Delivery of Therapeutic Agents to the Brain
Corneal Collagen Cross-linking
DNA Based Testing for Adolescent Idiopathic Scoliosis
Diagnosis and Treatment of Sacroiliac Joint Pain
Drug Testing in Pain Management and Substance Abuse Treatment
Dynamic Posturography
Electrodiagnostic Studies
Electrogastrography, Cutaneous
Electromagnetic Navigation Bronchoscopy
Electrostimulation and Electromagnetic Therapy for Chronic Wounds
Enhanced External Counterpulsation (EECP)
Enteral Nutrition
Epidural Steroid Injections for Back Pain
Esophageal pH Monitoring
Exhaled Nitric Oxide Measurement
Extracorporeal Photopheresis
Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
Fecal Calprotectin Test
Fecal Microbiota Transplantation
Gene Expression Testing in the Evaluation of Patients With Stable Ischemic Heart Disease
Gene Expression Profiling for Uveal Melanoma
General Approach to Evaluating the Utility of Genetic Panels
General Approach to Genetic Testing
Genetic and Protein Biomarkers for Diagnosis and Risk Assessment of Prostate Cancer
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
Genetic Testing for Alpha-1 Antitrypsin Deficiency
Genetic Testing for Alpha Thalassemia
Genetic Testing for Alzheimer's Disease
Genetic Testing for Breast and Ovarian Cancer
Genetic Testing for CADASIL Syndrome
Genetic Testing for Cardiac Ion Channelopathies
Genetic Testing for Colon Cancer
Genetic Testing for Cutaneous Malignant Melanoma
Genetic Testing for Dilated Cardiomyopathy
Genetic Testing for Duchenne and Becker Muscular Dystrophy
Genetic Testing for Epilepsy
Genetic Testing for Evaluation of Developmental Delay/Autism Spectrum Disorder
Genetic Testing for Fanconi Anemia
Genetic Testing for FLT3, NPM1 and CEBPA Mutations in Acute Myeloid Leukemia
Genetic Testing for FMR1 Mutations Including Fragile X Syndrome
Genetic Testing for Hereditary Hearing Loss
Genetic Testing for Hereditary Hemochromatosis
Genetic Testing for Hereditary Pancreatitis
Genetic Testing for Heterozygous Familial Hypercholesterolemia
Genetic Testing for Lactase Insufficiency
Genetic Testing for Macular Degeneration
Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
Genetic Testing for Myeloproliferative Neoplasms
Genetic Testing for Neurofibromatosis
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
Genetic Testing for PTEN Hamartoma Tumor Syndrome
Genetic Testing for Rett Syndrome
Genetic Testing for Statin-induced Myopathy
Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathy
Glaucoma, Evaluation by Ophthalmologic Techniques
Growth Factors in Wound Healing
Hemodialysis Treatment for ESRD Hyperbaric Oxygen Therapy
Hyperhidrosis, Treatment of
Identification of Microorganisms Using Nucleic Acid Probes
Immune Cell Function Assay
Ingestible pH and Pressure Capsule
Injectable Clostridial Collagenase for Fibroproliferative Disorders
Insulin Therapy, Chronic Intermittent Intravenous (CIIIT)
Intra Articular Hyaluronan Injections for Treatment of Osteoarthritis of the Knee
Intracellular Micronutrient Analysis
Intradialytic Parenteral Nutrition
Intravenous Anesthetics for the Treatment of Chronic Pain
Invasive Prenatal (Fetal) Diagnostic Testing
In Vitro Chemoresistance and Chemosensitivity Assays
Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients with Cancer
Laboratory Tests for Heart Transplant Rejection
Lipid Apheresis
Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (GERD)
Maternal and Fetal Diagnostics
Measurement of Serum Antibodies to Infliximab and Adalimumab
Microarray based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification
Microarray based Gene Expression Testing for Cancers of Unknown Primary
Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Risk
Molecular Analysis for Targeted Therapy for Non-Small Cell Lung Cancer (NSCLC)
Molecular Markers in Fine Needle Aspirates of the Thyroid
Molecular Panel Testing of Cancers to Identify Targeted Therapies
Molecular Testing in the Management of Pulmonary Nodules
Multigene Expression Assay for Predicting Recurrence in Colon Cancer
Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis
Necitumumab (Portrazza)
Nerve Fiber Density Testing
Non-Contact Ultrasound Treatment for Wounds
Non Pharmacologic Treatment of Rosacea
Nutrient/Nutritional Panel Testing
Observation Room Services
Occipital Nerve Stimulation
Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy
Paraspinal Surface Electromyography (SEMG)
PathFinder TG Molecular Testing
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
Peripheral Arterial Tonometry (PAT)
Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
Pharmacogenetic Testing for Drug Metabolism
Polysomnography for Non‒Respiratory Sleep Disorders
Private Duty Nursing Services
Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia
Proteogenomic Testing for Patients with Cancer (GPS CancerTM Test)
Proteomic Testing for Targeted Therapy in Non-Small Cell Lung Cancer
Quantitative Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers
Serum Biomarker Human Epididymis Protein 4 (HE4)
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus
Signal Averaged ECG
Skilled Nursing Facility Care
Skilled Nursing Services
Sleep Apnea: Diagnosis and Medical Management
ST2 Assay for Chronic Heart Failure
Talimogene Laherparepvec (ImlygicTM)
Testing Serum Vitamin D Levels
Testosterone Pellet Implantation for Androgen Deficiency
Tumor-Treatment Fields Therapy for Glioblastoma
Ultraviolet Light Therapy in the Home Setting(UVB)
Urinary Tumor Markers for Bladder Cancer
Vectra® DA Blood Test for Rheumatoid Arthritis
Vestibular Function Testing
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders

