Enhanced External Counterpulsation (EECP)

Medicine | January 1, 2003

Advanced Approval Waiver

Administrative | May 1, 1995

Allergy Immunotherapy

Medicine | October 15, 2000

Anesthesia Services

Other | January 1, 1975

Neuromuscular Electrical Stimulation (NMES)

Durable Medical Equipment | March 1, 2007

Influenza Vaccine

Medicine | October 31, 2008

Contraceptive Management

Medicine | July 1, 2010

Implantable Hormone Pellets for Females

Prescription Drug | August 1, 2010

Antineoplaston Therapy and Sodium Phenylbutyrate

Prescription Drug | October 1, 2011

Human Papillomavirus (HPV) Vaccines

Medicine | October 1, 2011

Colorectal Cancer Screening

Medicine | October 1, 2018

Measurement of Thromboxane Metabolites for Aspirin Resistance

Laboratory | January 1, 2013

Telemedicine

Medicine | March 6, 2013

Unicompartmental and Bicompartmental Knee Arthroplasties

Surgery | June 1, 2013

Blepharoplasty (Upper and Lower)

Surgery | January 1, 1982

Orthognathic Surgery

Surgery | July 1, 2013

Genetic Testing for Cystic Fibrosis

Laboratory | July 1, 2017

Suit Therapy

Therapy | July 1, 2013

Breast Pumps

Durable Medical Equipment | July 1, 2013

Amniotic Membrane and Limbal Stem Cell Transplantation for the Treatment of Ocular Conditions

Surgery | August 1, 2013

Brain Natriuretic Peptide (BNP)

Laboratory | July 1, 2005

Daily Hemodialysis and Hemodialysis in the Home Setting

Therapy | November 1, 2013

Allergen Testing

Laboratory | September 1, 2013

Clinical Trials

Medicine | February 1, 2014

Orthodontic Treatment

Medicine | January 1, 2014

Omalizumab (Xolair®)

Prescription Drug | April 1, 2014

Natalizumab (Tysabri®)

Prescription Drug | January 1, 2014

Rituximab

Prescription Drug | April 1, 2014

Tocilizumab (Actemra®)

Prescription Drug | April 1, 2014

Octreotide Acetate (Sandostatin)

Prescription Drug | January 1, 2014

Golimumab (Simponi) for subcutaneous use

Prescription Drug | January 1, 2014

Chemotherapy Drugs and the Administration by Physicians for the Treatment of Cancer

Prescription Drug | July 1, 2000

Chiropractic Services

Other | August 1, 1988

Hereditary Angioedema Drug Therapy

Prescription Drug | December 1, 2014

Bevacizumab (Avastin) for Oncologic Use

Prescription Drug | January 1, 2014

Abatacept (Orencia®)

Prescription Drug | April 1, 2014

Surgical Treatment of Chest Wall Deformities (Congenital or Acquired)

Surgery | January 1, 2014

Concurrent Care

Medicine | January 1, 1975

Controls

Administrative | August 1, 1988

Cell Transplantation (Mesencephalic, Adrenal-Brain and Fetal Xenograft)

Medicine | March 1, 2014

Oral Screening, Lesion Identification Systems and Genetic Screening

Laboratory | March 1, 2014

Discarded Drugs/Biologicals - Pharmaceutical Waste

Medicine | March 1, 2014

Breast Surgical Procedures/Prosthesis

Surgery | October 1, 1977

Cosmetic/Reconstructive Services

Surgery | June 1, 1975

Pegloticase (Krystexxa)

Prescription Drug | March 1, 2014

Preventive Services for Non-Grandfathered (PPACA) Plans: Behavioral Counseling for Prevention

Medicine | April 1, 2014

Preventive Services for Non-Grandfathered (PPACA) Plans: USPSTF recommended services

Medicine | January 1, 2015

Robotic Assisted Surgery - Reimbursement Policy

Surgery | August 1, 2014

Ipilimumab (Yervoy)

Prescription Drug | September 1, 2014

Pembrolizumab (Keytruda)

Prescription Drug | November 1, 2014

Women's Preventive Services

Medicine | June 1, 2015

Alemtuzumab (Lemtrada)

Prescription Drug | March 1, 2015

Deleted Claims

Administrative | June 1, 1992

Enteral Carbidopa and Levodopa Intestinal Gel Suspension

Medicine | March 1, 2015

Diagnostic Testing of Iron Homeostasis & Metabolism

Laboratory | January 1, 2016

Ambulance and Medical Transport Services

Other | April 15, 1998

Patient-Controlled Analgesia

Medicine | May 6, 1997

Diagnosis Codes (Changing)

Administrative | September 1, 1998

Air Fluidized Beds

Durable Medical Equipment | December 1, 1995

Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients With Elevated Office Blood Pressure

Durable Medical Equipment | December 1, 1995

Low Intensity Pulsed Ultrasound Fracture Healing Device

Durable Medical Equipment | December 23, 1995

Home Cardiorespiratory Monitoring

Durable Medical Equipment | March 1, 1996

Home Phototherapy for Neonatal Jaundice

Durable Medical Equipment | March 1, 1996

Transcutaneous Electrical Nerve Stimulation (TENS)

Durable Medical Equipment | November 1, 1996

Continuous Passive Motion (CPM) in the Home Setting

Durable Medical Equipment | January 15, 2013

Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses

Durable Medical Equipment | July 1, 1997

Oxygen Therapy

Durable Medical Equipment | July 1, 1997

Home Prothrombin Time Monitoring

Durable Medical Equipment | September 1, 2010

Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions

Durable Medical Equipment | November 1, 1997

Negative Pressure Wound Therapy in the Outpatient Setting

Durable Medical Equipment | June 1, 2013

Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence

Durable Medical Equipment | April 1, 1998

Pneumatic Compression Pumps for Treatment of Lymphedema

Durable Medical Equipment | July 1, 1998

Threshold Electrical Stimulation as a Treatment of Motor Disorders

Durable Medical Equipment | April 1, 2000

Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid

Durable Medical Equipment | August 1, 2000

Skin Contact Monochromatic Infrared Energy as a Technique to Treat Cutaneous Ulcers, Diabetic Neuropathy and Miscellaneous Musculoskeletal Conditions

Durable Medical Equipment | April 2, 2003

Transtympanic Micropressure Applications as a Treatment of Meniere’s Disease

Durable Medical Equipment | April 1, 2003

Interferential Current Stimulation

Durable Medical Equipment | November 1, 2009

Cooling Devices Used in the Outpatient Setting

Durable Medical Equipment | November 1, 2004

Electrical and Electromagnetic Stimulation for the Treatment of Arthritis

Durable Medical Equipment | April 1, 2009

Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis

Durable Medical Equipment | August 1, 2014

Tumor Treating Fields Therapy

Medicine | June 1, 2021

Artificial Pancreas Device Systems

Medicine | February 1, 2015

Admissions

Administrative | January 1, 1975

Total Parenteral Nutrition and Enteral Nutrition in the Home

Durable Medical Equipment | June 1, 2013

Thoracic-Lumbo-Sacral Orthosis With Pneumatics

Durable Medical Equipment | February 1, 2002

Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities

Durable Medical Equipment | February 1, 2015

Patient-Controlled End of Range Motion Stretching Devices

Durable Medical Equipment | February 1, 2015

Vedolizumab (Entyvio™)

