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Claims and Medical Policies
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Medical Policies
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For Providers
Claims and Medical Policies
Medical Policies
Archive
Policy Name
Date Archived
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Cryosurgical Ablation and Radiofrequency Ablation of Renal Tumors
April 28, 2023
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Donor Leukocyte Infusion
April 28, 2023
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Experimental-Investigational Laboratory Services
April 28, 2023
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Laboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease
April 28, 2023
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Magnetic Esophageal Ring to Treat GERD
April 28, 2023
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Ovarian and Internal Iliac Vein Embolization Treatment for Pelvic Congestion Syndrome
April 28, 2023
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Prostate Specific Antigen
April 28, 2023
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Selected Tests-Rheumatic Diseases
April 28, 2023
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Serum Biomarker Panel Testing for Systemic Lupus
April 28, 2023
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Transcutaneous Garments
April 28, 2023
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Whole Exome and Genome Sequencing for Diagnosis and Genetic Disorders
April 28, 2023
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Lymphedema Treatments
May 30, 2023
2022
Open
Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms - July 27, 2022
Biometric Bone Void Filler - July 27, 2022
Discography - July 27, 2022
Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia - July 27 2022
Hematopoietic Cell Transplantation for Acute Myeloid Leukemia - July 27, 2022
Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer - July 27, 2022
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma - July 27, 2022
Hematopoietic Cell Transplantation for Hodgkin Lymphoma - July 27, 2022
Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults - July 27, 2022
Hematopoietic Cell Transplantation for Multiple Myeloma and POEMS Syndrome - July 27, 2022
Hematopoietic Cell Transplantation for Primary Amyloidosis - July 27, 2022
Treatment of Acne - Aug. 24, 2022
Obstetrical Ultrasound - Oct. 26, 2022
Seat Lift Mechanisms - Oct. 26, 2022
Electromagnetic Navigational Bronchoscopy - Nov. 30, 2022
Hydrogel Spacer use During Radiotherapy for Prostate Cancer - Nov. 30, 2022
Multiple Surgical Procedures - Nov. 30, 2022
Ocular Photodynamic Therapy - Nov. 30, 2022
Recommendations for Evidence-Based Practice - Nov. 30, 2022
Saturation Biopsy for Diagnosis and Staging of Prostate Cancer - Nov. 30, 2022
Speech Therapy - Nov. 30, 2022
Standby Services (z-32) - Dec. 27, 2022
Dermatologic Applications of Photodynamic Therapy (s-71) - Dec. 28, 2022
Leadless Cardiac Pacemaker (s-267) - Dec. 28, 2022
Pre-Oral Endoscopic Myotomy (POEM) (s-269) - Dec. 28, 2022