Mental Health/Chemical Dependency   top

Adaptive Behavioral Treatment for Autism Spectrum Disorders
Biofeedback as a Treatment of Pain
Buprenorphine Implant for Treatment of Opioid Dependence
Quantitative Electroencephalography as a Diagnostic Aid for Attention Deficit/Hyperactivity Disorder
Residential Treatment

OB-GYN Reproduction   top

Acute and Maintenance Tocolysis
Chromosomal Microarray Analysis for the Evaluation of Pregnancy Loss
Fetal RHD Genotyping Using Cell-Free Fetal DNA
Hormone Pellet Implantation for Treatment of Menopause Related Symptoms
Infertility, Diagnosis and Treatment
Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids
Noninvasive Fetal RHD Genotyping Using Cell-Free Fetal DNA
Noninvasive Prenatal Testing for Fetal Aneuploidies Using Cell-Free Fetal DNA
Ovarian and Internal Iliac Vein Embolization
Progesterone Therapy in High Risk Pregnancies
Proteomics-based Testing Related to Ovarian Cancer
Salivary Hormone Tests

Radiology   top

Accelerated Partial Breast Radiotherapy (Breast Brachytherapy)
Beta Amyloid Imaging With Positron Emission Tomography for Alzheimer's Disease
Bone Mineral Density Studies
Brachytherapy, Intracavitary Balloon Catheter for Brain Cancer
Brachytherapy Treatment of Breast Cancer
Capsule Endoscopy, Wireless
Charged Particle Radiotherapy
Computed Tomography to Detect Coronary Artery Calcification
Computer-Aided Evaluation of Malignancy with MRI of the Breast
CT Perfusion Imaging of the Brain
Dopamine Transporter Imaging with Single Photon Emission Computed Tomography
Electronic Brachytherapy for Nonmelanoma Skin Cancer
Intensity Modulated Radiation Therapy (IMRT) for Sarcoma of the Extremities
Intensity Modulated Radiation Therapy (IMRT) for Tumors of the Central Nervous System
Intensity Modulated Radiation Therapy (IMRT) of Abdomen and Pelvis
Intensity Modulated Radiation Therapy (IMRT) of Head and Neck
Intensity Modulated Radiation Therapy (IMRT) of the Chest
Intensity Modulated Radiation Therapy (IMRT) of the Prostate
Magnetic Resonance Spectroscopy
Magnetoencephalography/Magnetic Source Imaging
Monoclonal Antibody Imaging for Prostate Cancer
MRI-Guided Focused Ultrasound (MRgFUS)
Myocardial Sympathetic Innervation Imaging
Noninvasive Fractional Flow Reserve Using Computed Tomography Angiography
Positional Magnetic Resonance Imaging (MRI)
Prostate Cancer Treatment with Brachytherapy
Screening for Vertebral Fracture with Dual X-ray Absorptiometry (DXA)
Vertebroplasty, Kyphoplasty, and Sacroplasty Percutaneous

Surgery   top

Abdominoplasty, Panniculectomy and Lipectomy
Ablation Procedures for Peripheral Neuromas
Allogeneic Hematopoietic Transplant for Genetic Diseases and Acquired Anemia
Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
Amniotic Membrane and Amniotic Fluid Injections
Artificial Intervertebral Disc
Autografts and Allografts in the Treatment of Focal Articular Cartilage
Autologous Chondrocyte Implantation
Automated Percutaneous and Endoscopic Discectomy
Axial Lumbosacral Interbody Fusion
Bioengineered Skin and Tissue
Bone Morphogenetic Protein
Breast Surgeries
Bronchial Thermoplasty
Cardiac (Heart) Transplantation