Prescription Drug | April 9, 2015

Myoelectric Prosthesis Components for the Upper Limb

Durable Medical Equipment | July 1, 2012

Microprocessor-Controlled Prosthetic for the Lower Limb

Durable Medical Equipment | October 1, 2003

Nivolumab (Opdivo)

Prescription Drug | June 1, 2015

Abdominoplasty, Panniculectomy and Lipectomy

Surgery | June 1, 2015

Preventive Services for Non Grandfathered (PPACA) Plans: Immunizations

Other | October 1, 2015

Pre-implantation Genetic Testing

Laboratory | October 1, 2015

Blinatumomab (Blincyto)

Prescription Drug | December 1, 2015

Siltuximab (Sylvant)

Prescription Drug | December 1, 2015

Belinostat (Beleodaq)

Prescription Drug | December 1, 2015

Drug Claim Processing

Administrative | May 1, 1992

Durable Medical Equipment (DME)

Durable Medical Equipment | August 1, 1988

External Insulin Infusion Pump

Durable Medical Equipment | January 3, 2007

Ramucirumab (Cyramza®)

Prescription Drug | December 1, 2015

Bulking Agents for the Treatment of Vocal Cord Paralysis

Prescription Drug | December 1, 2015

Prenatal Screening

Laboratory | January 1, 2016

Flow Cytometry

Laboratory | January 1, 2016

Vitamin D Testing

Laboratory | January 1, 2016

Hepatitis C Testing

Laboratory | January 1, 2016

ANA/ENA Testing

Laboratory | January 1, 2016

Vitamin B12 and Methylmalonic Acid Testing

Laboratory | January 1, 2016

Testosterone Testing

Laboratory | January 1, 2016

Hemoglobin A1c

Laboratory | January 1, 2016

Diagnostic Testing of Influenza

Laboratory | January 1, 2016

Thyroid Disease Testing

Laboratory | January 1, 2016

Spinal Epidural Injections

Therapy | February 1, 2016

Paravertebral Facet Joint Injections/Blocks

Medicine | February 1, 2016

Corporate Administrative/Medical Policy Guidelines (Medical Necessity, Investigational/Experimental)

Other | January 1, 1975

Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction Due to Benign Prostatic Hyperplasia (BPH)

Surgery | February 1, 2016

Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Laboratory | November 1, 2016

Mepolizumab (Nucala®)

Prescription Drug | March 1, 2016

Cervical Spine Procedures

Surgery | March 1, 2016

Extension of Liability

Administrative | May 1, 1989

Gender Reassignment Surgery

Surgery | March 1, 2016

Knee Braces, Orthopaedic Casts, Splints

Durable Medical Equipment | November 1, 1997

SIMPONI ARIA (golimumab injection for intravenous use)

Prescription Drug | May 1, 2016

TECENTRIQ™ (atezolizumab)

Prescription Drug | June 1, 2016

Quantose Impaired Glucose Tolerance (IGT) Test

Laboratory | July 1, 2016

Hypothermia to Prevent/Reduce Hair Loss During Chemotherapy

Medicine | July 1, 2016

Zika Virus Risk Assessment

Laboratory | August 1, 2016

DNA Ploidy Cell Cycle Analysis

Laboratory | October 1, 2016

InflammaDry Test

Laboratory | December 1, 2016

Medical Policy Development and Review

Other | January 1, 2017

SPECT/CT Fusion Imaging

Radiology | February 1, 2017

Lyme Disease Testing

Laboratory | February 1, 2017

Lumbar Spinal Procedures

Surgery | March 1, 2017

Testing of Homocysteine Metabolism-Related Conditions

Laboratory | March 1, 2017

Light Therapy for Dermatologic Conditions

Therapy | April 1, 2017

Ultraviolet Light Therapy in the Home Setting (UVB)

Therapy | April 1, 2017

Floor Limits

Administrative | August 15, 1988

General Genetic Testing, Germline Disorders

Laboratory | April 1, 2017

General Genetic Testing, Somatic Disorders

Laboratory | April 1, 2017

Genetic Testing for Polyposis Syndromes

Laboratory | May 1, 2017

Lynch Syndrome Testing

Laboratory | May 1, 2017

Ocrelizumab (Ocrevus™)

Prescription Drug | May 1, 2017

Radium Ra 223 (Xofigo®) Injection

Medicine | August 1, 2017

Daratumumab (Darzalex®) Injection

Prescription Drug | August 1, 2017

Medication Administration Site of Care

Medicine | September 1, 2017

Fractional Flow Reserve CT

Radiology | October 1, 2017

Telehealth

Medicine | October 1, 2017

RADICAVA (edaravone injection)

Prescription Drug | November 1, 2017

Olaratumab (Lartruvo)

Prescription Drug | November 1, 2017

Avelumab (Bavencio®)

Prescription Drug | November 1, 2017

Pathogen Panel Testing

Laboratory | December 1, 2017

BRINEURA (cerliponase alfa)

Prescription Drug | January 1, 2018

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Mental Health | January 1, 2018

Cardiovascular Disease Risk Assessment

Laboratory | January 1, 2018

PARSABIV™ (etelcalcetide)

Prescription Drug | March 1, 2018

Enteral Feeding In-Line Cartridge (EFIC™)/Immobilized Lipase Cartridge/Relizorb™

Prescription Drug | March 1, 2018

Medical Records Documentation Standards

Other | June 1, 2018

Serum Testing for Evidence of Mild Traumatic Brain Injury

Laboratory | May 1, 2018

Cardiac Biomarkers for Myocardial Infarction

Laboratory | August 13, 2018

ustekinumab (Stelara™)

Prescription Drug | June 1, 2018

Cimzia® (certolizumab pegol)

Prescription Drug | June 1, 2018

Hematopoietic Colony-Stimulating Factors (CSFs)

Prescription Drug | June 1, 2018

Pancreatic Enzyme Testing for Acute Pancreatitis

Laboratory | August 1, 2018

Folate Testing

Laboratory | October 1, 2018

Extended-Release Injectable (Sublocade)

Prescription Drug | July 1, 2018

Dynamic Posturography

Medicine | December 1, 1995

Gait Analysis

Other | December 15, 1995

Hyperbaric Oxygen Therapy

Medicine | December 1, 1995

Local or Whole Body Hyperthermia

Medicine | July 1, 2002

Hypnosis

Medicine | December 1, 1995

Topographic Brain Mapping

Medicine | December 1, 1995

Dry Needling of Trigger Point Injections for Myofascial Pain

Surgery | August 1, 2016

Multispectral Digital Skin Lesion Analysis

Medicine | January 1, 2016

Vestibular Function Testing

Laboratory | December 1, 2017

Human Antihemophilic Factor (AHF)

Prescription Drug | January 1, 2021

Recombinant and Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non‒Orthopedic Conditions

Medicine | March 1, 1996

Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy

Medicine | April 1, 2013

Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome

Medicine | May 1, 2013

Esophageal pH Monitoring

Medicine | July 1, 1996

Temporomandibular Joint Dysfunction

Medicine | July 1, 2010

Prolotherapy

Medicine | May 7, 1997

Biofeedback as a Treatment of Urinary Incontinence in Adults

Medicine | July 1, 1997

Neurofeedback

Medicine | January 1, 1998

Biofeedback as a Treatment of Headache

Medicine | April 1, 1998

Biofeedback as a Treatment of Chronic Pain

Medicine | April 1, 1998

Intra-Articular Hyaluronan Injections for Osteoarthritis

Medicine | February 1, 2013

Home Spirometry

Medicine | March 1, 1999

Cutaneous Electrogastrography (EGG)

