Archive

Policy Name	Date Archived
picture_as_pdfCryosurgical Ablation and Radiofrequency Ablation of Renal Tumors	April 28, 2023
picture_as_pdfDonor Leukocyte Infusion	April 28, 2023
picture_as_pdfExperimental-Investigational Laboratory Services	April 28, 2023
picture_as_pdfLaboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease	April 28, 2023
picture_as_pdfMagnetic Esophageal Ring to Treat GERD	April 28, 2023
picture_as_pdfOvarian and Internal Iliac Vein Embolization Treatment for Pelvic Congestion Syndrome	April 28, 2023
picture_as_pdfProstate Specific Antigen	April 28, 2023
picture_as_pdfSelected Tests-Rheumatic Diseases	April 28, 2023
picture_as_pdfSerum Biomarker Panel Testing for Systemic Lupus	April 28, 2023
picture_as_pdfTranscutaneous Garments	April 28, 2023
picture_as_pdfWhole Exome and Genome Sequencing for Diagnosis and Genetic Disorders	April 28, 2023
picture_as_pdfLymphedema Treatments	May 30, 2023
picture_as_pdfBiochemical Markers of Bone Remodeling	December 8, 2023
picture_as_pdfOcular Photodynamic Therapy	December 8, 2023
picture_as_pdfAcne Treatment	December 8, 2023
picture_as_pdfPsychiatric Care Defined	December 8, 2023
picture_as_pdfCOVID-19 Testing and Coding Guidelines (Updated Sept. 13, 2022)	December 8, 2023
picture_as_pdfMedication Assisted Treatment for Opioid Use Disorder: Methadone	December 8, 2023
picture_as_pdfRadiofrequency Ablation and Cryosurgery of Primary or Metastatic Liver Tumors	December 8, 2023
picture_as_pdfRecombinant and Autologous Platelet-Derived Growth Factors for Wound Healing and Other Nonorthopedic Conditions	December 8, 2023
picture_as_pdfBalloon Ostial Dilation of the Sinus and Implantable Sinus Stents	December 8, 2023
picture_as_pdfEndovascular Procedures for Intracranial and Extracranial Cerebral Vascular Disease	December 8, 2023
picture_as_pdfHome Dialysis Equipment and Supplies	December 8, 2023
picture_as_pdfEsophageal pH Monitoring	December 8, 2023
picture_as_pdfProstate Cancer - Biopsy	December 8, 2023
picture_as_pdfBiometric Bone Void Filler	December 8, 2023
picture_as_pdfDiscography	December 8, 2023
picture_as_pdfProstate Cancer - Radiotherapy	December 8, 2023
picture_as_pdfIntra-Arterial/Intravenous Therapeutic Procedures	December 8, 2023
picture_as_pdfBioengineered Skin	December 8, 2023
picture_as_pdfSkin Replacement Therapy in Chronic Wounds	December 8, 2023
picture_as_pdfSpeech Therapy	December 8, 2023
picture_as_pdfSurgical Procedures, Multiple	December 8, 2023
picture_as_pdfOccupational Therapy (OT)	December 8, 2023
picture_as_pdfUltrasound - Obstetrical	December 8, 2023
picture_as_pdfEvidence-Based Practice, Recommendations	December 8, 2023
picture_as_pdfSeatlift Mechanisms	December 8, 2023
picture_as_pdfAmniotic Membrane and Amniotic Fluid	December 8, 2023
picture_as_pdfChromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP)	December 8, 2023
picture_as_pdfEustachian Tube Balloon Dilation	December 8, 2023
picture_as_pdfAcellular Dermal Matrix Grafts	December 8, 2023
picture_as_pdfArthrex Bovine Collagen	December 8, 2023
picture_as_pdfPacemaker - Leadless	December 8, 2023
picture_as_pdfPer-Oral Endoscopic Myotomy (POEM)	December 8, 2023
picture_as_pdfPhotodynamic Therapy - Dermatologic Applications	December 8, 2023
picture_as_pdfStandby Services	December 8, 2023
picture_as_pdfNoninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C	December 13, 2023
picture_as_pdfSupervised Exercise Therapy for Peripheral Artery Disease (PAD)	December 13, 2023