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A
Abatacept (Orencia®)
ABDOMEN MRA (Angiography)
Abdominoplasty, Panniculectomy and Lipectomy
Ablation of Peripheral Nerves to Treat Pain
Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early-Stage Breast Cancer
Acoustic Cardiography
Actigraphy
Acupuncture and Dry Needling
Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast
Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses
Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER-2 Positive Malignancies
Adoptive Immunotherapy
Advanced Therapies for Pharmacologic Treatment of Pulmonary Hypertension
Aerosolized Antibiotics as a Treatment of Chronic Sinusitis
Air Fluidized Beds
Alcohol Injections for Treatment of Peripheral Neuromas
Alemtuzumab (Lemtrada)
Allergen Testing
Allergy Immunotherapy
Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
Allogeneic Hematopoietic Stem-Cell Transplantation for Genetic Diseases and Acquired Anemias
Allogeneic Pancreas Transplant
Ambulance and Medical Transport Services
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
Ambulatory or Video Electroencephalogram (EEG) Monitoring, Including Digital Analysis of Electroencephalogram
Amniotic Membrane and Amniotic Fluid Injections for Non Ophthalmic Applications
Amniotic Membrane and Limbal Stem Cell Transplantation for the Treatment of Ocular Conditions
ANA/ENA Testing
Anesthesia Services
Angelchik™ Anti-Reflux Prosthesis
Antineoplaston Therapy and Sodium Phenylbutyrate
Aqueous Shunts and Devices for Glaucoma
Arthroscopic Debridement and Lavage as Treatment for Osteoarthritis of the Knee
Artificial Pancreas Device Systems
Auditory Brainstem Implant
Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
Autologous Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas
Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients With Elevated Office Blood Pressure
Automated Point-of-Care Nerve Conduction Tests
Autonomic Nervous System Testing
Avelumab (Bavencio®)
Axial Lumbosacral Interbody Fusion
B
Back School
Balloon Dilation of the Eustachian Tube
Balloon Ostial Dilation for Treatment of Chronic and Recurrent Acute Rhinosinusitis
Bariatric Surgery
Baroreflex Stimulation Devices
BCR-ABL1 Testing
Belinostat (Beleodaq)
Beta Amyloid Imaging with Positron Emission Tomography (PET) for Alzheimer's Disease
Bevacizumab in Advanced Adenocarcinoma of the Pancreas
Bevacizumab (Avastin) for Oncologic Use
Biochemical Markers of Alzheimer Disease and Dementia
Biofeedback as a Treatment of Chronic Pain
Biofeedback as a Treatment of Fecal Incontinence or Constipation
Biofeedback as a Treatment of Headache
Biofeedback as a Treatment of Urinary Incontinence in Adults
Biofeedback for Miscellaneous Indications
Bioimpedance Devices for Detection and Management of Lymphedema
Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases
BioZorb®
Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Blepharoplasty (Upper and Lower)
Blinatumomab (Blincyto)
Bone Mineral Density Studies
Bone Morphogenetic Protein
Bone Turnover Markers Testing
Botulinum Toxin
Bowel Management Devices
Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds
Brain Natriuretic Peptide (BNP)
Brain PET Scan
Brain (Head) MRA/MRV
Brain (Head) MRS
BRCA
Breast Duct Endoscopy
Breast Pumps
Breast Surgical Procedures/Prosthesis
Brexanolone for Postpartum Depression
BRINEURA (cerliponase alfa)
Bronchial Thermoplasty
Bronchial Valves
Bulking Agents for the Treatment of Vocal Cord Paralysis
Buprenorphine Implant for Treatment of Opioid Dependence
C
Cardiac Applications of PET Scanning
Cardiac Biomarkers for Myocardial Infarction
Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
Cardiac Rehabilitation in the Outpatient Setting
Cardiovascular Disease Risk Assessment
Catheter Ablation as Treatment for Atrial Fibrillation
Catheter Ablation for Cardiac Arrhythmias
CD 5 Complement Inhibitors
Celiac Disease Testing
Cell Transplantation (Mesencephalic, Adrenal-Brain and Fetal Xenograft)