Medicine | August 1, 2000

Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain

Medicine | August 1, 2013

Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease

Medicine | December 1, 2000

Quantitative Sensory Testing

Medicine | June 1, 2013

Extracorporeal Shock Wave Treatment for Plantar Faciitis and Other Musculoskeletal Conditions

Durable Medical Equipment | May 1, 2001

Noncontact Radiant Heat Bandage for the Treatment of Wounds

Medicine | May 1, 2001

Chronic Intermittent Intravenous Insulin Therapy (CIIIT)

Therapy | November 1, 2001

Dermatologic Applications of Photodynamic Therapy

Medicine | November 1, 2001

Vacuum Therapy as a Treatment for Female Sexual Dysfunction

Medicine | November 18, 2001

Inpatient Intestinal Rehabilitation Therapy

Medicine | November 1, 2001

Biofeedback for Miscellaneous Indications

Medicine | July 1, 1997

Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

Medicine | December 3, 2002

Breast Duct Endoscopy

Medicine | April 1, 2003

Low-Level Laser Therapy

Medicine | April 1, 2003

Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds

Surgery | July 1, 2003

Transanal Radiofrequency Treatment of Fecal Incontinence

Medicine | July 1, 2003

Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence

Medicine | July 1, 2003

Biofeedback as a Treatment of Fecal Incontinence or Constipation

Medicine | December 1, 2003

Aerosolized Antibiotics as a Treatment of Chronic Sinusitis

Medicine | July 15, 2004

Laser Treatment of Active Acne

Medicine | November 1, 2004

Non-Pharmacologic Treatment of Rosacea

Medicine | February 1, 2011

Insulin Potentiation Therapy

Medicine | February 1, 2005

Actigraphy

Medicine | March 1, 2005

Percutaneous Treatment of Fracture Non-Unions or Bone Defects With Autologous Bone Marrow With or Without Demineralized Bone Matrix (DBM)

Medicine | May 1, 2013

Automated Point-of-Care Nerve Conduction Tests

Medicine | June 1, 2013

Non-contact Ultrasound Treatment of Wounds

Medicine | November 1, 2008

Endoscopic Radiofrequency Ablation or Cryoablation for Barrett's Esophagus

Medicine | February 1, 2011

Ingestible pH and Pressure Capsule

Medicine | February 1, 2011

Bioimpedance Devices for Detection and Management of Lymphedema

Medicine | April 1, 2011

Interventions for Progressive Scoliosis

Medicine | June 1, 2010

Chromoendoscopy as an Adjunct to Colonoscopy

Medicine | April 1, 2012

Neural Therapy

Medicine | January 1, 2012

Targeted Phototherapy and Psoralen With Ultraviolet A for Vitiligo

Medicine | May 1, 2013

Confocal Laser Endomicroscopy

Medicine | June 1, 2013

Laser Treatment of Onychomycosis

Medicine | June 1, 2013

Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia

Medicine | October 1, 2013

Fecal Microbiota Transplantation

Medicine | July 1, 2014

Autonomic Nervous System Testing

Medicine | February 1, 2015

Alcohol Injections for Treatment of Peripheral Neuromas

Medicine | October 1, 2018

Orthopedic Applications of Platelet-Rich Plasma

Medicine | June 1, 2015

Polysomnography for Non‒Respiratory Sleep Disorders

Medicine | August 1, 2015

Incapacitated Dependent Coverage

Other | July 1, 2018

Catheter Ablation for Cardiac Arrhythmias

Medicine | December 1, 1995

Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry

Medicine | July 1, 1998

Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure

Medicine | July 1, 1999

Intravascular Brachytherapy for Preventing and Managing Restenosis After Percutaneous Transluminal Angioplasty (PTA)

Medicine | July 1, 1999

T-Wave Alternans

Medicine | December 23, 2000

Transcoronary Ablation of Septal Hypertrophy (TASH)

Medicine | August 1, 2001

Wearable Cardioverter-Defibrillators

Medicine | April 1, 2003

Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis

Medicine | July 1, 2003

Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia

Medicine | April 1, 2004

Catheter Ablation as Treatment for Atrial Fibrillation

Medicine | July 1, 2004

Ultrafiltration in Decompensated Heart Failure

Medicine | February 1, 2007

Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting

Durable Medical Equipment | May 1, 2011

Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease

Medicine | August 1, 2013

Percutaneous Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

Medicine | April 1, 2013

Transcatheter Mitral Valve Repair

Medicine | December 1, 2014

Myocardial Strain Imaging

Medicine | April 1, 2020

Leadless Cardiac Pacemakers

Medicine | December 1, 2019

Donor Lymphocyte Infusion for Malignancies Treated With an Allogeneic Hematopoietic Cell Transplant

Medicine | January 1, 1998

Melanoma Vaccines

Medicine | April 1, 1998

Uses of Monoclonal Antibodies

Prescription Drug | August 1, 2013

Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

Medicine | June 1, 2005

ZOMETA (zoledronic acid)

Prescription Drug | July 1, 2018

Gene Therapy for Inherited Retinal Dystrophy/Luxturna™

Prescription Drug | May 1, 2019

Multianalyte Assays with Algorithmic Analyses for Predicting Risk of Type 2 Diabetes

Medicine | August 1, 2013

General Inflammation Testing

Laboratory | November 1, 2018

Urine Culture Testing for Bacteria

Laboratory | December 1, 2018

Diagnostic Testing of Most Common Sexually Transmitted Infections

Laboratory | February 1, 2019

Testing for Mosquito- or Tick-Related Infections

Laboratory | February 1, 2019

β-Hemolytic Streptococcus Testing

Laboratory | February 1, 2019

Intracardiac Ischemia Monitoring

Medicine | December 1, 2018

Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies

Laboratory | January 1, 2019

Service Intensity Guidelines

Mental Health | January 1, 2019

Imfinzi (durvalumab)

Prescription Drug | March 1, 2019

Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Laboratory | July 1, 2019

Pharmacogenetic Testing

Laboratory | April 1, 2019

CD 5 Complement Inhibitors

Prescription Drug | April 1, 2019

Zolgensma® (Onasemnogene Abeparvovec-Xioi)

Prescription Drug | June 1, 2019

Home Health Services Policy

Medicine | June 1, 2019

Tagraxofusp-erzs (Elzonris)

Prescription Drug | July 1, 2019

Emapalumab-lzsg (Gamifant)

Prescription Drug | July 1, 2019

Sufentanil Sublingual Tablet (Dsuvia)

Prescription Drug | July 1, 2019

BioZorb®

Surgery | July 1, 2019

Pharmacologic Treatment of Hereditary Transthyretin-Mediated Amyloidosis (Onpattro™/Tegsedi™)

Prescription Drug | August 1, 2019

Genicular Nerve Blocks and Ablation for Chronic Knee Pain

Medicine | August 1, 2019

Cemiplimab-rwlc (Libtayo®)

Prescription Drug | September 1, 2019

Hospice Care

Other | March 1, 1995

Genetic Testing for Neurodegenerative Disorders

Laboratory | January 1, 2020

Laboratory Guideline Policy

Laboratory | January 1, 2020

Therapeutic Drug Monitoring for 5-Fluorouracil

Laboratory | October 1, 2019

Speech Generating Devices

Durable Medical Equipment | October 1, 2019

VYONDYS 53 (golodirsen)

