Allergy Immunotherapy
Medicine | October 15, 2000
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
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
Measurement of Thromboxane Metabolites for Aspirin Resistance
Laboratory | January 1, 2013
Telemedicine
Medicine | March 6, 2013
Unicompartmental and Bicompartmental Knee Arthroplasties
Surgery | June 1, 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
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
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
Pembrolizumab (Keytruda)
Prescription Drug | November 1, 2014
Women's Preventive Services
Medicine | June 1, 2015
Alemtuzumab (Lemtrada)
Prescription Drug | March 1, 2015
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
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
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
Pre-implantation 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
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
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
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
Quantose Impaired Glucose Tolerance (IGT) Test
Laboratory | July 1, 2016
Hypothermia To Prevent/Reduce Hair Loss During Chemotherapy
Medicine | July 1, 2016
InflammaDry Test
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
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
Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence
Medicine | 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
Intravascular Brachytherapy for Preventing and Managing Restenosis After Percutaneous Transluminal Angioplasty (PTA)
Medicine | July 1, 1999
T-Wave Alternans
Medicine | December 23, 2000
Wearable Cardioverter-Defibrillators
Medicine | April 1, 2003
Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis
Medicine | July 1, 2003
Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia
Medicine | April 1, 2004
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
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
Vectra DA Blood Test for Rheumatoid Arthritis
Laboratory | May 1, 2014
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
Laboratory | August 1, 2013
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
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
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
Laboratory | April 1, 2020
Trastuzumab
Prescription Drug | April 4, 2013
Maternity/Obstetrical Care Benefits
Other | July 1, 1998
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
Pain Management Services (Chronic Pain and Rehabilitation Therapies)
Medicine | June 1, 1987
Registered Nurses Practicing in Extended Roles
Other | May 1, 1993
Inpatient Rehabilitation
Therapy | August 1, 1995
Drug Coverage
Prescription Drug | January 1, 1980
Laboratory/Pathology Services
Laboratory | April 1, 1997
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
Bevacizumab in Advanced Adenocarcinoma of the Pancreas
Prescription Drug | August 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 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
Salivary Hormone Testing
Laboratory | December 1, 2005
Surgical Guidelines (Secondary, Multiple Procedures, Co-Surgeons, Assistant Surgeons, Standby Physicians, Microsurgery/Microdissection)
Surgery | April 1, 1987
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
Videofluoroscopic Evaluation of Velopharyngeal Dysfunction
Radiology | July 17, 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
Percutaneous Vertebroplasty and Sacroplasty
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
Percutaneous Balloon Kyphoplasty and Mechanical Vertebral Augmentation
Radiology | May 1, 2013
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
Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer Disease
Radiology | July 1, 2012
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
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
Wireless Pressure Sensors in Endovascular Aneurysm Repair
Surgery | July 1, 2008
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 Resistant 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
Endovascular Therapies for Extracranial Vertebral Artery Disease
Surgery | March 1, 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
Vagus Nerve Blocking Therapy for Treatment of Obesity
Surgery | September 1, 2016
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 (PENS) and Percutaneous Neuromodulation Therapy (PNT)
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 Annuloplasty and 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
Thermal Capsulorrhaphy as a Treatment of Joint Instability
Surgery | July 2, 2002
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
Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
Therapy | December 11, 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
Medicine | 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
Hippotherapy
Therapy | July 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
Retinal Prosthesis
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 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
Ocriplasmin for Symptomatic Vitreomacular Adhesion
Prescription Drug | September 29, 2013
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®)
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