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Policy Index


  
     
 

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0-9 | A | B | C | D | E | F | G | H | I | J | K | L | M
N | O | P | Q | R | S | T | U | V | W | X | Y | Z


0-9
  2009 11/1 Update to the Medical Policy Manual (What's New)
  2009 10/1 Update to the Medical Policy Manual (What's New)
  2009 9/1 Update to the Medical Policy Manual (What's New)
  2009 8/1 Update to the Medical Policy Manual (What's New)
  2009 7/1 Update to the Medical Policy Manual (What's New)
  2009 6/1 Update to the Medical Policy Manual (What's New)
  2009 5/1 Update to the Medical Policy Manual (What's New)
  2009 4/1 Update to the Medical Policy Manual (What's New)
  2009 3/1 Update to the Medical Policy Manual (What's New)
  2009 2/1 Update to the Medical Policy Manual (What's New)
  2009 1/1 Update to the Medical Policy Manual (What's New)
  2008 12/1 Update to the Medical Policy Manual (What's New)
  2008 11/1 Update to the Medical Policy Manual (What's New)
  2008 10/1 Update to the Medical Policy Manual (What's New)
  2008 9/1 Update to the Medical Policy Manual (What's New)
  2008 8/1 Update to the Medical Policy Manual (What's New)
  2008 7/1 Update to the Medical Policy Manual (What's New)
  2008 6/1 Update to the Medical Policy Manual (What's New)
  2008 5/1 Update to the Medical Policy Manual (What's New)
  2008 4/1 Update to the Medical Policy Manual (What's New)
  2008 3/1 Update to the Medical Policy Manual (What's New)
  2008 2/1 Update to the Medical Policy Manual (What's New)
  2008 1/1 Update to the Medical Policy Manual (What's New)
  2007 12/1 Update to the Medical Policy Manual (What's New)
  2007 11/1 Update to the Medical Policy Manual (What's New)
  2007 10/1 Update to the Medical Policy Manual (What's New)
  2007 9/1 Update to the Medical Policy Manual (What's New)
  2007 8/1 Update to the Medical Policy Manual (What's New)
  2007 7/1 Update to the Medical Policy Manual (What's New)
  2007 6/1 Update to the Medical Policy Manual (What's New)
  2007 5/1 Update to the Medical Policy Manual (What's New)
  2007 4/1 Update to the Medical Policy Manual (What's New)
  2007 3/1 Update to the Medical Policy Manual (What's New)
  2007 2/1 Update to the Medical Policy Manual (What's New)
  2007 1/1 Update to the Medical Policy Manual (What's New)
 
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A
  Abdominoplasty/Panniculectomy (III-SUR.13) (UM Policies)
 Usage Notice
  Actigraphy (Coverage Policies)

Usage Notice

  Adult Gender Reassignment Surgery (III-SUR.20) (UM Policies) 
 Usage Notice
  Adult Low Back Pain (ICSI Guidelines) 
  Ambulatory Blood Pressure Monitoring (Coverage Policies)

Usage Notice

  Amino Acid-Based Elemental Oral Formulas (Coverage Policies)

Usage Notice

  Antigen Leukocyte Cellular Antibody Test (ALCAT Test) for Food & Chemical Allergies (Coverage Policies)

Usage Notice

  Antithrombotic Therapy Supplement (ICSI Guidelines) 
  Artificial Intervertebral Disc Replacement (Coverage Policies)
Usage Notice
  Assessment and Management of Acute Pain (ICSI Guidelines) 
  Assessment and Management of Chronic Pain (ICSI Guidelines)
  Atrial Fibrillation (ICSI Guidelines) 
  Auditory Integration Training (AIT) (Coverage Policies) 
 Usage Notice
Autologous Blood-Derived Products for Chronic Non-Healing Wounds (Coverage Policies)
 Usage Notice
  Autologous Chondrocyte Transplantation (ACT) for the Knee (Coverage Policies) 
 Usage Notice
  Automated, Non-Invasive Nerve Conduction Testing: NC-Stat® (Coverage Policies) Usage Notice
 