Prescription Drug | December 1, 2019

Proteogenomic Testing of Individuals with Cancer

Laboratory | January 1, 2020

Crizanlizumab-tmca (Adakveo)

Prescription Drug | February 1, 2020

Gene Expression Profiling and Protein Biomarkers for Prostate Cancer

Laboratory | June 15, 2020

Esophageal Pathology Testing

Laboratory | April 1, 2020

Onychomycosis Testing

Laboratory | April 1, 2020

COVID-19 Testing

Laboratory | May 1, 2020

Ambulatory or Video Electroencephalogram (EEG) Monitoring, Including Digital Analysis of Electroencephalogram

Medicine | May 1, 2020

Gamma-glutamyl Transferase

Laboratory | August 15, 2020

Redblood Cell Molecular Testing

Laboratory | September 1, 2020

Mental Health Services

Mental Health | June 1, 2020

Mitomycin for Pyelocalyceal Solution (Jelmyto)

Prescription Drug | September 1, 2020

Hospital Medical Services (Inpatient and Observation) and Consultation

Medicine | January 1, 1975

Minimal Residual Disease

Laboratory | January 1, 2021

Bowel Management Devices

Medicine | December 1, 2020

Surgical Treatments for Lymphedema and Lipedema

Surgery | December 1, 2020

Prenatal Screening for Fetal Aneuploidy

Laboratory | April 15, 2003

Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma

Laboratory | August 1, 2013

Genetic Testing for Germline Mutations of the RET Proto-Oncogene

Laboratory | November 1, 1997

Genetic Testing for Familial Cutaneous Malignant Melanoma

Laboratory | December 18, 2012

Genetic Testing of Mitochondrial Disorders

Laboratory | July 1, 2014

Testing for Autism Spectrum Disorder and Developmental Delay

Laboratory | January 1, 2021

Genetic Testing for Hereditary Hemochromatosis

Laboratory | April 1, 2013

BRCA

Laboratory | July 1, 1997

Teprotumumab-trbw (TEPEZZA™)

Prescription Drug | February 1, 2021

Bezlotoxumab (Zinplava)

Prescription Drug | March 1, 2021

Vectra DA Blood Test for Rheumatoid Arthritis

Laboratory | May 1, 2014

Genetic Cancer Susceptibility Panels Using Next Generation Sequencing

Laboratory | August 1, 2013

Genetic Testing for Epilepsy

Laboratory | January 1, 2014

Diagnosis and Management of Idiopathic Environmental Intolerance (i.e., Clinical Ecology)

Laboratory | December 1, 1995

Urinary Tumor Markers for Bladder Cancer

Laboratory | January 23, 1998

Diagnosis of Vaginitis including Multi-target PCR Testing

Laboratory | February 1, 2000

Intracellular Micronutrient Analysis

Laboratory | May 1, 2013

Testing for Diagnosis of Helicobacter Pylori

Laboratory | January 23, 1998

Fibromyalgia Testing

Laboratory | July 1, 2021

Liquid Biopsy

Laboratory | July 1, 2016

Cluneal Nerve Block For Treatment Of Low Back Pain

Medicine | August 1, 2021

Genetic Testing for Inherited Cardiomyopathies and Channelopathies

Laboratory | April 1, 2013

Serum Tumor Markers for Malignancies

Laboratory | November 6, 1996

Gene Expression Testing for Breast Cancer Prognosis

Laboratory | July 1, 2004

Molecular Markers in Fine Needle Aspirates of the Thyroid

Laboratory | February 1, 2012

Mutation Analysis in Myeloproliferative Neoplasms

Laboratory | February 1, 2011

Genetic Testing for Connective Tissue Disorders

Laboratory | May 1, 2017

Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection

Laboratory | November 1, 1996

Venous and Arterial Thrombosis Risk Testing

Laboratory | April 1, 2013

Eptinezumab-jjmr (Vyepti™)

Medicine | May 1, 2021

Viltepso® (Viltolarsen)

Prescription Drug | June 1, 2021

Genetic Testing for Alzheimer’s Disease

Laboratory | April 1, 2013

Testing for Targeted Therapy of Non-Small-Cell Lung Cancer

Laboratory | August 1, 2013

Erectile Dysfunction

Laboratory | May 1, 1997

Genetic Testing for Adolescent Idiopathic Scoliosis

Laboratory | June 1, 2013

Whole Genome and Whole Exome Sequencing

Laboratory | October 1, 2013

Genetic Testing for Neurofibromatosis and Related Disorders

Laboratory | April 1, 2016

Pancreatic Cancer Risk Testing Using Pancreatic Cyst Fluid

Laboratory | June 1, 2009

Molecular Testing for Chronic Heart Failure and Heart Transplant

Laboratory | February 1, 2015

Multigene Expression Assay for Predicting Recurrence in Colon Cancer

Laboratory | May 1, 2011

Genetic Testing for Alpha- and Beta-Thalassemia

Laboratory | April 1, 2014

Molecular Profiling for Cancers of Unknown Primary Origin

Laboratory | February 1, 2013

Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies

Laboratory | August 1, 2013

Genetic Testing for Lactase Insufficiency

Laboratory | June 1, 2013

Genetic Testing for Ophthalmologic Conditions

Laboratory | January 1, 2014

Opioid Antagonists Under Heavy Sedation or General Anesthesia as a Technique of Opioid Detoxification

Mental Health | October 1, 2002

Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder

Mental Health | November 1, 2013

HIV Genotyping and Phenotyping

Laboratory | April 1, 2000

Methadone Treatment for Opiate Addiction

Mental Health | May 1, 1997

Identification of Microorganisms Using Nucleic Acid Probes

Laboratory | July 1, 1998

Genetic Testing for Li-Fraumeni Syndrome

Laboratory | July 1, 2014

Genetic Testing for Mental Health Conditions

Laboratory | January 1, 2014

Genetic Testing for Acute Myeloid Leukemia

Laboratory | December 1, 2014

KRAS, NRAS, and BRAF Mutation Analysis in Metastatic Colorectal Cancer

Laboratory | June 1, 2009

Testing for Alpha-1 Antitrypsin Deficiency

Laboratory | May 1, 2013

Genetic Testing for Hereditary Pancreatitis

Laboratory | April 1, 2014

BCR-ABL1 Testing

Laboratory | August 1, 2013

Genetic Testing for PTEN Hamartoma Tumor Syndrome

Laboratory | April 1, 2014

Chromosomal Microarray

Laboratory | July 1, 2014

Cervical Cancer Screening Technologies with Pap and HPV

Laboratory | July 1, 1998

Celiac Disease Testing

Laboratory | April 1, 2003

Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Laboratory | November 15, 2001

In Vitro Chemoresistance and Chemosensitivity Assays

Laboratory | March 1, 1996

Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Laboratory | February 1, 2000

Nerve Fiber Density Testing

Laboratory | June 1, 2010

Genetic Testing for Heterozygous Familial Hypercholesterolemia

Laboratory | July 1, 2016

Epithelial Cell Cytology in Breast Cancer Risk Assessment and High-Risk Patient Management (Ductal Lavage and Suction Collection Systems)

