Advanced Approval Waiver

Administrative | May 1, 1995

Administrative Charges for Medical Services

Administrative | January 1, 1975

Allergy Immunotherapy

Medicine | October 15, 2000

Alternative Treatment Plan

Administrative | January 1, 1979

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

Assignment Guidelines and Assignment Conflicts

Administrative | May 1, 1992

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

Telemedicine

Medicine | March 6, 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

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

Somatostatin Analogs

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

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 and Testing

Laboratory | March 1, 2014

Discarded Drugs/Biologicals — Pharmaceutical Waste

Medicine | March 1, 2014

Breast Surgical Procedures/Prosthesis

Surgery | October 1, 1977

Coordination of Benefits (COB) Excluding Medicare, Workers Compensation and Subrogation

Administrative | January 1, 1975

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

Date Stamping of Claims

Administrative | March 1, 1991

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

Prescription Drug | March 1, 2015

Diagnostic Testing of Iron Homeostasis and 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

Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid

Prescription Drug | 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

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

Preimplantation 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 (Nongenetics)

Laboratory | January 1, 2016

Flow Cytometry

Laboratory | January 1, 2016

Vitamin D Testing

Laboratory | January 1, 2016

Hepatitis Testing

Laboratory | January 1, 2016

Biomarker Testing for Autoimmune Rheumatic Disease

Laboratory | January 1, 2016

Accident and Medical Emergency Services

Administrative | January 15, 1997

Vitamin B12 and Methylmalonic Acid Testing

Laboratory | January 1, 2016

Testosterone

Laboratory | January 1, 2016

Diabetes Mellitus Testing

Laboratory | January 1, 2016

Diagnostic Testing of Influenza

Laboratory | January 1, 2016

Thyroid Disease Testing

Laboratory | January 1, 2016

Epidural Spinal Injections

Therapy | February 1, 2016

Paravertebral Facet Joint Injections/Blocks

Surgery | 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

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

Hypothermia To Prevent/Reduce Hair Loss During Chemotherapy

Medicine | July 1, 2016

Evaluation of Dry Eyes

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

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

Prescription Drug | August 1, 2017

Daratumumab (Darzalex®) Injection

Prescription Drug | August 1, 2017

Medication Administration Site of Care

Prescription Drug | September 1, 2017

Fractional Flow Reserve CT

Radiology | October 1, 2017

Telehealth

Medicine | October 1, 2017

Radicava (edaravone injection)

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

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

Biomarkers for Myocardial Infarction and Chronic Heart Failure

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

Hyperbaric Oxygen Therapy

Medicine | December 1, 1995

Local or Whole Body Hyperthermia

Medicine | July 1, 2002

Hypnosis

Medicine | December 1, 1995

Dry Needling for Myofascial Pain

Surgery | August 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 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

Prescription Drug | February 1, 2013

Home Spirometry

Medicine | March 1, 1999

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

Chronic Intermittent Intravenous Insulin Therapy (CIIIT)

Therapy | November 1, 2001

Dermatologic Applications of Photodynamic 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

Low-Level Laser Therapy

Medicine | April 1, 2003

Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds

Surgery | July 1, 2003

Non-Pharmacologic Treatment of Rosacea

Medicine | February 1, 2011

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

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

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

Wearable Cardioverter-Defibrillators

Medicine | April 1, 2003

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

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

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 Vector-Borne 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

Administrative | 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™/Amvuttra™)

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

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

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 Testing for Fetal Aneuploidy

Laboratory | April 15, 2003

Molecular Testing for Cutaneous Melanoma

Laboratory | August 1, 2013

Genetic Testing for Germline Mutations of the RET Proto-Oncogene

Laboratory | November 1, 1997

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

Genetic Testing for Breast, Ovarian, Pancreatic and Prostate Cancers

Laboratory | July 1, 1997

Teprotumumab-trbw (Tepezza™)

Prescription Drug | February 1, 2021

Bezlotoxumab (Zinplava)

Prescription Drug | March 1, 2021

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

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

Molecular Diagnostics 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

Human Immunodeficiency Virus Testing

Laboratory | November 1, 1996

Venous and Arterial Thrombosis Risk Testing

Laboratory | April 1, 2013

Eptinezumab-jjmr (Vyepti™)

Medicine | May 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

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

Genetic Testing for Hereditary Hearing Loss

Laboratory | December 1, 2014

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

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

Mental Health | November 1, 2013

Identification of Microorganisms Using Nucleic Acid Probes

Laboratory | July 1, 1998

Genetic Testing for Li-Fraumeni Syndrome

Laboratory | July 1, 2014

Testing for Colorectal Cancer Management

Laboratory | June 1, 2009

Testing for Alpha-1 Antitrypsin Deficiency

Laboratory | May 1, 2013

Genetic Testing for Hereditary Pancreatitis

Laboratory | April 1, 2014

Genetic Testing for PTEN Hamartoma Tumor Syndrome

Laboratory | April 1, 2014

Chromosomal Microarray and Low-Pass Whole Genome Sequencing

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 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