Cellular Immunotherapy for Prostate Cancer
Cemiplimab-rwlc (Libtayo®)
Cerebral Perfusion Analysis CT
Cervical Cancer Screening Technologies with Pap and HPV
Cervical Spine Procedures
Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions
Chelation Therapy for Off-Label Uses
Chemical Peels
Chemotherapy Drugs and the Administration by Physicians for the Treatment of Cancer
Chimeric Antigen Receptor Therapy for Hematologic Malignancies
Chiropractic Services
Chromoendoscopy as an Adjunct to Colonoscopy
Chromosomal Microarray
Chronic Intermittent Intravenous Insulin Therapy (CIIIT)
Chronic Pulmonary Thromboendarterectomy
Cimzia® (certolizumab pegol)
Clinical Trials for Cancer and Life-Threatening Conditions
Cochlear Implant
Cognitive Rehabilitation
Colorectal Cancer Screening
Composite Tissue Allotransplantation of the Hand and Face
Computed Tomography to Detect Coronary Artery Calcification
Computer-Assisted Navigation for Orthopedic Procedure
Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease
Concurrent Care
Confocal Laser Endomicroscopy
Conjunctival Incision with Posterior Juxtascleral Placement of Anecortave Acetate Depot Suspension
Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
Continuous Passive Motion (CPM) in the Home Setting
Contraceptive Management
Cooling Devices Used in the Outpatient Setting
Corneal Collagen Cross-linking
Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy
Corporate Administrative/Medical Policy Guidelines (Medical Necessity, Investigational/Experimental)
Cosmetic/Reconstructive Services
COVID-19 Testing
Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation
Crizanlizumab-tmca (Adakveo)
Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate Tumors or Dermatologic Tumors
Cryosurgical Ablation of Primary or Metastatic Liver Tumors
CT Abdomen
CT Abdomen and Pelvis
CT Angiography, Abdomen
CT Angiography, Abdomen and Pelvis
CT Angiography, Abdominal Arteries
CT Angiography, Chest (non coronary)
CT Angiography, Head/Brain
CT Angiography, Neck
CT Angiography, Pelvis
CT Angiography, Upper Extremity
CT Bone Density Study
CT Cervical Spine
CT Chest (Thorax)
CT Head/Brain
CT Heart
CT Lower Extremity (Ankle, Foot, Hip or Knee)
CT Lumbar Spine
CT Pelvis
CT Soft Tissue Neck
CT Thoracic Spine
CT Upper Extremity
CT (Virtual) Colonoscopy
CTA Coronary Arteries (CCTA)
Cutaneous Electrogastrography (EGG)
D
Daily Hemodialysis and Hemodialysis in the Home Setting
Daratumumab (Darzalex®) Injection
Decompression of the Intervertebral Disc Using Laser (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty™)
Deep Brain Stimulation
Dermatologic Applications of Photodynamic Therapy
Desensitization Treatment for Peanut Allergies
Diagnosis and Management of Idiopathic Environmental Intolerance (i.e., Clinical Ecology)
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis
Diagnosis and Treatment of Non-Surgical Sacroiliac Joint Pain
Diagnosis of Vaginitis including Multi-target PCR Testing
Diagnostic Testing of Influenza
Diagnostic Testing of Iron Homeostasis & Metabolism
Diagnostic Testing of Most Common Sexually Transmitted Infections
Digital Breast Tomosynthesis
Discarded Drugs/Biologicals - Pharmaceutical Waste
DNA Ploidy Cell Cycle Analysis
Donor Lymphocyte Infusion for Malignancies Treated With an Allogeneic Hematopoietic Cell Transplant
Dopamine Transporter Imaging with Single Photon Emission Computed Tomography (DAT-SPECT)
Drug Coverage
Dry Needling and Trigger Point Injections for Myofascial Pain
Durable Medical Equipment (DME)
Dynamic Cardiomyoplasty
Dynamic Posturography
Dynamic Spinal Visualization
E
Electrical and Electromagnetic Stimulation for the Treatment of Arthritis
Electrical Bone Growth Stimulation of the Appendicular Skeleton
Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
Electromagnetic Navigation Bronchoscopy
Electronic Brachytherapy for Nonmelanoma Skin Cancer
Electrophrenic Pacemaker
Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds
Emapalumab-lzsg (Gamifant)
End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema
Endobronchial Brachytherapy
Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer
Endometrial Ablation
Endoscopic Injection Sclerotherapy for Esophageal Varices
Endoscopic Laser for Gastrointestinal Bleeding
Endoscopic Radiofrequency Ablation or Cryoablation for Barrett's Esophagus
Endothelial Keratoplasty
Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
Endovascular Stent Grafts for Abdominal Aortic Aneurysms
Endovascular Stent Grafts for Disorders of the Thoracic Aorta
Endovascular Therapies for Extracranial Vertebral Artery Disease
Enhanced External Counterpulsation (EECP)
Enteral Carbidopa and Levodopa Intestinal Gel Suspension
Enteral Feeding In-Line Cartridge (EFIC™)/Immobilized Lipase Cartridge/Relizorb™
Epithelial Cell Cytology in Breast Cancer Risk Assessment and High-Risk Patient Management (Ductal Lavage and Suction Collection Systems)
Erectile Dysfunction
Erythopoiesis Stimulating Agents and Darbepoetin Alfa (Aranesp)
Esketamine Nasal Spray for Treatment-Resistant Depression
Esophageal Pathology Testing
Esophageal pH Monitoring
Eteplirsen for Duchenne Muscular Dystrophy
Evaluation of Hearing Impairment
Extended-Release Injectable (Sublocade)
External Insulin Infusion Pump
Extracorporeal Immunoadsorption Using Protein A Columns
Extracorporeal Membrane Oxygenation for Adult Conditions
Extracorporeal Photopheresis
Extracorporeal Shock Wave Therapy in the Treatment of Peyronie's Disease
Extracorporeal Shock Wave Treatment for Plantar Faciitis and Other Musculoskeletal Conditions
Extracranial Carotid Angioplasty/Stenting
Eye Movement Desensitization and Reprocessing (EMDR) Therapy
Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome
F
Facet Arthroplasty
FDG Using Camera-Based Imaging (FDG-SPECT)
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing
Fecal Microbiota Transplantation
Fetal MRI
Fetal Surgery for Prenatally Diagnosed Malformations
Flow Cytometry
Focal Treatments for Prostate Cancer
Folate Testing
Fractional Flow Reserve CT
Functional MRI Brain
Functional Neuromuscular Electrical Stimulation , Robotic-assisted Rehabilitation & Robotic-assisted Orthotics
G
Gait Analysis
Gamma-glutamyl Transferase
Gas Permeable Scleral Contact Lens
Gastric Electrical Stimulation
Gender Reassignment Surgery
Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
Gene Expression Testing for Breast Cancer Prognosis
Gene Therapy for Inherited Retinal Dystrophy/Luxturna™
General Genetic Testing, Germline Disorders
General Genetic Testing, Somatic Disorders
General Inflammation Testing
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma
Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma
Genetic Testing for Acute Myeloid Leukemia
Genetic Testing for Adolescent Idiopathic Scoliosis
Genetic Testing for Alpha- and Beta-Thalassemia
Genetic Testing for Alzheimer’s Disease
Genetic Testing for CHARGE Syndrome
Genetic Testing for Connective Tissue Disorders
Genetic Testing for Cystic Fibrosis
Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies
Genetic Testing for Epilepsy
Genetic Testing for Familial Cutaneous Malignant Melanoma
Genetic Testing for Fanconi Anemia
Genetic Testing for FMR1 mutations (including Fragile X Syndrome)
Genetic Testing for Germline Mutations of the RET Proto-Oncogene
Genetic Testing for Hereditary Hearing Loss
Genetic Testing for Hereditary Hemochromatosis
Genetic Testing for Hereditary Pancreatitis
Genetic Testing for Heterozygous Familial Hypercholesterolemia
Genetic Testing for Inherited Cardiomyopathies and Channelopathies
Genetic Testing for Lactase Insufficiency
Genetic Testing for Li-Fraumeni Syndrome
Genetic Testing for Lipoprotein A Variant as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment
Genetic Testing for Mental Health Conditions
Genetic Testing for Neurodegenerative Disorders