Laboratory | August 1, 2001

Immune Cell Function Assay

Laboratory | July 1, 2013

Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

Laboratory | November 28, 2012

Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases

Laboratory | June 1, 2014

Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer

Laboratory | July 1, 2012

Molecular Testing of Pulmonary Specimens

Laboratory | August 1, 2017

Bone Turnover Markers Testing

Laboratory | July 1, 1999

Transplant Rejection Testing

Laboratory | January 1, 2010

Metabolite Markers of Thiopurines Testing

Laboratory | December 6, 2000

Saturation Biopsy for Diagnosis and Staging of Prostate Cancer

Surgery | January 1, 2011

Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease

Laboratory | March 1, 2005

Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma

Laboratory | July 1, 2014

Intravenous Iron

Medicine | January 1, 2022

Biochemical Markers of Alzheimer Disease and Dementia

Laboratory | July 1, 1999

Testing for Diagnosis of Active or Latent Tuberculosis

Laboratory | November 15, 2001

Molecular Analysis for Gliomas

Laboratory | February 1, 2015

Human Growth Hormone

Prescription Drug | September 1, 2014

Eteplirsen for Duchenne Muscular Dystrophy

Medicine | November 1, 2018

Microsatellite Instability and Tumor Mutational Burden Testing

Laboratory | January 1, 2022

Genetic Testing for CHARGE Syndrome

Laboratory | April 1, 2014

Genetic Testing for Lipoprotein A Variant as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment

Laboratory | May 1, 2013

Genetic Testing for Fanconi Anemia

Laboratory | December 1, 2014

Genetic Testing of CADASIL Syndrome

Laboratory | August 1, 2013

Genetic Testing for Rett Syndrome

Laboratory | April 1, 2013

Genetic Testing for FMR1 mutations (including Fragile X Syndrome)

Laboratory | July 1, 2012

Monoclonal Antibody Therapies for Migraine Prevention

Prescription Drug | March 1, 2019

Nusinersen for Spinal Muscular Atrophy

Prescription Drug | March 1, 2017

Esketamine Nasal Spray for Treatment-Resistant Depression

Laboratory | April 1, 2020

Trastuzumab

Prescription Drug | April 4, 2013

Maternity/Obstetrical Care Benefits

Other | July 1, 1998

Confidential Records and Information (Security, Storage and Destruction)

Administrative | October 1, 1976

Medicare Coordination of Benefits

Administrative | June 1, 1992

Medicare Coordination – Laboratory Services

Administrative | June 1, 1993

Prenatal Genetic and Chromosomal Metabolic Testing

Ob/Gyn/Reproduction | December 6, 1995

Transfusion Therapy for Hemolytic Disease of the Fetus and the Newborn

Ob/Gyn/Reproduction | March 1, 1996

Home Uterine Activity Monitoring

Ob/Gyn/Reproduction | December 1, 2013

Fetal Surgery for Prenatally Diagnosed Malformations

Ob/Gyn/Reproduction | March 1, 1998

Occlusion of Uterine Arteries Using Transcatheter Embolization

Ob/Gyn/Reproduction | July 1, 1999

Progesterone Therapy as a Technique to Reduce Preterm Delivery in High-Risk Pregnancies

Ob/Gyn/Reproduction | December 3, 2003

Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea

Ob/Gyn/Reproduction | February 1, 2004

Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome

Ob/Gyn/Reproduction | April 1, 2004

Laparoscopic, Percutaneous and Transcervical Techniques for the Myolysis of Uterine Fibroids

Ob/Gyn/Reproduction | July 1, 2004

Reproductive Techniques

Ob/Gyn/Reproduction | April 11, 2013

Uterus Transplantation for Absolute Uterine Factor Infertility

Medicine | May 1, 2022

Overpayment Detection Due to a Member Inquiry

Administrative | May 1, 1989

Pain Management Services (Chronic Pain and Rehabilitation Therapies)

Medicine | June 1, 1987

Registered Nurses Practicing in Extended Roles

Other | May 1, 1993

Phone Transfers and Second Requests

Administrative | May 5, 1992

Inpatient Rehabilitation

Therapy | August 1, 1995

Pricing Services (Professional Services and Blue Card ITS Home/Control Plan and Blue Card ITS Host Plan)

Administrative | August 1, 1988

Drug Coverage

Prescription Drug | January 1, 1980

Laboratory/Pathology Services

Laboratory | April 1, 1997

Qualified Medical Child Support

Administrative | October 9, 1996

Transition of Care (TOC)/Continuation of Care (COC)

Administrative | September 15, 2020

Erythopoiesis Stimulating Agents and Darbepoetin Alfa (Aranesp)

Prescription Drug | December 1, 1995

Botulinum Toxin

Prescription Drug | July 1, 1997

Intravenous Antibiotic Therapy for Lyme Disease

Prescription Drug | January 1, 1998

Advanced Therapies for Pharmacologic Treatment of Pulmonary Hypertension

Prescription Drug | January 1, 1998

Immune Prophylaxis for Respiratory Syncytial Virus

Prescription Drug | March 1, 2010

Infliximab

Prescription Drug | June 25, 2013

Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders

Prescription Drug | April 1, 2004

Repository Corticotropin Injection

Prescription Drug | October 1, 2013

Bevacizumab in Advanced Adenocarcinoma of the Pancreas

Prescription Drug | August 1, 2013

Injectable Clostridial Collagenase for Fibroproliferative Disorders

Prescription Drug | January 29, 2013

Pertuzumab for Treatment of Malignancies

Prescription Drug | August 1, 2013

Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER-2 Positive Malignancies

Prescription Drug | August 1, 2013

Testosterone Replacement Therapies

Prescription Drug | April 1, 2014

Buprenorphine Implant for Treatment of Opioid Dependence

Prescription Drug | July 1, 2019

Brexanolone for Postpartum Depression

Prescription Drug | August 1, 2019

Prescription Digital Therapeutics for Substance Abuse

Therapy | August 1, 2020

Desensitization Treatment for Peanut Allergies

Medicine | July 1, 2020

Lumasiran for Primary Hyperoxaluria Type 1

Prescription Drug | June 1, 2021

Aducanumab for Alzheimer Disease

Prescription Drug | July 1, 2021

Radiation Oncology Services

Medicine | July 1, 2000

Radiopharmaceutical Agents and Other In Vivo Diagnostic Aids

Radiology | January 1, 2006

Revenue Code, Non-covered Services

Administrative | September 6, 1995

Salivary Hormone Testing

Laboratory | December 1, 2005

Service Dates on Inpatient Facility Claims

Administrative | September 1, 1990

Surgical Guidelines (Secondary, Multiple Procedures, Co-Surgeons, Assistant Surgeons, Stand- By Physicians, Microsurgery/Microdissection)

Surgery | April 1, 1987

Timely Filing

Administrative | June 1, 1992

Bone Mineral Density Studies

Radiology | March 1, 2013

Computed Tomography to Detect Coronary Artery Calcification

Radiology | July 1, 2011

Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography

Radiology | February 1, 2013

Vacuum-Assisted Breast Biopsy

Radiology | December 22, 2005

Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy

Radiology | January 1, 1999

Thermography

Radiology | March 1, 1996

Ultrasound for the Evaluation of Paranasal Sinuses

Radiology | March 23, 1996

Videofluoroscopic Evaluation of Velopharyngeal Dysfunction

Radiology | July 17, 1996

Scintimammography and Gamma Imaging of the Breast and Axilla

Radiology | January 1, 1998

Magnetoencephalography/Magnetic Source Imaging

Radiology | December 1, 1999

Diagnosis and Treatment of Non-Surgical Sacroiliac Joint Pain

Radiology | February 1, 2013

Percutaneous Vertebroplasty and Sacroplasty

Radiology | April 10, 2013

FDG Using Camera-Based Imaging (FDG-SPECT)