Prostate Biopsy Specimen Analysis

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

Prescription Drug | 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

Lifetime Benefit Accumulations When Coverage Changes

Administrative | May 1, 1989

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

Nusinersen for Spinal Muscular Atrophy

Prescription Drug | March 1, 2017

Esketamine Nasal Spray for Treatment-Resistant Depression

Prescription Drug | 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

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

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 Uterine Fibroids Myolysis

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

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 (Zulresso®) for Postpartum Depression

Prescription Drug | August 1, 2019

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, Standby Physicians, Microsurgery/Microdissection)

Surgery | April 1, 1987

Timely Filing

Administrative | June 1, 1992

Bone Mineral Density Studies

Radiology | March 1, 2013

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

Radiology | February 1, 2013

Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy

Radiology | January 1, 1999

Thermography

Radiology | March 1, 1996

Scintimammography and Gamma Imaging of the Breast and Axilla

Radiology | January 1, 1998

Diagnosis and Non-Surgical Treatment of Sacroiliac Joint Pain

Radiology | February 1, 2013

Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine

Radiology | April 10, 2013

FDG Using Camera-Based Imaging (FDG-SPECT)

Radiology | August 1, 2000

Wireless Capsule Endoscopy for Gastrointestinal (GI) Disorders

Radiology | February 17, 2002

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

Radiology | February 1, 2012

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

Digital Breast Tomosynthesis

Radiology | July 1, 2011

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

Radiology | July 1, 2013

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 for Neuroendocrine Tumors

Therapy | June 1, 2019

Veterans Administration/Military Services

Administrative | June 17, 1996

Neck CTA

Radiology | January 1, 2020

MR Angiography Upper Extremity

Radiology | January 1, 2021

Acupuncture and Dry Needling

Surgery | November 12, 1998

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

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

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

Implantable Peripheral Nerve Stimulators for the Treatment of Chronic Pain

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 Uncontrolled 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

Amniotic Membrane and Amniotic Fluid Injections for Non-Ophthalmic Applications

Surgery | July 1, 2015

Meniscal Allografts and Other Meniscal Implants

Surgery | December 1, 1995

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, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy

Surgery | July 1, 2013

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

Intraoperative Neurophysiologic Monitoring

Surgery | January 24, 2013

Minimally Invasive Coronary Artery Bypass Graft Surgery

Other | June 1, 2011

Deep Brain Stimulation

Surgery | January 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 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

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

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

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 MRE MRU Abdomen

Radiology | January 1, 2020

Lower Extremity MRI (Foot, Ankle, Knee, Leg or Hip MRI)

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

CTA Aortogram with Runoff

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, Sella, Internal Auditory Canal 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 (Noncoronary)

Radiology | January 1, 2020

CT Chest (Thorax)

Radiology | January 1, 2021

Brain PET Scan

Radiology | January 1, 2021

PELVIS MRA/MRV (Angiography/Venography)

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

PET Scan

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

Heart (Cardiac) PET With CT for Attenuation

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

Prescription Drug | December 1, 1995

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

Prescription Drug | December 1, 1995

Immune Globulin Therapy

Prescription Drug | January 16, 2013

Oncologic Applications of Photodynamic Therapy, Including Barrett 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

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

Medicine | 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 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 Radiotherapy: Abdomen, Pelvis and Chest

Therapy | August 1, 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

Prescription Drug | November 1, 2019

Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and Failure

Medicine | January 1, 2022

Chimeric Antigen Receptor Therapy for Multiple Myeloma

Prescription Drug | June 1, 2021

Lipid Apheresis

Therapy | July 1, 1999

Functional Neuromuscular Electrical Stimulation, Robotic-Assisted Rehabilitation and 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

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

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

Photodynamic Therapy for Choroidal Neovascularization

Medicine | December 1, 2001

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

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 and Intracanalicular 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

Prescription Drug | 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

Prolia (Denosumab)

Prescription Drug | December 1, 2022

Remote Electrical Neuromodulation for Migraines

Medicine | June 15, 2022

Xgeva (Denosumab)

Prescription Drug | December 1, 2022

Antiemetics

Prescription Drug | July 1, 2022

Dry Hydrotherapy for Chronic Pain Condition

Medicine | July 1, 2022

Skilled Nursing Facility

Medicine | November 1, 2021

Genetic Markers for Assessing Risk of Cardiovascular Disease

Laboratory | August 3, 2022

Prenatal Screening (Genetic)

Laboratory | August 4, 2022

Fasenra benralizumab

Prescription Drug | December 1, 2022

Medical Management of Obstructive Sleep Apnea Syndrome

Medicine | August 18, 2022

Nexviazyme™ (avalglucosidase alfa-ngpt) Injection

Prescription Drug | December 1, 2022

Bimatoprost Implant (Durysta™)

Prescription Drug | December 1, 2022

Nulojix® (belatacept)

Prescription Drug | December 1, 2022

Vabysmo™ (faricimab-svoa)