Genetic Testing for Neurofibromatosis and Related Disorders
Genetic Testing for Ophthalmologic Conditions
Genetic Testing for Polyposis Syndromes
Genetic Testing for PTEN Hamartoma Tumor Syndrome
Genetic Testing for Rett Syndrome
Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
Genetic Testing of CADASIL Syndrome
Genetic Testing of Mitochondrial Disorders
Genicular Nerve Blocks and Ablation for Chronic Knee Pain
Golimumab (Simponi) for subcutaneous use
H
H-wave Electrical Stimulation
Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery
Heart Transplant
Heart/Lung Transplant
Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia
Hematopoietic Cell Transplantation for Breast Cancer
Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer
Hematopoietic Cell Transplantation for Hodgkin Lymphoma
Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults
Hematopoietic Cell Transplantation for Primary Amyloidosis
Hematopoietic Cell Transplantation for Solid Tumors of Childhood
Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia
Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors
Hematopoietic Colony-Stimulating Factors (CSFs)
Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas
Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia
Hematopoietic Stem Cell Transplantation for Autoimmune Diseases
Hemoglobin A1c
Hepatitis C testing
Hereditary Angioedema Drug Therapy
High-Dose Rate Temporary Prostate Brachytherapy
Hip Resurfacing
Hippotherapy
HIV Genotyping and Phenotyping
Home Cardiorespiratory Monitoring
Home Health Services Policy
Home Phototherapy for Neonatal Jaundice
Home Prothrombin Time Monitoring
Home Spirometry
Home Uterine Activity Monitoring
Hospice Care
Hospital Medical Services (Inpatient and Observation) and Consultation
Human Antihemophilic Factor (AHF)
Human Growth Hormone
Human Papillomavirus (HPV) Vaccines
Hyperbaric Oxygen Therapy
HYPERTHERMIA With Radiation
Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Hypnosis
Hypothermia to Prevent/Reduce Hair Loss During Chemotherapy
I
Identification of Microorganisms Using Nucleic Acid Probes
Ilizarov Bone-Lengthening Procedure
Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis
Imfinzi (durvalumab)
Immune Cell Function Assay
Immune Globulin Therapy
Immune Prophylaxis for Respiratory Syncytial Virus
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies
Implantable Bone Conduction and Bone Anchored Hearing Aids
Implantable Cardioverter Defibrillator (ICD)
Implantable Hormone Pellets for Females
Implantable Infusion Pump for Pain and Spasticity
Implantation of Intrastromal Corneal Ring Segments
In Vitro Chemoresistance and Chemosensitivity Assays
Incapacitated Dependent Coverage
InflammaDry Test
Infliximab
Influenza Vaccine
Ingestible pH and Pressure Capsule
Inhaled Nitric Oxide
Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence
Injectable Clostridial Collagenase for Fibroproliferative Disorders
Inpatient Intestinal Rehabilitation Therapy
Inpatient Rehabilitation
Insulin Potentiation Therapy
Intensity-Modulated Radiation Therapy (IMRT): Abdomen and Pelvis
Intensity-Modulated Radiotherapy of the Breast and Lung
Intensity-Modulated Radiotherapy of the Prostate
Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid
Intensity-Modulated Radiotherapy: Central Nervous System Tumors
Interferential Current Stimulation
Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment
Interlukin 2 as a Treatment for HIV Infection
Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
Interspinous Fixation (Fusion) Devices
Interventions for Progressive Scoliosis
Intra-Articular Hyaluronan Injections for Osteoarthritis
Intracardiac Ischemia Monitoring
Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain
Intracellular Micronutrient Analysis
Intracoronary Doppler Ultrasound
Intradialytic Parenteral Nutrition
Intraocular Radiation Therapy for Age-Related Macular Degeneration
Intraoperative Neurophysiologic Monitoring
