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#
3D Rendering on CT/MRI/US
A
Acupuncture Therapy
Ankle Arthroplasty
Artificial Disc Replacement
Autologous Chondrocyte Implantation and MACI
B
Back Pain Procedures - Epidural Injections
Back Pain Procedures - Radiofrequency Ablation, Facet Joint and Other Injections
Back Pain - Sacroiliac Joint and Coccydynia Treatments
Bariatric Surgery
Biofeedback Treatments and Devices
Blepharoplasty, Blepharoptosis, and Brow Lift
Bone Growth Stimulators
C
Capsule Endoscopy
Cartilage Transfer Procedures: OATS and Mosaicplasty
Cell-Free Fetal DNA Testing
Chiropractic Services
Cochlear Implants Bone Anchored Hearing Aids
Corneal Treatments and Specialized Contact Lenses
Cranial Orthotic Device
D
Deep Brain Stimulation and Responsive Cortical Stimulation
F
Fecal Microbiota Transplant
G
Gastrointestinal (GI) Pathogen Testing
Gender Dysphoria Treatment
Glaucoma Surgical Treatments
H
Hip Replacement Surgery
Hyperbaric Oxygen Therapy
I
Infertility and Recurrent Pregnancy Loss Testing and Treatment
K
Knee Replacement Surgery
M
Meniscal Allograft Transplantation
Microprocessor Controlled and Myoelectric Limb Prosthesis
N
Negative Pressure Wound Therapy
Neuropsychological Testing
New-to-Market Medication List
New-to-Market Medication Policy
Non-Covered Services and Procedures
O
Otoplasty and Reconstruction of External Ear
P
Panniculectomy, Abdominoplasty, and Repair of Diastasis Recti
Pectus Excavatum, Pectus Carinatum, and Poland Syndrome Treatment
Pneumatic Compression Devices
Pulmonary Artery Pressure Monitoring (CardioMEMS)
R
Reduction Mammoplasty for Symptomatic Macromastia
S
Septoplasty and Rhinoplasty
Shoulder Replacement Surgery
Sleep Disorder Testing
Sleep Disorder Treatment (Oral Appliances and PAP devices)
Spinal Cord and Peripheral Nerve Stimulators
Surgical Removal of Redundant Skin and Face/Neck Lift Procedures
T
Telehealth, Telemedicine (Temporary Medical Policy)
Tumor Treating Fields (Alternating Electric Field Therapy)
U
Urine Drug/Alcohol Screening and Testing
V
Varicose Vein Treatments
W
Wearable Cardiac Defibrillator Vest
Whole Exome Sequencing (WES) and Whole Genome Sequencing (WGS)
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