Carotid Artery Angioplasty / Stenting (CAS)
Catheter Ablation as a Treatment for Atrial Fibrillation
Chromoendoscopy as an Adjunct to Colonoscopy
Cochlear Implant
Composite Allotransplantation of the Hand and Face
Computer Assisted Surgical Navigational Orthopedic Procedures
Confocal Laser Endomicroscopy
Congenital Heart Defect, Repair Devices
Cord Blood as a Source of Stem Cells
Cosmetic and Reconstructive Surgery
Cryosurgical Ablation of Primary or Metastatic Liver Tumors
Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)
Dental Inpatient and Outpatient Services
Dental, Reconstructive Services
Electrical Bone Growth Stimulation
Endobronchial Valves
Endothelial Keratoplasty
Endovascular Procedures for Intracranial Arterial Disease
Endovascular Therapies for Extracranial Vertebral Artery Disease
Epiretinal Radiation Therapy for Age-Related Macular Degeneration
Extracorporeal Shock Wave Treatment for Musculoskeletal Conditions and Wound Healing
Facet Joint Denervation
Gastric Electrical Stimulation
Gastroesophageal Reflux Disease, Transendoscopic Therapies
Gender Confirmation Surgery and Hormone Therapy
Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins during Breast-Conserving Surgery
Heart-Lung Transplantation
Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
Hematopoietic Cell Transplantation for CLL and SLL
Hematopoietic Cell Transplantation for Hodgkin Lymphoma
Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
Hematopoietic Stem-Cell Transplant for Non Hodgkin's Lymphomas
Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia
Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia
Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases
Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma
Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer
Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults
Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis
Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood
Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia
Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors
Hyperthermic Intraperitoneal Chemotherapy
Intraoperative Neurophysiologic Monitoring (sensory-evoked potentials, motor-evoked potentials, EEG monitoring)
Islet Cell Transplantation
Image-Guided Minimally Invasive Decompression (IG-MLD) for Spinal Stenosis
Implantable Bone Conduction Hearing Aids
Implantable Cardioverter Defibrillator
Implantation of Intrastromal Corneal Ring Segments
Intrauterine Ablation or Resection of the Endometrium
Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence
Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
Interspinous Fixation (Fusion) Devices
Intravitreal Implant
Laser Treatment of Onychomycosis
Laser Treatment of Port Wine Stains
Liver Transplant
Lumbar Spine Fusion Surgery
Lung and Lobar Lung Transplantation
Lung Volume Reduction Surgery
Lysis of Epidural Adhesions
Magnetic Resonance Imaging (MRI) Targeted Biopsy of the Prostate
Meniscal Allografts and Other Meniscal Implants
Microwave Tumor Ablation
Mohs' Micrographic Surgery
MRI-Guided Laser-induced Thermotherapy for Neurological Indications
Navigated Transcranial Magnetic Stimulation (nTMS)