Intraoperative Radiotherapy
Intravascular Brachytherapy for Preventing and Managing Restenosis after Percutaneous Transluminal Angioplasty (PTA)
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders
Intravenous Antibiotic Therapy for Lyme Disease
Intravitreal Angiogenesis Inhibitors for Choroidal Vascular Conditions
Intravitreal Angiogenesis Inhibitors for Retinal Vascular Conditions
Intravitreal Corticosteroid Implants
Iontophoresis and Phonophoresis
Ipilimumab (Yervoy)
Islet Cell Transplantation
Isolated Limb Perfusion/Infusion for Malignant Melanoma
Isolated Small Bowel Transplant
J
K
Keratoprosthesis
Ketogenic Diet as a Treatment of Refractory Epilepsy
Kidney Transplant
Knee Braces, Orthopaedic Casts, Splints
KRAS, NRAS, and BRAF Mutation Analysis in Metastatic Colorectal Cancer
L
Laboratory Guideline Policy
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease
Laboratory/Pathology Services
Laparoscopic, Percutaneous and Transcervical Techniques for the Myolysis of Uterine Fibroids
Laser-Assisted Tonsillectomy
Laser Treatment of Active Acne
Laser Treatment of Onychomycosis
Laser Treatment of Port Wine Stain
Light Therapy for Dermatologic Conditions
Lipid Apheresis
Liquid Biopsy
Liver Transplant and Combined Liver-Kidney Transplant
Local or Whole Body Hyperthermia
Low-Level Laser Therapy
Low Field MRI
Lower Extremity CTA/CTV
LOWER EXTREMITY MRA/MRV
Lumbar Spinal Procedures
Lung and Lobar Lung Transplant
Lung Volume Reduction Surgery for Severe Emphysema
Lyme Disease Testing
Lynch Syndrome Testing
Lysis of Epidural Adhesions
M
Magnetic Resonance‒Guided Focused Ultrasound
Magnetoencephalography/Magnetic Source Imaging
Manipulation Under Anesthesia
Maternity/Obstetrical Care Benefits
Measurement of Thromboxane Metabolites for Aspirin Resistance
Medical Policy Development and Review
Medical Records Documentation Standards
Medication Administration Site of Care
Melanoma Vaccines
Meniscal Allografts and Other Meniscal Implants
Mental Health Services
Mepolizumab (Nucala®)
Metabolite Markers of Thiopurines Testing
Methadone Treatment for Opiate Addiction
Microprocessor-Controlled Prosthetic for the Lower Limb
Microwave Tumor Ablation
Minimal Residual Disease
Minimally Invasive Coronary Artery Bypass Graft Surgery
Minimally Invasive Hip and Knee Arthroplasty
Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography
Mitomycin for Pyelocalyceal Solution (Jelmyto)
Molecular Analysis for Gliomas
Molecular Markers in Fine Needle Aspirates of the Thyroid
Molecular Panel Testing of Cancers for Diagnosis, Prognosis, and Identification of Targeted Therapy
Molecular Profiling for Cancers of Unknown Primary Origin
Molecular Testing for Chronic Heart Failure and Heart Transplant
Molecular Testing of Pulmonary Specimens
Monoclonal Antibody Therapies for Migraine Prevention
MR Angiography Chest
MR Angiography Spinal Canal
MR Angiography Upper Extremity
MRI Bone Marrow
MRI Brain (includes Internal Auditory Canal)
MRI Breast
MRI Cervical Spine
MRI Chest (Thorax)
MRI Heart
MRI Lower Extremity (Ankle, Foot, Knee, Hip, Leg) (Joint and other than joint)
MRI Lumbar Spine
MRI MRCP Abdomen
MRI Pelvis
MRI Pelvis
MRI Temporomandiublar Joint (TMJ)
MRI Thoracic Spine
MUGA Scan
Multianalyte Assays with Algorithmic Analyses for Predicting Risk of Type 2 Diabetes
Multigene Expression Assay for Predicting Recurrence in Colon Cancer
Multispectral Digital Skin Lesion Analysis
Mutation Analysis in Myeloproliferative Neoplasms
Myocardial Perfusion Imaging (Nuc Card)
Myocardial Strain Imaging
Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure
Myoelectric Prosthesis Components for the Upper Limb
N
Natalizumab (Tysabri®)
NECK MRA/MRV
Negative Pressure Wound Therapy in the Outpatient Setting
Nerve Fiber Density Testing
Nerve Graft with Radical Prostatectomy
Neural Therapy
Neurofeedback
Neuromuscular Electrical Stimulation (NMES)
NEUTRON BEAM THERAPY (NBT)
Nivolumab (Opdivo)
Non-contact Ultrasound Treatment of Wounds