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B
  Bevacizumab (Avastin®) (Coverage Policies)

Usage Notice

  Biventricular Pacing (Cardiac Resynchronization Therapy) for Heart Failure (Coverage Policies)
 Usage Notice
  Bladder Cancer Screening, Diagnosis and Monitoring Using Ancillary Urinary Tests (Coverage Policies)

Usage Notice

  Blood Coagulation Home Testing Devices (Coverage Policies)
Usage Notice
  Bone Anchored Hearing Aid (BAHA) (Coverage Policies)
Usage Notice
  Bone Growth Stimulators (III-DEV.07) (UM Policies) 
 Usage Notice
  Bone Marrow or Stem Cell (Peripheral or Umbilical Cord Blood) Transplantation (III-TRA.01) (UM Policies) 
 Usage Notice
  Botulinum Toxin (BTX) Treatment for Non-Cosmetic Indications (Coverage Policies)  
 Usage Notice
Breast Ductal Lavage (Coverage Policies)
 Usage Notice
  Breast Implant Removal, Revision, or Reimplantation (III-SUR.11) (UM Policies) 
 Usage Notice
  Breast Magnetic Resonance Imaging (MRI) (Coverage Policies)

Usage Notice

  Breast Pumps (Coverage Policies) 
 Usage Notice
 
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C
  Cancer Clinical Trial Participation, Coverage of Routine Supplies and Services (III-MED.04) (UM Policies) 
 Usage Notice
Cervicography (Coverage Policies)
 Usage Notice
  Chelation Therapy (Coverage Policies) 
 Usage Notice
  Chemiluminescent Testing (ViziLite®) for Oral Cancer Screening (Coverage Policies)

Usage Notice

  Chemoembolization for Hepatic Tumors (Coverage Policies) 
 Usage Notice
  Cleft Lip and Palate - Tooth Extractions and Dental Implants (Coverage Policies)
 Usage Notice
  Colorectal Cancer Screening (ICSI Guidelines) 
  Computed Tomography (CT) Coronary Angiography for Detection or Assessment of Coronary Artery Disease (CAD) (III-DIA.03) (UM Policies)  Usage Notice
  Computed Tomography (CT) for Coronary Artery Calcium Scoring (CACS) (III-DIA.02) (UM Policies)   Usage Notice
  Computerized Dynamic Posturography (Coverage Policies)

Usage Notice

  Continuous Glucose Monitoring (Coverage Policies) 
 Usage Notice
 

Coverage Policies Background Information, June 2009 (Instructions) 

  Cranial Electrotherapy Stimulation (CES) (Coverage Policies)
 Usage Notice
  Cytochrome P450 (CYP450) Genotyping (Coverage Policies)

Usage Notice

  Cytotoxic Testing for Allergy Diagnosis (Coverage Policies) 
 Usage Notice
 
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D
  Darbepoetin alfa (Aranesp®) and Epoetin alfa (Epogen®, Procrit®) (Coverage Policies)

Usage Notice

  Deep Brain Stimulation (Coverage Policies) 
 Usage Notice
  Diagnosis and Initial Treatment of Ischemic Stroke (ICSI Guidelines) 
  Diagnosis and Management of Asthma (ICSI Guidelines) 
  Diagnosis and Management of Attention Deficit Hyperactivity Disorder in Primary Care for School-Age Children and Adolescents (ICSI Guidelines) 
  Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) (ICSI Guidelines)
  Diagnosis and Management of Type 2 Diabetes Mellitus in Adults (ICSI Guidelines)
  Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS) (ICSI Guidelines) 
  Diagnosis and Treatment of Headache (ICSI Guidelines) 
  Diagnosis and Treatment of Obstructive Sleep Apnea in Adults (ICSI Guidelines) 
  Diagnosis and Treatment of Osteoporosis (ICSI Guidelines) 
  Diagnosis and Treatment of Otitis Media in Children (ICSI Guidelines) 
  Diagnosis and Treatment of Respiratory Illness in Children and Adults (ICSI Guidelines)
  Diagnosis of Breast Disease (ICSI Guidelines) 
  Dietitian Consultations (Coverage Policies)
Usage Notice
  Dynamic Stabilization Devices for Chronic Back Pain (Coverage Policies)

