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Medical and Payment Policies



Name
Type
Ambulatory Blood Pressure Monitors Medical
Bariatric Surgery Medical
BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia Medical
BRCA1 and BRCA2 Genetic Mutation Testing and Related Genetic Counseling Medical
BRAF Mutation Analysis Medical
Breast Reconstruction Medical
Bronchial Thermoplasty Medical
Capsule Endoscopy Medical
Cardiac Rehabilitation, Phase II Outpatient Medical
Carpal Tunnel Medical
Chromosomal Microarray Analysis Medical
Cochlear Implants Medical
Colorectal Cancer Screening Medical
Custom Made Oral Appliances Medical
EGD Medical
Electrical Bone Growth Stimulators in Long Bones Medical
Electrical Bone Growth Stimulation-Spinal Medical
Enteral Feeding In-line Cartridge Medical
Fecal Transplant Medical
Fetal Aneuploidy Medical
Gender Transition Services Medical
Gene Expression Profiling in Tumor Tissue (Oncotype DX) Medical
Genetic Testing for Colorectal Cancer Susceptibility Medical
Genetic Testing for Cystic Fibrosis Medical
Genetic Testing for Warfarin Therapy Medical
Genetic Testing Panels Medical
Home Oxygen Therapy Medical
Hyperbaric Oxygen Therapy Medical
Implantable Cardioverter Defibrillator (ICD) Medical
Long‐Term Use Continuous Glucose Monitoring of Interstitial Fluid Medical
Macular Degeneration Medical
Maternal Genetic Testing Medical
Molecular Markers for Lung Cancer Medical
Molecular Markers Thyroid Medical
Negative Pressure Wound Therapy (NPWT) in the Outpatient Setting Medical
Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C Medical
Noninvasive Positive Pressure Ventilation Medical
Oncologic Genetic Panels Medical
Panniculectomy Medical
Passive Oscillatory Devices in the Outpatient Setting Medical
Place of Service Medical
Pulmonary Rehabilitation Medical
Single Use ECG Monitoring Medical
Skin Replacement Therapy in Chronic Wounds Medical
Supervised Exercise Therapy for Peripheral Artery Disease (PAD) Medical
Testing for Genetic Disease Medical
Transcranial Magnetic Stimulators Medical
Ultrasound Bone Growth Stimulators Medical
Wearable Cardioverter-Defibrillators Medical
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders Medical
Hypoglossal Nerve Stimulator Medical
Ambulance - Air Medical
Ambulance - Ground Medical
Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) Medical
Myoelectric Upper Extremity Orthoses Medical
Artificial Pancreas Medical
Percutaneous Left Atrial Appendage Medical
Deep Brain Stimulation Medical
Labiaplasty Medical
Scanning Computerized Ophthalmic Imaging Medical
Prostate Cancer Testing Medical
Upper Gastrointestinal Endoscopy Medical


Medical and Payment Policy:
Health Options Readmission Policy
Observation and Extended Assessment and Management in Facilities
Practitioner and Facility Emergency Department Policy


Post Service Claim Edit Policies
Brineura
Interleukin 5 Inhibitors
Lupron
Velcade