Non-Pharmacologic Treatment of Rosacea
Noncontact Radiant Heat Bandage for the Treatment of Wounds
Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease
Nusinersen for Spinal Muscular Atrophy
Nutrient/Nutritional Panel Testing
O
Occipital Nerve Stimulation
Occlusion of Uterine Arteries Using Transcatheter Embolization
Occupational Therapy
Ocrelizumab (Ocrevus™)
Ocriplasmin for Symptomatic Vitreomacular Adhesion
Octreotide Acetate (Sandostatin)
Ocular Photoscreening in the Primary Care Physician's Office as a Screening Tool to Detect Amblyogenic Factors
Olaratumab (Lartruvo)
Omalizumab (Xolair®)
Oncologic Applications of Interleukin-2 (Aldesleukin) When Used as Monotherapy
Oncologic Applications of PET Scanning
Oncologic uses of Interferon Therapy
Onychomycosis Testing
Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma
Opioid Antagonists Under Heavy Sedation or General Anesthesia as a Technique of Opioid Detoxification
Optical Coherence Tomography for Imaging of Coronary Arteries
Optical Coherence Tomography of the Anterior Eye Segment
Oral Screening, Lesion Identification Systems and Genetic Screening
ORBIT, FACE, NECK, SINUS MRI
Orthodontic Treatment
Orthognathic Surgery
Orthopedic Applications of Platelet-Rich Plasma
Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used With Autologous Bone Marrow)
Orthoptic Training for the Treatment of Vision or Learning Disabilities
Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions
Outpatient Pulmonary Rehabilitation
Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome
Oxygen Therapy
P
Pain Management Services (Chronic Pain and Rehabilitation Therapies)
Pancreatic Cancer Risk Testing Using Molecular Classifier in Pancreatic Cyst Fluid
Pancreatic Enzyme Testing for Acute Pancreatitis
Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain
Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing
Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis)
Paravertebral Facet Joint Injections/Blocks
PARSABIV™ (etelcalcetide)
Partial Left Ventriculectomy
Pathogen Panel Testing
Patient-Controlled Analgesia
Patient-Controlled End of Range Motion Stretching Devices
Patient-Specific Instrumentation (eg, Cutting Guides) for Joint Arthroplasty
Pegloticase (Krystexxa)
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
PELVIS MRAngiography
Pembrolizumab (Keytruda)
Percutaneous Balloon Kyphoplasty and Mechanical Vertebral Augmentation
Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty
Percutaneous Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Percutaneous Tibial Nerve Stimulation
Percutaneous Treatment of Fracture Non-Unions or Bone Defects with Autologous Bone Marrow with or without Demineralized Bone Matrix (DBM)
Percutaneous Vertebroplasty and Sacroplasty
Peripheral Subcutaneous Field Stimulation
Periureteral Bulking Agents for the Treatment of Vesicoureteral Reflux (VUR)
Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
Pertuzumab for Treatment of Malignancies
Pharmacogenetic Testing
Pharmacologic Treatment of Hereditary Transthyretin-Mediated Amyloidosis (Onpattro™/Tegsedi™)
Photocoagulation of Macular Drusen
Photodynamic Therapy for Choroidal Neovascularization
Phototherapeutic Keratectomy
Physical Therapy
Placental and Umbilical Cord Blood as a Source of Stem Cells
Plasma Exchange (Plasmapheresis)
Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection
Plugs for Fistula Repair
Pneumatic Compression Pumps for Treatment of Lymphedema
Polysomnography for Non‒Respiratory Sleep Disorders
Positional Magnetic Resonance Imaging (MRI)
Positron Emission Mammography (PEM)
Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities
Pre-implantation Genetic Testing
Prenatal Genetic and Chromosomal Metabolic Testing
Prenatal Screening
Prenatal Screening for Fetal Aneuploidy
Prescription Digital Therapeutics for Substance Abuse
Prescription Medication and Illicit Drug Testing in the Outpatient Setting