Usage Notice

 
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E
  Electrical or Electromagnetic Stimulation for Healing of Chronic Wounds (Coverage Policies)
 Usage Notice
  Electromagnetic Navigation Bronchoscopy Systems (Coverage Policies)

Usage Notice

  Electrothermal Therapy for Treatment of Joint Instability or Laxity of Ligaments (Coverage Policies)
 Usage Notice
  Endoscopic Balloon Sinuplasty for Treatment of Chronic Sinusitis (Coverage Policies)

Usage Notice

  Endoscopic Procedures for Treatment of Gastroesophageal Reflux Disease (GERD) (Coverage Policies) 
 Usage Notice
  Endovenous Radiofrequency or Laser Ablation for Varicose Veins and Chronic Venous Insufficiency (III-SUR.26) (UM Policies)   Usage Notice
  Epidural Lysis of Adhesions (Coverage Policies) 
 Usage Notice
 

Essure® Micro-Insert System (Coverage Policies) 

 Usage Notice

 

 

E-visits (Coverage Policies)

Usage Notice

  Exhaled Breath Tests for Asthma and Other Inflammatory Pulmonary Conditions: Exhaled Nitric Oxide Breath Test and Exhaled Breath Condensate pH Measurement (Coverage Policies)

Usage Notice

  Extended Hours Home Care (Skilled Nursing Services) for Patients with Medically Complex or Medically Fragile Conditions (III-HOM.01) (UM Policies)  Usage Notice
  External Counterpulsation (ECP) (Coverage Policies) 
 Usage Notice
  Extracorporeal Magnetic Stimulation (EMS) for the Treatment of Urinary Incontinence (Coverage Policies)
Usage Notice
  Extracorporeal Photopheresis (Photochemotherapy) (Coverage Policies)

Usage Notice

  Extracorporeal Shock Wave Treatment for Musculoskeletal Indications (Coverage Policies) 
 Usage Notice
  Eye Movement Desensitization and Reprocessing (Coverage Policies) 
 Usage Notice
 
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F
Fast ForWordTM Speech Therapy Software (Coverage Policies)
 Usage Notice
  Fecal/Stool DNA (sDNA) Testing for Colorectal Cancer Screening and Monitoring (Coverage Policies)
 Usage Notice
  Female Breast Reduction Surgery – Reduction Mammoplasty (III-SUR.27) (UM Policies)

Usage Notice

  Fetal Fibronectin Testing (Coverage Policies) 
 Usage Notice
  Foreword to the Medical Policy Manual, December 2008 (Instructions) 
  Functional Magnetic Resonance Imaging (fMRI) (Coverage Policies)

Usage Notice

 
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G
  Gastric Electrical Stimulation (Coverage Policies) 
 Usage Notice
  Gastrointestinal Monitoring System (SmartPill) (Coverage Policies)

Usage Notice

  Gastrointestinal Surgery for Morbid Obesity (III-SUR.30) (UM Policies) 
 Usage Notice
  Gene Expression Profiling for Prediction of Breast Cancer Recurrence (Coverage Policies)

Usage Notice

  Genetic Assay for Warfarin Response (Coverage Policies)

Usage Notice

  Genetic Testing (Coverage Policies)

Usage Notice

  Genetic Testing for Large Rearrangements in BRCA 1 and BRCA 2 Genes (BRACAnalysis® Rearrangement Test [BART]) (UM Policies)

Usage Notice

  Gynecomastia Surgery (Coverage Policies)
 Usage Notice
 
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H
  Hair Analysis in the Clinical Setting (Coverage Policies)

Usage Notice

  Health Research Institute/Pfeiffer Treatment Center Protocols (Coverage Policies)
 Usage Notice

