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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

Herceptin
Infliximab
Intravitreal Drug Delivery System for Ganciclovir
Respiratory Syncytial Virus Prophylaxis
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
Hospice Care
Implantable Infusion Pumps
Nebulizers and Humidifiers
Photodynamic Therapy for Treatment of Specific Cancers
Photodynamic Therapy Ocular
Phototherapy for Neonatal Jaundice in the Home
Prothrombin Time Monitoring In The Home
Sentinel Node Biopsy
Therapeutic Apheresis
Tilt Table for Syncope
Ultraviolet Light Box Therapy in the Home (UVB)
Water Induced Thermotherapy for Treatment of Benign Prostatic Hypertrophy

Cardiac Rehabilitation
Donor Leukocyte Infusion
ECMO Extracorporeal Membrane Oxygenation
Evoked Otoacoustic Emissions
Human Antihemophilic Factor (Factor VIII Human AHF)
Human Papillomavirus (HPV) Vaccine
Intrahepatic Arterial Chemotherapy
Pachymetry
Pharmacogenetic Testing for Warfarin Dose
Photodynamic Therapy for the Treatment of Actinic Keratoses
Radiofrequency Ablation of Osteoid Osteomas and Bone Metastases
Rapid Flu Tests in the Outpatient Setting
Thermotherapy, Transpupillary
Total Body Photography
Transcoronary Ablation of Septal Hypertrophy (TASH)

Mental Health/Chemical Dependency

EMDR (Eye Movement Desensitization and Reprocessing)

OB-GYN Reproduction

External Cephalic Version
Hysteroscopic Tubal Occlusion for Permanent Sterilization
Intrauterine Ablation or Resection of the Endometrium
Twin-Twin Transfusion Syndrome, Treatment
Maternal and Fetal Diagnostics
Uterine Artery Occlusion in the Treatment of Uterine Fibroids

Breast Lesion Localization, Stereotactic Approach
Charged Particle Radiotherapy
Intraoperative Radiation Therapy
Transcranial Doppler Ultrasound
Transrectal Ultrasound
Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia
Transurethral Radiofrequency Needle Ablation of the Prostate
Videofluoroscopic Evaluation of Velopharyngeal Closure for Speech Disorders

Auditory Brain Stem Implant
Biventricular Pacemakers for CHF
Balloon Dilatation of the Prostatic Urethra
Balloon Valvuloplasty, Percutaneous
Bone Allotransplantation
Chronic Pulmonary Thromboendarterectomy
Cingulotomy, Stereotactic Approach
Colon Cancer Screening
Cryosurgery Ablation of the Prostate
Deep Brain Stimulation
Dental, Inpatient and Outpatient Services
Drug Eluting Coronary Stent
Electrocorticography
Electrophrenic Pacemaker
Endoscopic Ultrasonography (EUS)
Free Vascularized Fibular Graft for Avascular Necrosis
Ilizarov Bone Lengthening Procedure
Infrared Coagulation
Intraoperative Transesophageal Echocardiography
Lithotripsy, Extracorporeal, for Gallstones
Maze Procedure for Atrial Fibrillation or Flutter
Pallidotomy for Parkinson Disease
Partial Left Ventriculectomy
Patient Controlled Analgesics
Secondary Physician Attendance at Delivery
Selective Posterior Rhizotomy for Spasticity in Cerebral Palsy
Sentinel Node Biopsy
Tissue Pressure Measurement
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Transmyocardial Revascularization (TMR)
Ventricular Assist Devices and Total Artificial Hearts

None

Other Treatments

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