Radiology | August 1, 2000

Wireless Capsule Endoscopy to Diagnose Disorders of the Small Bowel, Esophagus, and Colon

Radiology | February 17, 2002

Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer

Radiology | December 1, 2002

Percutaneous Balloon Kyphoplasty and Mechanical Vertebral Augmentation

Radiology | May 1, 2013

Whole Body Dual X-ray Absorptiometry (DEXA) to Determine Body Composition

Radiology | February 1, 2012

Whole Body Computed Tomography Scan as a Screening Test

Radiology | December 17, 2003

Vertebral Fracture Assessment with Densitometry

Radiology | February 4, 2011

Dynamic Spinal Visualization and Vertebral Motion Analysis

Radiology | February 1, 2007

Positional Magnetic Resonance Imaging (MRI)

Radiology | June 1, 2008

Use of Magnetic Resonance Imaging to Monitor Integrity of Silicone Gel-Filled Breast Implants

Radiology | June 1, 2010

Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment

Radiology | June 1, 2013

Positron Emission Mammography (PEM)

Radiology | February 1, 2011

Digital Breast Tomosynthesis

Radiology | July 1, 2011

Dopamine Transporter Imaging with Single Photon Emission Computed Tomography (DAT-SPECT)

Radiology | July 1, 2013

Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer Disease

Radiology | July 1, 2012

Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure

Radiology | August 1, 2013

Radioactive Seed Localization of Nonpalpable Breast Lesions

Radiology | October 1, 2013

Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer

Radiology | December 1, 2014

Therapeutic Radiopharmaceuticals in Oncology

Therapy | June 1, 2019

Veterans Administration/Military Services

Administrative | June 17, 1996

CT Angiography, Neck

Radiology | January 1, 2020

MR Angiography Upper Extremity

Radiology | January 1, 2021

Acupuncture and Dry Needling

Surgery | November 12, 1998

Angelchik™ Anti-Reflux Prosthesis

Surgery | December 1, 1995

Implantable Bone Conduction and Bone Anchored Hearing Aids

Surgery | December 1, 1995

Cochlear Implant

Surgery | December 1, 1995

Electrical Bone Growth Stimulation of the Appendicular Skeleton

Surgery | December 1, 1995

Risk-Reducing Mastectomy

Surgery | April 4, 2013

Bone Morphogenetic Protein

Surgery | July 1, 2004

Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome

Surgery | June 1, 2010

Periureteral Bulking Agents for the Treatment of Vesicoureteral Reflux (VUR)

Surgery | March 2, 2005

Surgical Ventricular Restoration

Surgery | June 1, 2008

Subtalar Arthroereisis and Subtalar Joint Implant

Durable Medical Equipment | October 1, 2005

Balloon Ostial Dilation for Treatment of Chronic and Recurrent Acute Rhinosinusitis

Surgery | September 1, 2007

Percutaneous Tibial Nerve Stimulation

Surgery | February 1, 2007

Interspinous and Interlaminar Stabilization/Distraction Devices Spacers

Durable Medical Equipment | January 1, 2007

Magnetic Resonance — Guided Focused Ultrasound

Surgery | June 1, 2011

Vertical Expandable Prosthetic Titanium Rib

Surgery | September 1, 2007

Wireless Pressure Sensors in Endovascular Aneurysm Repair

Surgery | July 1, 2008

Transanal Endoscopic Microsurgery (TEMS)

Surgery | August 1, 2013

Reverse Shoulder Arthroplasty

Surgery | October 1, 2009

Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis)

Surgery | November 1, 2011

Arthroscopic Debridement and Lavage as Treatment for Osteoarthritis of the Knee

Surgery | December 6, 2012

Surgical Treatment of Femoroacetabular Impingement

Surgery | June 1, 2010

Isolated Limb Perfusion/Infusion for Malignant Melanoma

Surgery | December 1, 2000

Facet Arthroplasty

Surgery | June 1, 2013

Electromagnetic Navigation Bronchoscopy

Surgery | December 1, 2009

Plugs for Fistula Repair

Surgery | August 1, 2013

Treatment of Varicose Veins/Venous Insufficiency

Surgery | February 21, 2013

Occipital Nerve Stimulation

Surgery | May 1, 2010

Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis

Surgery | April 1, 2013

Bronchial Thermoplasty

Surgery | February 1, 2011

Bronchial Valves

Surgery | August 1, 2013

Surgical Treatment of Bilateral Gynecomastia

Surgery | August 1, 2013

Axial Lumbosacral Interbody Fusion

Surgery | December 1, 2011

Transcatheter Pulmonary Valve Implantation

Surgery | January 16, 2013

Transcatheter Aortic-Valve Implantation for Aortic Stenosis

Surgery | December 1, 2012

Microwave Tumor Ablation

Surgery | December 6, 2012

Steroid-Eluting Sinus Stents and Implants

Surgery | August 1, 2013

Surgical and Ablative Treatments for Chronic Headaches

Surgery | August 1, 2013

Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension

Surgery | August 1, 2013

Interspinous Fixation (Fusion) Devices

Surgery | June 1, 2013

Peripheral Subcutaneous Field Stimulation

Surgery | August 1, 2013

Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)

Surgery | December 1, 1995

Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery

Surgery | July 1, 2019

Surgery for Groin Pain in Athletes

Surgery | June 1, 2015

Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy

Medicine | December 1, 2014

Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty

Surgery | June 18, 2015

Endovascular Therapies for Extracranial Vertebral Artery Disease

Surgery | March 1, 2015

Amniotic Membrane and Amniotic Fluid Injections for Non Ophthalmic Applications

Surgery | July 1, 2015

Meniscal Allografts and Other Meniscal Implants

Surgery | December 1, 1995

Vagus Nerve Blocking Therapy for Treatment of Obesity

Surgery | September 1, 2016

Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast

Surgery | August 1, 2016

Ablation of Peripheral Nerves to Treat Pain

Surgery | May 1, 2016

Balloon Dilation of the Eustachian Tube

Medicine | October 1, 2020

Sphenopalatine Ganglion Block for Headache

Medicine | August 1, 2017

Three-Dimensional Printed Orthopedic Implants

Surgery | June 1, 2018

Absorbable Nasal Implant for Treatment of Nasal Valve Collapse

Surgery | October 1, 2019

Allograft Injection for Degenerative Disc Disease

Medicine | May 1, 2021

Cryoablation, Radiofrequency Ablation and Laser Ablation for Treatment of Chronic Rhinitis

Surgery | January 1, 2022

Laser Interstitial Thermal Therapy for Neurological Conditions

Therapy | December 1, 2021

Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence

Surgery | December 1, 1995

Vagus Nerve Stimulation

Surgery | December 18, 1995

Reduction Mammaplasty for Breast-Related Symptoms

Surgery | August 1, 2013

Spinal Cord and Dorsal Root Ganglion Stimulation

Surgery | March 6, 1996

Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)

Surgery | July 1, 2013

Electrophrenic Pacemaker

Surgery | March 1, 1996

Implantable Infusion Pump for Pain and Spasticity

Surgery | November 1, 1996

Implantable Cardioverter Defibrillator (ICD)