Heart Failure in Adults (ICSI Guidelines) 

  Heart Transplantation (Adult and Pediatric) (III-TRA.12) (UM Policies) 
 Usage Notice
  Heart/Lung Transplantation (III-TRA.08) (UM Policies) 
 Usage Notice
  Helical Computed Tomography (CT) for Lung Cancer Screening (Coverage Policies) 
 Usage Notice
  Herpes Zoster Vaccine (Zostavax®) (Coverage Policies)
Usage Notice
  High Intensity Focused Ultrasound (HIFU) Therapy for Uterine Fibroids (Coverage Policies)
 Usage Notice
  Hip Resurfacing Arthroplasty (Coverage Policies)

Usage Notice

  Home Health Care (III-HOM.02) (UM Policies)

Usage Notice

  Home Sleep Studies for Diagnosis of Obstructive Sleep Apnea / Hypopnea Syndrome (OSAHS) (Coverage Policies)   Usage Notice
Home Use of Bilevel Positive Airway Pressure (Bilevel PAP) (Coverage Policies)

 Usage Notice

Home Use of Continuous Positive Airway Pressure (CPAP) (Coverage Policies)

 Usage Notice

  Human Cell Derived Skin Substitutes for Chronic Wound Healing (Coverage Policies) 
 Usage Notice
  Human Papillomavirus (HPV) Vaccine (Gardasil®) (Coverage Policies)
Usage Notice
  Humanitarian Device Exemptions (Coverage Policies)

Usage Notice

  Hyperbaric Oxygen Chamber Therapy (HBOT) (Coverage Policies)
 Usage Notice
  Hypertension Diagnosis and Treatment (ICSI Guidelines) 
 
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I
  Immune Globulin Therapy (Intravenous and Subcutaneous) (Coverage Policies)

Usage Notice

  Immunizations (ICSI Guidelines) 
  Implanted Spinal Cord Stimulation for Chronic Intractable Pain (Coverage Policies)

Usage Notice

  Inactivated Policies (Coverage Policies)
  Infliximab (Remicade®) (Coverage Policies)

Usage Notice

  Initial Management of Abnormal Cervical Cytology (Pap Smear) and HPV Testing (ICSI Guidelines)
  Injury to a Pierced Body Part - Indications for Repair (Coverage Policies) 
 Usage Notice
  Inpatient (Hospital) Level of Care (III-INP.01) (UM Policies) 
 Usage Notice
  Insulin Potentiation Therapy (Coverage Policies)

Usage Notice

  Interferential Current Stimulation (Coverage Policies) 

 Usage Notice

  Intestinal Transplantation (III-TRA.13) (UM Policies)

Usage Notice

  Intra-articular Hyaluronan Therapy (Viscosupplementation) (Coverage Policies)

Usage Notice

  Intracellular Nutrient Analysis: MicroNutrient Testing; Intracellular Mineral Electrolyte Analysis (Coverage Policies)

Usage Notice

  Intracoronary Autologous Cell Transplantation for Cardiac Disease (Coverage Policies)

Usage Notice

  Intradiscal Electrothermal Therapy (IDET) (Coverage Policies) 
 Usage Notice
  Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitor Antibody Treatment for Neovascular Ocular Indications (Coverage Policies)

Usage Notice

  In Vitro Chemosensitivity and Chemoresistance Assays (Coverage Policies)
 Usage Notice
  Iontophoresis for Hyperhidrosis (Coverage Policies) 
 Usage Notice
 
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K
  Keratoprosthesis for Corneal Opacity (Coverage Policies)
Usage Notice
  Kidney Transplantation (III-TRA.03) (UM Policies) 
 Usage Notice
  KRAS Mutation Analysis for Predicting Response to Drug Therapy (Coverage Policies)

Usage Notice

 
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L
  Laser Surgery for Corneal Pathology (Coverage Policies)

Usage Notice

  Laser Therapy for Smoking Cessation (Coverage Policies)