Prescription Drug | December 1, 2022

Digital Health Technologies: Diagnostic Applications

Durable Medical Equipment | September 1, 2022

Therapeutic Radiopharmaceuticals for Prostate Cancer

Therapy | October 19, 2022

efgartigimod alfa -Vyvgart™ and Vyvgart Hytrulo (efgartigimod alfa/hyaluronidase-qvfc)

Prescription Drug | February 1, 2023

Nivolumab; Relatlimab-rmbw (Opdualag) injection

Prescription Drug | January 1, 2023

inclisiran (Leqvio®)

Prescription Drug | January 1, 2023

Gender Affirmation Surgery and Hormone Therapy

Therapy | January 15, 2023

Annular Closure Devices (e.g., BARRICAID®, XCLOSE®, INCLOSE™)

Durable Medical Equipment | January 1, 2023

Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Surgery | November 15, 2022

Betibeglogene autotemcel (Zynteglo®) (Intravenous)

Prescription Drug | January 1, 2023

Axillary Reverse Mapping for Breast Cancer-Related Lymphedema

Surgery | November 21, 2022

Elivaldogene autotemcel (Skysona) Suspension for Intravenous Infusion

Prescription Drug | January 1, 2023

Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders

Medicine | January 18, 2023

Biofeedback as a Treatment of Fecal Incontinence or Constipation

Medicine | December 1, 2003

Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia

Other | March 1, 2023

Coronary Artery Calcium Scoring by Electron-Beam Tomography (EBCT) OR Non-Contrast Coronary Computed Tomography (Non-Contrast CCT)

Radiology | February 6, 2023

Antisense oligonucleotides

Prescription Drug | February 21, 2023

Coronavirus Testing in the Outpatient Setting

Laboratory | May 1, 2023

Breast Cancer Radiation Oncology

Radiology | April 1, 2023

Hemgenix® (Etranacogene Dezaparvovec-Drlb)

Prescription Drug | March 20, 2023

Percutaneous Arteriovenous Fistula

Medicine | May 1, 2023

Colorectal Cancer Screening

Laboratory | April 24, 2023

Vascular Endothelial Growth Factor Inhibitors for Sickle Cell Retinopathy

Medicine | May 17, 2023

Digital Health Technologies: Therapeutic Applications

Mental Health | May 1, 2023

Minimally Invasive Ablation Procedures for Morton and Other Peripheral Neuromas

Therapy | July 24, 2023

Zilretta

Prescription Drug | July 1, 2023

Orthopedic Implants

Surgery | September 1, 2023

Phototherapy: PUVA, UV-B and Targeted Phototherapy

Medicine | September 1, 2023

Applied Behavioral Analysis Services

Mental Health | November 1, 2023

Trigger Point and Tender Point Injections

Medicine | November 1, 2023

Lumbar Artificial Disc Replacement

Surgery | October 16, 2023

Genomic Testing for Hematopoietic Neoplasms

Laboratory | November 1, 2023

Low-Dose CT for Lung Cancer Screening

Radiology | January 1, 2024

SACROILIAC JOINT FUSION

Surgery | November 1, 2023

Phrenic Nerve Stimulation for Central Sleep Apnea

Therapy | December 20, 2023

Heart (Cardiac) PET

Radiology | December 6, 2023

Briumvi (ublituximab)

Prescription Drug | December 1, 2023

Benlysta® (belimumab)

Prescription Drug | December 1, 2023

Evenity (romosozumab-aqqg)

Prescription Drug | December 1, 2023

Canakinumab (Ilaris®)

Prescription Drug | December 1, 2023

Tepilizumab-mzwv (Tzield)

Prescription Drug | December 1, 2023

Pharyngometry and Rhinometry

Other | February 1, 2024

Givosiran (Givlaari)

Prescription Drug | January 1, 2024

Lumasiran (Oxlumo)

Prescription Drug | January 1, 2024

Roctavian® (valoctocogene roxaparvovec-rvox)

Prescription Drug | January 1, 2024

Vyjuvek (beremagene geperpavec)

Prescription Drug | January 1, 2024

Leqembi™ (lecanemab-irmb)

Prescription Drug | January 1, 2024

Pegcetacoplan (Syfovre™)

Prescription Drug | February 1, 2024

Elevidys® (delandistrogene moxeparvovec-rokl)

Prescription Drug | February 1, 2024

Capsaicin patch (Qutenza®)

Prescription Drug | February 1, 2024

Allogeneic processed thymus tissue–agdc (Rethymic®)

Prescription Drug | February 1, 2024

Exagamglogene autotemcel (Casgevy)

Prescription Drug | February 1, 2024

Lyfgenia (lovotibeglogene autotemcel)

Prescription Drug | April 1, 2024

Ilumya (tildrakizumab-asmn)

Prescription Drug | April 1, 2024

Veopoz® (pozelimab-bbfg)

Prescription Drug | June 1, 2024

Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

Therapy | July 20, 2024

Intraosseous Radiofrequency Ablation (Intracept) Procedure

Surgery | July 17, 2024

Nplate (Romiplostim)

Prescription Drug | July 1, 2024

Beovu (Brolucizumab)

Prescription Drug | July 1, 2024

High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell's Palsy

Therapy | September 2, 2024

Complementary Content
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