Surgery | March 1, 1996

Bariatric Surgery

Surgery | July 2, 1996

Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions

Surgery | December 1, 2009

Placental and Umbilical Cord Blood as a Source of Stem Cells

Surgery | November 5, 1996

Transmyocardial Revascularization

Surgery | May 1, 1997

Laser-Assisted Tonsillectomy

Surgery | July 1, 1997

Intraoperative Neurophysiologic Monitoring

Surgery | January 24, 2013

Dynamic Cardiomyoplasty

Surgery | November 1, 1997

Minimally Invasive Coronary Artery Bypass Graft Surgery

Other | June 1, 2011

Deep Brain Stimulation

Surgery | January 1, 1998

Chronic Pulmonary Thromboendarterectomy

Surgery | April 1, 1998

Partial Left Ventriculectomy

Surgery | April 1, 1998

Endovascular Stent Grafts for Abdominal Aortic Aneurysms

Surgery | July 1, 1998

Extracranial Carotid Angioplasty/Stenting

Surgery | January 1, 2012

Sacral Nerve Neuromodulation/Stimulation

Surgery | November 5, 1998

Lung Volume Reduction Surgery for Severe Emphysema

Surgery | July 1, 1999

Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty

Surgery | December 7, 1999

Gastric Electrical Stimulation

Surgery | December 1, 2000

Cryosurgical Ablation of Primary or Metastatic Liver Tumors

Surgery | December 1, 2000

Total Ankle Replacement

Surgery | May 1, 2001

Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions

Surgery | August 1, 2001

Whole Gland Cryoablation of Prostate Cancer

Surgery | May 1, 2013

Hip Resurfacing

Surgery | February 1, 2009

Nerve Graft with Radical Prostatectomy

Surgery | November 1, 2001

Thermal Capsulorrhaphy as a Treatment of Joint Instability

Surgery | July 2, 2002

Auditory Brainstem Implant

Surgery | July 1, 2002

Semi-Implantable and Fully Implantable Middle Ear Hearing Aids

Surgery | October 3, 2002

Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

Surgery | December 1, 2002

Endovascular Stent Grafts for Disorders of the Thoracic Aorta

Surgery | July 1, 2013

Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee

Surgery | April 23, 2003

Radiofrequency Ablation of Primary or Metastatic Liver Tumors

Surgery | July 1, 2013

Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone

Surgery | October 1, 2003

Decompression of the Intervertebral Disc Using Laser (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty™)

Surgery | October 1, 2003

Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors

Surgery | July 1, 2013

Computer-Assisted Navigation for Orthopedic Procedure

Surgery | February 1, 2004

Minimally Invasive Hip and Knee Arthroplasty

Surgery | April 1, 2004

Vasectomy Using a Polymeric Clip

Surgery | April 18, 2004

MR Angiography Spinal Canal

Radiology | January 1, 2020

CT Angiography, Pelvis

Radiology | January 1, 2020

Kidney Transplant

Surgery | December 1, 1995

Allogeneic Pancreas Transplant

Surgery | December 15, 1996

Isolated Small Bowel Transplant

Surgery | December 1, 1995

Small Bowel/Liver and Multivisceral Transplant

Surgery | December 1, 1995

Liver Transplant and Combined Liver-Kidney Transplant

Surgery | December 1, 1995

Lung and Lobar Lung Transplant

Surgery | July 1, 1996

Heart/Lung Transplant

Surgery | July 1, 1996

Heart Transplant

Surgery | July 1, 1996

Total Artificial Hearts and Implantable Ventricular Assist Devices

Surgery | November 1, 1996

Islet Cell Transplantation

Surgery | August 1, 2001

Composite Tissue Allotransplantation of the Hand and Face

Surgery | August 1, 2013

Lower Extremity CTA/CTV

Radiology | January 1, 2020

CT Cervical Spine

Radiology | January 1, 2020

CT Angiography, Abdomen

Radiology | January 1, 2020

CT Thoracic Spine

Radiology | January 1, 2020

CT Angiography, Abdomen and Pelvis

Radiology | January 1, 2020

MRI Lumbar Spine

Radiology | January 1, 2020

MRI Thoracic Spine

Radiology | January 1, 2020

CT Pelvis

Radiology | January 1, 2020

CT Heart

Radiology | January 1, 2020

CT Lumbar Spine

Radiology | January 1, 2020

MRI Pelvis

Radiology | January 1, 2020

CT Lower Extremity (Ankle, Foot, Hip or Knee)

Radiology | January 1, 2020

CT Abdomen and Pelvis

Radiology | January 1, 2020

CT Abdomen

Radiology | January 1, 2020

UPPER EXTREMITY MRI (Hand, Wrist, Arm, Elbow, Long bone, or Shoulder MRI)

Radiology | December 1, 2019

MRI Heart

Radiology | January 1, 2020

MRI MRCP Abdomen

Radiology | January 1, 2020

MRI Lower Extremity (Ankle, Foot, Knee, Hip, Leg) (Joint and other than joint)

Radiology | January 1, 2020

Radiopharmaceutical Tumor Localization (SPECT), Single Area

Radiology | November 1, 2020

CT (Virtual) Colonoscopy - DIAGNOSTIC

Radiology | January 1, 2021

NECK MRA/MRV

Radiology | January 1, 2021

CT Upper Extremity

Radiology | January 1, 2020

CT Angiography, Upper Extremity

Radiology | January 1, 2021

CT Angiography, Head/Brain

Radiology | January 1, 2020

CT Angiography, Abdominal Arteries

Radiology | January 1, 2020

Fetal MRI

Radiology | January 1, 2020

MUGA Scan

Radiology | January 1, 2020

MRI Bone Marrow

Radiology | January 1, 2020

Low Field MRI

Radiology | January 1, 2020

ORBIT, FACE, NECK, SINUS MRI

Radiology | January 1, 2021

CT Soft Tissue Neck

Radiology | January 1, 2021

MRI Temporomandiublar Joint (TMJ)

Radiology | January 1, 2020

MRI Cervical Spine

Radiology | January 1, 2020

CT Head/Brain

Radiology | January 1, 2020

MRI Chest (Thorax)

Radiology | January 1, 2021

MRI Brain (includes Internal Auditory Canal)

Radiology | January 1, 2020

TEMPORAL BONE, MASTOID, ORBITS CT

Radiology | January 1, 2020

Sinus Maxillofacial CT

Radiology | January 1, 2020

Myocardial Perfusion Imaging (Nuc Card)

Radiology | January 1, 2020

CT Bone Density Study

Radiology | January 1, 2020

CT Angiography, Chest (non coronary)

Radiology | January 1, 2020

CT Chest (Thorax)

Radiology | January 1, 2021

Brain PET Scan

Radiology | January 1, 2021

PELVIS MRAngiography

Radiology | January 1, 2021

ABDOMEN MRA (Angiography)

Radiology | January 1, 2021

LOWER EXTREMITY MRA/MRV

Radiology | January 1, 2021

Brain (Head) MRA/MRV

Radiology | January 1, 2021

HYPERTHERMIA With Radiation

Radiology | January 1, 2021

NEUTRON BEAM THERAPY (NBT)

Radiology | January 1, 2021

Radiation Therapy for Non-Cancerous Conditions

Radiology | January 1, 2021

Oncologic Applications of PET Scanning

Radiology | February 1, 2013

Cerebral Perfusion Analysis CT

Radiology | November 1, 2007

Functional MRI Brain

Radiology | February 1, 2007

MR Angiography Chest

Radiology | November 1, 1997

Cardiac Applications of PET Scanning

Radiology | January 1, 2021

MRI Breast

Radiology | December 1, 2000

CTA Coronary Arteries (CCTA)