Usage Notice

Laser Treatments for Neovascularization Associated with Macular Degeneration (Coverage Policies)

 Usage Notice

  Leuprolide Acetate - Depot and Implant (Lupron Depot®, Lupron Depot-Ped®, Eligard®, Viadur®) (Coverage Policies)

Usage Notice

  Light Treatment for Dermatologic Conditions (Coverage Policies)
Usage Notice
  Lipid Management in Adults (ICSI Guidelines) 
  Lipoprotein-associated Phospholipase A2 (Lp-PLA2) Immunoassay for Prediction of Risk for Coronary Heart Disease or Ischemic Stroke (PLAC® Test) (Coverage Policies)

Usage Notice

  Liver Transplantation (III-TRA.02) (UM Policies) 
 Usage Notice
  Lovaas Therapy/Intensive Early Intervention Behavior Therapy Services (IEIBTS)/Intensive Behavior Intervention (IBI) (Coverage Policies)  Usage Notice
  LTX 3000™ (Spinal Unloading Device for Treatment of Low Back Pain) (Coverage Policies) 
 Usage Notice
  Lung Transplantation (Single or Double) (III-TRA.11) (UM Policies) 
 Usage Notice
 
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M
  Magnetic Resonance (MR) Coronary Angiography (Coverage Policies)
 Usage Notice
  Magnetic Resonance Spectroscopy (MRS) (Coverage Policies)

Usage Notice

  Magnetoencephalography and Magnetic Source Imaging (Coverage Policies)
 Usage Notice
  Major Depression in Adults in Primary Care (ICSI Guidelines) 
  Management of Benign Uterine Conditions (Medica Clinical Guidelines)
 Usage Notice
  Management of Labor (ICSI Guidelines)
  Mechanized Spinal Decompression Traction Tables for Low Back Pain (Coverage Policies) 
 Usage Notice
  Medicaid Home Health Aide (III-HOM.04) (UM Policies)

Usage Notice

  Medical Technology Assessment Submission Form (Instructions)
MeniettTM Portable Pulse Generator for Treatment of Meniere's Disease (Coverage Policies)
 Usage Notice
  Menopause and Hormone Therapy (HT): Collaborative Decision-Making and Management (ICSI Guidelines) 
  Microprocessor Controlled Knee Prostheses (III-DEV.17) (UM Policies)

Usage Notice

  Minimally Invasive Spinal Fusion Surgery Using Axial Lumbar Interbody Fusion (AxiaLIF) or eXtreme Lateral Interbody Fusion (XLIF) (Coverage Policies)

Usage Notice

 
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N
  Nasal Reconstructive Surgery - Rhinoplasty Procedure With or Without Septoplasty (III-SUR.04) (UM Policies) 
 Usage Notice
  Nebulized Intranasal Antibiotics/Antifungals (Coverage Policies) 
 Usage Notice
  Neutralizing Antibody Tests in the Management of Multiple Sclerosis (Coverage Policies)

Usage Notice

  Noncontact, Low-frequency Ultrasound Therapy for Healing of Chronic Wounds (MIST Therapy System™) (Coverage Policies)

Usage Notice

  Noncontact Normothermic Wound Therapy (Coverage Policies) 
 Usage Notice
  Non-Invasive Measurement of Left Ventricular End Diastolic Pressure (Coverage Policies)
 Usage Notice
  Nuclear Magnetic Resonance-determined Lipoprotein Subclass Test (LipoProfile®) (Coverage Policies)

Usage Notice

 
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O
  OncoSorb® Therapy (UltraPheresis) for Non-Hematologic Cancer (Coverage Policies)

Usage Notice

  Orthognathic Surgery (Coverage Policies) 
 Usage Notice
  Orthotrac™ Pneumatic Vest (Spinal Unloading Device for Low Back Pain) (Coverage Policies) 
 Usage Notice
  Otoplasty (Coverage Policies) 
 Usage Notice
  Outpatient Enteral Nutrition Therapy (III-MED.03) (UM Policies) 
 Usage Notice
 