Preventive Services for Non-Grandfathered (PPACA) Plans: Behavioral Counseling for Prevention
Preventive Services for Non-Grandfathered (PPACA) Plans: USPSTF recommended services
Preventive Services for Non Grandfathered (PPACA) Plans: Immunizations
Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia
Progesterone Therapy as a Technique to Reduce Preterm Delivery in High-Risk Pregnancies
Prolotherapy
Proteogenomic Testing of Individuals with Cancer
Q
Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder
Quantitative Sensory Testing
Quantose Impaired Glucose Tolerance (IGT) Test
R
Radiation Oncology Services
Radiation Therapy forNon-Cancerous Conditions
RADICAVA (edaravone injection)
Radioactive Seed Localization of Nonpalpable Breast Lesions
Radioembolization for Primary and Metastatic Tumors of the Liver
Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension
Radioimmunoscintigraphy Imaging (Monoclonal Antibody Imaging) Using Technetium-99m Nofetumomab Merpentan (Verluma)
Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
Radiopharmaceutical Agents and Other In Vivo Diagnostic Aids
Radiopharmaceutical Tumor Localization (SPECT), Single Area
Radium Ra 223 (Xofigo®) Injection
Ramucirumab (Cyramza®)
Recombinant and Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non‒Orthopedic Conditions
Redblood Cell Molecular Testing
Reduction Mammaplasty for Breast-Related Symptoms
Registered Nurses Practicing in Extended Roles
Repository Corticotropin Injection
Reproductive Techniques
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy
Retinal Prosthesis
Retinal Telescreening for Diabetic Retinopathy
Reverse Shoulder Arthroplasty
Risk-Reducing Mastectomy
Rituximab
Robotic Assisted Surgery - Reimbursement Policy
S
Sacral Nerve Neuromodulation/Stimulation
Salivary Hormone Testing
Saturation Biopsy for Diagnosis and Staging of Prostate Cancer
Scintimammography and Gamma Imaging of the Breast and Axilla
Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
Sensory Integration Therapy and Auditory Integration Therapy
Sensory Stimulation for Coma Patients
Serum Testing for Evidence of Mild Traumatic Brain Injury
Serum Tumor Markers for Malignancies
Signal-Averaged Electrocardiography
Siltuximab (Sylvant)
SIMPONI ARIA (golimumab injection for intravenous use)
Sinus Maxillofacial CT
Skin Contact Monochromatic Infrared Energy as a Technique to Treat Cutaneous Ulcers, Diabetic Neuropathy and Miscellaneous Musculoskeletal Conditions
Small Bowel/Liver and Multivisceral Transplant
SPECT/CT Fusion Imaging
Speech Generating Devices
Speech Therapy
Sphenopalatine Ganglion Block for Headache
Spinal Cord and Dorsal Root Ganglion Stimulation
Spinal Epidural Injections
Stem-cell Therapy for Peripheral Arterial Disease
Stereotactic Electroencephalography
Stereotactic Radiofrequency Pallidotomy for the Treatment of Parkinson’s Disease
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Steroid-Eluting Sinus Stents
Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy
Subtalar Arthroereisis and Subtalar Joint Implant
Sufentanil Sublingual Tablet (Dsuvia)
Suit Therapy
Surgery for Groin Pain in Athletes
Surgical and Ablative Treatments for Chronic Headaches
Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Surgical Guidelines (Secondary, Multiple Procedures, Co-Surgeons, Assistant Surgeons, Stand- By Physicians, Microsurgery/Microdissection)
Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
Surgical Treatment of Bilateral Gynecomastia
Surgical Treatment of Chest Wall Deformities (Congenital or Acquired)
Surgical Treatment of Femoroacetabular Impingement
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Surgical Treatments for Lymphedema and Lipedema
Surgical Ventricular Restoration
Sympathetic Therapy for the Treatment of Pain
T
T-Wave Alternans
Tagraxofusp-erzs (Elzonris)
Targeted Phototherapy and Psoralen with Ultraviolet A for Vitiligo
TECENTRIQ™ (atezolizumab)
Telehealth
Telemedicine
TEMPORAL BONE, MASTOID, ORBITS CT