Orthodontics for Pediatric Patients
Orthognathic Surgery
Pancreas Transplant
Patient-Specific Cutting Guides and Custom Knee Implants
Percutaneous Electrical Nerve Stimulation (PENS) or Neuromodulation Therapy
Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty
Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention
Percutaneous Tibial Nerve Stimulation for Voiding Dysfunction
Plugs for Fistula Repair
Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Prostatic Urethral Lift
Pulmonary Artery Balloon Angioplasty, Percutaneous Transluminal Approach
Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
Radiofrequency Ablation of the Renal Nerves as a Treatment of Hypertension
Radiosurgery, Stereotactic Approach
Reconstructive Eyelid Surgery and Brow Lift
Refractive Surgery
Renal (Kidney) Transplantation
Retinal Prosthesis
Sacral Nerve Neuromodulation/Stimulation for Pelvic Floor Dysfunction
Sacroiliac Joint Fusion
Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
Semi Implantable and Fully Implantable Middle Ear Hearing Aid
Small Bowel, Small Bowel with Liver, or Multivisceral Transplant
Somatostatin Analogs
Spinal Cord Stimulation
Subtalar Arthroereisis
Surgery for Femoroacetabular Impingement
Surgery for Groin Pain in Athletes
Surgery for Morbid Obesity
Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome
Surgical Deactivation of Headache Trigger Sites
Surgical Management of Transcatheter Heart Valves
Surgical Treatment of Chest Wall Deformities (Congenital or Acquired)
Surgical Treatment of Sinus Disease
Surgical Ventricular Restoration
Temporomandibular Joint Dysfunction (TMJD)
TENS (Transcutaneous Electrical Nerve Stimulator)
Tinnitus Treatment
Topical Negative Pressure Therapy for Wounds
Total Facet Arthroplasty
Transanal Endoscopic Microsurgery
Transanal Radiofrequence Treatment of Fecal Incontinence
Transcatheter Closure of Ventricular Septal Defects
Ultrasound Accelerated Fracture Healing Device
Vagus Nerve Stimulation
Varicose Veins, Treatment for
Vesicoureteral Reflux, Treatment with Periureteral Bulking Agents
Viscocanalostomy and Canaloplasty

Therapy   top

Cellular Immunotherapy for Prostate Cancer
Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation
Dermatologic Applications of Photodynamic Therapy
Light Therapy for Dermatologic Conditions
Microprocessor-Controlled Prostheses for the Lower Limb
Myoelectric Prosthetic Components for the Upper Limb
Neural Therapy
Rehabilitative Therapies
Radioembolization for Primary and Metastatic Tumors of the Liver
Stem-cell Therapy for Peripheral Arterial Disease

Other Treatments   top

Chiropractic Services
Computerized Corneal Topography
Dry Needling of Myofascial Trigger Points
Focal Treaments for Prostate Cancer
Functional Capacity Assessment and Work Hardening
Fundus Photography
Optical Coherence Tomography (OCT) Anterior Segment of the Eye
Orthopedic Applications of Stem Cell Therapy
Romiplostim (NPlate)
Sensory Integration Therapy
Sphenopalatine Ganglion Block for Headache
Spinal Manipulation under Anesthesia
Vertebral Axial Decompression (VAX-D)


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