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P
  Palatal Implants for Obstructive Sleep Apnea (Coverage Policies) 
 Usage Notice
  Palliative Care (ICSI Guidelines)
  Pancreas Transplantation (Pancreas Alone) (III-TRA.04) (UM Policies) 
 Usage Notice
  Pancreas-Kidney (SPK, PAK) Transplantation (III-TRA.05) (UM Policies) 
 Usage Notice
  Pelvic Vein Embolization (Coverage Policies) 
 Usage Notice
  Percutaneous Disc Decompression Procedures (Manual, Automated or Laser Discectomy; and Nucleoplasty®) (Coverage Policies)   Usage Notice
  Percutaneous Neuromodulation Therapy (PNT) for the Treatment of Pain (Coverage Policies)

Usage Notice

  Percutaneous Vertebroplasty and Kyphoplasty (Coverage Policies) 
 Usage Notice
  Personal Care Assistant (PCA) (III-HOM.03) (UM Policies) 
 Usage Notice
  Positron Emission Tomography (PET) Scan for Oncology, Neurology, and Cardiology Applications (Coverage Policies)   Usage Notice
  Preoperative Evaluation (ICSI Guidelines) 
  Preventive Services for Children and Adolescents Enrolled in Medica Choice CareSM and Medica MinnesotaCare (Medica Clinical Guidelines)  Usage Notice
  Prevention and Management of Obesity (Mature Adolescents and Adults) (ICSI Guidelines) 
  Preventive Services for Adults (ICSI Guidelines) 
  Preventive Services for Children and Adolescents (ICSI Guidelines) 
  Primary Prevention of Chronic Disease Risk Factors (ICSI Guidelines)
  Prolotherapy (Coverage Policies) 
 Usage Notice
 
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Q
Quantitative Sensory Tests (Coverage Policies)
Usage Notice
 
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R
Radiofrequency Bladder Neck Suspension for Treatment of Stress Incontinence in Women (SURx®) (Coverage Policies)

 Usage Notice

  Radiofrequency Volumetric Tissue Reduction (RFVTR) for Breathing Disorders (Coverage Policies) 
 Usage Notice
  Real-Time Continuous Glucose Monitoring Systems (III-DEV.16) (UM Policies)

Usage Notice

  Recombinant Coagulation Factor VIIa (NovoSeven®) Therapy (III-DRU.05) (UM Policies)

Usage Notice

  Respiratory Syncytial Virus (RSV) Prophylaxis (Coverage Policies)
 Usage Notice
  Rituxamab (Rituxan®) (Coverage Policies)

Usage Notice

  Routine Prenatal Care (ICSI Guidelines) 
 
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S
  Sacral Nerve Stimulation (Coverage Policies) 
 Usage Notice
  Salivary Estriol Test for Preterm Labor (Coverage Policies) 
 Usage Notice
  Salivary Hormone Tests (Coverage Policies)

Usage Notice

  Scanning Laser Technologies for Retina and Optic Nerve Imaging (Coverage Policies)

Usage Notice

  Scar Revision (Coverage Policies)

Usage Notice

  Sclerotherapy for Varicose Veins of the Leg (III-SUR.19) (UM Policies) 
 Usage Notice
  Sensory Integration Therapy (Coverage Policies) 
 Usage Notice
Serial Dilution Endpoint Titration for Diagnosis and Treatment of Airborne Allergy (Coverage Policies)
 Usage Notice
  Serological Testing for Diagnosis and Management of Inflammatory Bowel Disease (pANCA/ASCA) (Coverage Policies)