Temporomandibular Joint Dysfunction
Teprotumumab-trbw (TEPEZZA™)
Testing for Alpha-1 Antitrypsin Deficiency
Testing for Autism Spectrum Disorder and Developmental Delay
Testing for Diagnosis of Active or Latent Tuberculosis
Testing for Mosquito- or Tick-Related Infections
Testing for Targeted Therapy of Non-Small-Cell Lung Cancer
Testing of Homocysteine Metabolism-Related Conditions
Testosterone Replacement Therapies
Testosterone Testing
Therapeutic Drug Monitoring for 5-Fluorouracil
Therapeutic Radiopharmaceuticals in Oncology
Thermal Capsulorrhaphy as a Treatment of Joint Instability
Thermography
Thoracic-Lumbo-Sacral Orthosis with Pneumatics
Three-Dimensional Printed Orthopedic Implants
Threshold Electrical Stimulation as a Treatment of Motor Disorders
Thyroid Disease Testing
Tocilizumab (Actemra®)
Topographic Brain Mapping
Total Ankle Replacement
Total Artificial Hearts and Implantable Ventricular Assist Devices
Total Parenteral Nutrition and Enteral Nutrition in the Home
Transanal Endoscopic Microsurgery (TEMS)
Transanal Radiofrequency Treatment of Fecal Incontinence
Transcatheter Aortic-Valve Implantation for Aortic Stenosis
Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
Transcatheter Mitral Valve Repair
Transcatheter Pulmonary Valve Implantation
Transcoronary Ablation of Septal Hypertrophy (TASH)
Transcranial Doppler Ultrasound
Transcutaneous Electrical Nerve Stimulation (TENS)
Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
Transfusion Therapy for Hemolytic Disease of the Fetus and the Newborn
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Transmyocardial Revascularization
Transplant Rejection Testing
Transtympanic Micropressure Applications as a Treatment of Meniere’s Disease
Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence
Trastuzumab
Treatment of Hyperhidrosis
Treatment of Tinnitus
Treatment of Varicose Veins/Venous Insufficiency
Tumor Treatment Fields Therapy for Glioblastoma
U
Ultrafiltration in Decompensated Heart Failure
Ultrasonographic Evaluation of Skin Lesions
Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis
Ultrasound Accelerated Fracture Healing Device
Ultrasound for the Evaluation of Paranasal Sinuses
Ultraviolet Light Therapy in the Home Setting (UVB)
Unicompartmental and Bicompartmental Knee Arthroplasties
Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee
UPPER EXTREMITY MRI (Hand, Wrist, Arm, Elbow, Long bone, or Shoulder MRI)
Urinary Tumor Markers for Bladder Cancer
Urine Culture Testing for Bacteria
Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer
Use of Magnetic Resonance Imaging to Monitor Integrity of Silicone Gel-Filled Breast Implants
Uses of Monoclonal Antibodies
ustekinumab (Stelara™)
V
Vacuum-Assisted Breast Biopsy
Vacuum Therapy as a Treatment for Female Sexual Dysfunction
Vagus Nerve Blocking Therapy for Treatment of Obesity
Vagus Nerve Stimulation
Vasectomy Using a Polymeric Clip
Vectra DA Blood Test for Rheumatoid Arthritis
Vedolizumab (Entyvio™)
Venous and Arterial Thrombosis Risk Testing
Vertebral Axial Decompression
Vertebral Fracture Assessment with Densitometry
Vertical Expandable Prosthetic Titanium Rib
Vestibular Function Testing
Videofluoroscopic Evaluation of Velopharyngeal Dysfunction
Viscocanalostomy and Canaloplasty
Visual and Auditory Evoked Potentials
Vitamin B12 and Methylmalonic Acid Testing
Vitamin D Testing
VYONDYS 53 (golodirsen)
W
Wearable Cardioverter-Defibrillators
Whole Body Computed Tomography Scan as a Screening Test
Whole Body Dual X-ray Absorptiometry (DEXA) to Determine Body Composition
Whole Genome and Whole Exome Sequencing
Whole Gland Cryoablation of Prostate Cancer
Wireless Capsule Endoscopy to Diagnose Disorders of the Small Bowel, Esophagus, and Colon
Wireless Pressure Sensors in Endovascular Aneurysm Repair
Women's Preventive Services
Work Hardening Programs
X
Y
Z
Zika Virus Risk Assessment
Zolgensma® (Onasemnogene Abeparvovec-Xioi)
ZOMETA (zoledronic acid)