Radiology | July 1, 2011

Brain (Head) MRS

Radiology | April 1, 2000

Adoptive Immunotherapy

Medicine | December 1, 1996

Chelation Therapy for Off-Label Uses

Therapy | December 1, 1995

Oncologic uses of Interferon Therapy

Therapy | December 1, 1995

Oncologic Applications of Interleukin-2 (Aldesleukin) When Used as Monotherapy

Therapy | December 1, 1995

Immune Globulin Therapy

Therapy | January 16, 2013

Oncologic Applications of Photodynamic Therapy, Including Barrett's Esophagus

Therapy | September 1, 2007

Intraoperative Radiotherapy

Therapy | December 1, 2011

Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions

Therapy | July 1, 1996

Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies

Therapy | July 1, 2013

Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early-Stage Breast Cancer

Therapy | July 1, 1996

Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds

Therapy | May 1, 2013

Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Therapy | July 1, 2013

Chemical Peels

Therapy | April 1, 1998

Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome

Therapy | February 1, 2011

Lysis of Epidural Adhesions

Therapy | November 1, 1998

Treatment of Hyperhidrosis

Therapy | July 24, 1999

Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas

Therapy | July 1, 2013

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms

Therapy | July 1, 2013

Allogeneic Hematopoietic Stem-Cell Transplantation for Genetic Diseases and Acquired Anemias

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

Therapy | July 1, 2013

Hematopoietic Stem Cell Transplantation for Autoimmune Diseases

Therapy | July 1, 2013

Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Breast Cancer

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Hodgkin Lymphoma

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia

Therapy | December 13, 2012

Autologous Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas

Therapy | July 1, 2013

Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia

Therapy | June 1, 2013

High-Dose Rate Temporary Prostate Brachytherapy

Therapy | May 1, 2013

Hematopoietic Cell Transplantation for Solid Tumors of Childhood

Therapy | May 1, 2014

Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors

Therapy | April 1, 2013

Extracorporeal Photopheresis

Therapy | August 2, 2000

Inhaled Nitric Oxide

Therapy | August 1, 2000

Treatment of Tinnitus

Therapy | August 23, 2001

Manipulation Under Anesthesia

Therapy | May 1, 2002

Interlukin 2 as a Treatment for HIV Infection

Prescription Drug | July 1, 1999

Hematopoietic Cell Transplantation for Primary Amyloidosis

Therapy | April 10, 2013

Radioembolization for Primary and Metastatic Tumors of the Liver

Therapy | October 1, 2003

Intradialytic Parenteral Nutrition

Therapy | December 1, 2003

Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain

Therapy | June 1, 2010

Intensity-Modulated Radiotherapy of the Breast and Lung

Therapy | August 1, 2012

Intensity-Modulated Radiotherapy of the Prostate

Therapy | August 1, 2012

Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid

Therapy | August 1, 2012

Intensity-Modulated Radiation Therapy (IMRT): Abdomen and Pelvis

Therapy | August 1, 2012

Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma

Therapy | December 11, 2012

Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used With Autologous Bone Marrow)

Therapy | April 1, 2013

Cellular Immunotherapy for Prostate Cancer

Therapy | June 1, 2010

Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia

Therapy | July 1, 2013

Stem-cell Therapy for Peripheral Arterial Disease

Therapy | May 1, 2013

Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis

Therapy | July 1, 2012

Baroreflex Stimulation Devices

Therapy | August 1, 2013

Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation

Therapy | August 1, 2013

Intensity-Modulated Radiotherapy: Central Nervous System Tumors

Therapy | September 1, 2012

Extracorporeal Membrane Oxygenation for Adult Conditions

Therapy | February 1, 2015

Focal Treatments for Prostate Cancer

Therapy | June 1, 2015

Electronic Brachytherapy for Nonmelanoma Skin Cancer

Therapy | June 1, 2015

Chimeric Antigen Receptor Therapy for Hematologic Malignancies

Medicine | November 1, 2019

Home Non-Invasive Positive Airway Pressure for Chronic Obstructive Pulmonary Disease

Medicine | January 1, 2022

Chimeric Antigen Receptor Therapy for Multiple Myeloma

Prescription Drug | June 1, 2021

Plasma Exchange (Plasmapheresis)

Therapy | December 6, 1995

Lipid Apheresis

Therapy | July 1, 1999

Functional Neuromuscular Electrical Stimulation , Robotic-assisted Rehabilitation & Robotic-assisted Orthotics

Therapy | March 15, 1996

Physical Therapy

Therapy | June 1, 2013

Occupational Therapy

Therapy | June 1, 2013

Speech Therapy

Therapy | June 1, 2013

Outpatient Pulmonary Rehabilitation

Therapy | July 6, 2005

Back School

Therapy | November 1, 1996

Cardiac Rehabilitation in the Outpatient Setting

Therapy | August 1, 2013

Vertebral Axial Decompression

Therapy | May 17, 1997

Cognitive Rehabilitation

Therapy | November 1, 1997

Endobronchial Brachytherapy

Therapy | March 1, 1999

Hippotherapy

Therapy | July 1, 1999

Sensory Integration Therapy and Auditory Integration Therapy

Therapy | April 1, 2000

Iontophoresis and Phonophoresis

Therapy | May 1, 2001

Evaluation of Hearing Impairment

Other | November 1, 1997

Keratoprosthesis

Other | March 1, 1996

Orthoptic Training for the Treatment of Vision or Learning Disabilities

Other | July 1, 1996

Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy

Other | November 1, 1997

Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma

Other | March 1, 2011

Phototherapeutic Keratectomy

Surgery | November 4, 1998

Photodynamic Therapy for Choroidal Neovascularization

Medicine | December 1, 2001

Photocoagulation of Macular Drusen

Other | July 1, 2008

Ocular Photoscreening in the Primary Care Physician's Office as a Screening Tool to Detect Amblyogenic Factors

Other | September 1, 2007

Retinal Telescreening for Diabetic Retinopathy

Other | November 1, 2004

Implantation of Intrastromal Corneal Ring Segments

Other | February 1, 2005

Retinal Prosthesis

Other | February 1, 2005

Optical Coherence Tomography of the Anterior Eye Segment

Other | September 1, 2008

Intraocular Radiation Therapy for Age-Related Macular Degeneration

Other | March 1, 2011

Aqueous Shunts and Devices for Glaucoma

Other | October 1, 2009

Endothelial Keratoplasty

Other | January 15, 2013

Intravitreal Corticosteroid Implants

Other | April 13, 2013

Intravitreal Angiogenesis Inhibitors for Choroidal Vascular Conditions

Prescription Drug | February 1, 2013

Gas Permeable Scleral Contact Lens

Other | February 1, 2013

Viscocanalostomy and Canaloplasty

Surgery | October 24, 2012

Intravitreal Angiogenesis Inhibitors for Retinal Vascular Conditions

Other | April 4, 2013

Corneal Collagen Cross-linking

Other | April 1, 2012

Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome

Other | August 1, 2013

Remote Electrical Neuromodulation for Migraines

Medicine | June 15, 2022

Antiemetics

Prescription Drug | July 1, 2022

Dry Hydrotherapy for Chronic Pain Condition

Medicine | July 1, 2022

Skilled Nursing Facility

Medicine | November 1, 2021

Complementary Content
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