Usage Notice

  Skilled Nursing Facility (III-INP.03) (UM Policies) 
 Usage Notice
  Speech Therapy (Coverage Policies) 
 Usage Notice
  Stable Coronary Artery Disease (ICSI Guidelines) 
  Subdermal Contraceptive Implant (Implanon™) (Coverage Policies)
Usage Notice
  Sublingual, Oral or Intranasal Allergenic Extracts for Allergy Diagnosis and/or Immunotherapy (Coverage Policies)  Usage Notice
  Surgical and Minimally Invasive Treatments for Benign Prostatic Hypertrophy/Hyperplasia (BPH) (Coverage Policies)   Usage Notice
  Surgical Interruption of Pelvic Nerve Pathways for Treatment of Pelvic Pain (e.g. Presacral Neurectomy and Uterosacral Nerve Ablation) (Coverage Policies)  Usage Notice
 
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T
  Telehealth Services (Coverage Policies)

Usage Notice

  Therapeutic Apheresis (TA) - Plasmapheresis, Plasma Exchange (Coverage Policies) 
 Usage Notice
  Thermography (Coverage Policies)
 Usage Notice
  Thoracic Electrical Bioimpedance (TEB) for Cardiac Output Measurement (Coverage Policies)
Usage Notice
  Thoracic Sympathectomy for Hyperhidrosis (III-SUR.25) (UM Policies) 
 Usage Notice
  Tidal Knee Lavage for Osteoarthritis (Coverage Policies) 
 Usage Notice
  Topographic Genotyping (PathFinderTG®) for Diagnosis of Cancer (Coverage Policies)

Usage Notice

  Transcatheter Closure of Septal Defect or Patent Ductus Arteriosus (Coverage Policies) 
 Usage Notice
  Transcranial Magnectic Stimulation (TMS) Therapy  (Coverage Policies) 
 Usage Notice
  Transilluminated Powered Phlebectomy (TIPP) for Varicose Veins of the Legs (Coverage Policies)

Usage Notice

  Transmyocardial Revascularization (Coverage Policies) 
 Usage Notice
  Transobturator Tape (TOT) Sling Treatment for Female Stress Urinary Incontinence (Coverage Policies)

Usage Notice

  Trastuzumab (Herceptin®) (Coverage Policies)

Usage Notice

  Trigger Point Dry Needling (Coverage Policies)

Usage Notice

 
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U
  Upper Eyelid Reconstructive Blepharoplasty (III-SUR.29) (UM Policies) 
 Usage Notice
  Upright Magnetic Resonance Imaging (MRI) (Standing/Seated/Weight Bearing/Vertical/Positional MRI) (Coverage Policies)

Usage Notice

  Urethral Bulking Agents for Urinary Incontinence (Coverage Policies) 
 Usage Notice
  Uvulopalatopharyngoplasty (UPPP or U3P) for Obstructive Sleep Apnea/Hypopnea Syndrome (III-SUR.08) (UM Policies) 
 Usage Notice
  Uvulopalatoplasty for Sleep Disorders (Including Radiofrequency Uvulopalatoplasty [UP2 or UPP] and Laser-Assisted Uvulopalatoplasty [LAUP]) (Coverage Policies)   Usage Notice
 
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V
  Vacuum-Assisted Closure for Wound Healing (Coverage Policies) 
 Usage Notice
  Vagus Nerve Stimulation (Coverage Policies) 
 Usage Notice

VasClip® (Coverage Policies)

 Usage Notice
  Venous Thromboembolism Diagnosis and Treatment (ICSI Guidelines) 
  Venous Thromboembolism Prophylaxis (ICSI Guidelines) 
  Virtual Colonoscopy (Computed Tomographic Colonography or Magnetic Resonance Colonography) (Coverage Policies)   Usage Notice
  Virtual Reality (VR) Therapy for Phobias (Coverage Policies) 
 Usage Notice
  Vision Therapy (Coverage Policies) 
 Usage Notice
 
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W
  Wireless Capsule Endoscopy (CE) and Capsule Technology to Verify Patency Prior to Capsule Endoscopy (Coverage Policies) 
 Usage Notice
  Wireless Esophageal pH Monitoring (Bravo™ System) (Coverage Policies)

Usage Notice


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X
  X Stop® Interspinous Process Decompression (IPD) System (Coverage Policies)

Usage Notice