Medical Policies - Medical

Accelerated Partial Breast Irradiation Commercial - Medical 207

Accelerated Partial Breast Irradiation Medicaid - Medical 207

Actigraphy Commercial - Medical 259

Actigraphy Medicaid - Medical 259

Ambulance Transport Services Commercial - Medical 105

Apheresis Commercial - Medical 128

Apheresis Medicaid - Medical 128

Apixaban (Eliquis) Drug Level Commercial - Medical 303

Apixaban (Eliquis) Drug Level Medicaid - Medical 303

Apixaban (Eliquis) Drug Level Medicare - Medical 303

Autologous Myoblast and Muscle Cell Injection Commercial - Medical 262

Autologous Myoblast and Muscle Cell Injection Medicaid - Medical 262

Autologous Serum Tears Commercial - Medical 244

Autologous Serum Tears Medicaid - Medical 244

Autologous Serum Tears Medicare - Medical 244

Automated Nerve Conduction Testing Commercial - Medical 250

Automated Nerve Conduction Testing Medicaid - Medical 250

Bone Scaffolding Commercial - Medical 02

Bone Scaffolding Medicaid - Medical 02

Brachytherapy Commercial - Medical 71

Brachytherapy Medicaid - Medical 71

Bulking Agents for Vocal Cord Insufficiency Commercial - Medical 153

Bulking Agents for Vocal Cord Insufficiency Medicaid - Medical 153

Bulking Agents for Vocal Cord Insufficiency Medicare - Medical 153

Category III codes Commercial - Medical 336

Category III codes Medicaid - Medical 336

Cell Enumeration Commercial - Medical 310

Cell Enumeration Medicaid - Medical 310

Chemotherapy Administration Commercial - Medical 316

Chemotherapy Administration Medicaid - Medical 316

Chiropractic Services Commercial - Medical 182

Chromoendoscopy Commercial - Medical 283

Chromoendoscopy Medicaid - Medical 283

Chromoendoscopy Medicare - Medical 283

Colonic Lavage Therapy Commercial - Medical 178

Colonic Lavage Therapy Medicaid - Medical 178

Dermal Fillers Commercial - Medical 201

Dermal Fillers Medicaid - Medical 201

Dry Hydrotherapy Commercial - Medical 267

Dry Hydrotherapy Medicaid - Medical 267

Dry Needling Commercial - Medical 173

Dry Needling Medicaid - Medical 173

Early Inpatient Admission Commercial - Medical 145

Early Inpatient Admission Medicaid - Medical 145

Electric Cell-Signaling Energy Waves (EcST and ESI) Commercial - Medical 179

Electric Cell-Signaling Energy Waves (EcST and ESI) Medicaid - Medical 179

Ellipsys Vascular Access System Commercial - Medical 318

Ellipsys Vascular Access System Medicaid - Medical 318

Ellipsys Vascular Access System Medicare Medical 318

Enteral and Parenteral Feeding and Intradialytic Parenteral Nutrition Commercial - Medical 13

Enteral and Parenteral Feeding and Intradialytic Parenteral Nutrition Medicaid - Medical 13

Equestrian Therapy (e.g., Hippotherapy) Medicaid - Medical 268

Erector Spinae Plane Block Commercial - Medical 332

Erector Spinae Plane Block Medicaid - Medical 332

Erector Spinae Plane Block Medicare - Medical 332

Eustachian tube balloon dilation (ETBD) Tuboplasty Commercial - Medical 328

Eustachian tube balloon dilation (ETBD) Tuboplasty Medicaid - Medical 328

Eustachian tube balloon dilation (ETBD) Tuboplasty Medicare - Medical 328

Exhaled Breath Condensate (EBC ph) Commercial - Medical 286

Exhaled Breath Condensate (EBC ph) Medicaid - Medical 286

Extracorporeal Photopheresis Commercial - Medical 237

Extracorporeal Photopheresis Medicaid - Medical 237

Fecal Bacteriotherapy Commercial - Medical 181

Fecal Bacteriotherapy Medicaid - Medical 181

Fecal Bacteriotherapy Medicare - Medical 181

Fecal Incontinence Treatments Commercial - Medical 300

Fecal Incontinence Treatments Medicaid - Medical 300

Fetal Magnetic Cardiac Signal Commercial - Medical 297

Fetal Magnetic Cardiac Signal Medicaid -Medical 297

Fetal Magnetic Cardiac Signal Medicare - Medical 297

Gait analysis and surface electromyography Commercial - Medical 345.pdf

Gait Analysis and Surface Electromyography Medicaid - Medical 345.pdf

Gait Analysis and Surface Electromyography Medicare - Medical 345.pdf

Galectin 3 (LGALS3) Commercial - Medical 304

Galectin 3 (LGALS3) Medicaid - Medical 304

Galectin 3 (LGALS3) Medicare - Medical 304

Gastrointestinal Capsule Endoscopy Commercial - Medical 81

Gastrointestinal Capsule Endoscopy Medicaid - Medical 81

Genetic Testing - Cardioneurovascular and Developmental Diagnosis Commercial - Medical 34C

Genetic Testing - Cardioneurovascular and Developmental Diagnosis Medicaid - Medical 34C

Genetic Testing - Cardioneurovascular and Developmental Diagnosis Medicare - Medical 34C

Genetic Testing - Pharmacogenetic Testing Commercial - Medical 34E

Genetic Testing - Pharmacogenetic Testing Medicaid - Medical 34E

Genetic Testing - Pharmacogenetic Testing Medicare - Medical 34E

Genetic Testing - Preconceptional-Prenatal-Preimplantation Commercial - Medical 34D

Genetic Testing - Preconceptional-Prenatal-Preimplantation Medicaid - Medical 34D

Genetic Testing - Preconceptional-Prenatal-Preimplantation Medicare - Medical 34D

Genetic Testing - Pre-Treatment or Post-Intervention Commercial - Medical 34B

Genetic Testing - Pre-Treatment or Post-Intervention Medicaid - Medical 34B

Genetic Testing - Pre-Treatment or Post-Intervention Medicare - Medical 34B

Genetic Testing-Cancer Prevention, Diagnosis and Treatment Commercial - Medical 34A

Genetic Testing-Cancer Prevention, Diagnosis and Treatment Medicaid - Medical 34A

Genetic Testing-Cancer Prevention, Diagnosis and Treatment Medicare - Medical 34A

Genicular Artery Embolization (GAE) Commercial - Medical 342

Genicular Artery Embolization (GAE) Medicaid - Medical 342

Home Health Aide Commercial - Medical 144

Home Health Aide Medicaid - Medical 144

Home Health Aide Medicare - Medical 144

Immunoglobulin Light Chains Commercial - Medical 333

Immunoglobulin Light Chains Medicaid - Medical 333

Immunoglobulin Light Chains Medicare - Medical 333

Implantable Hemodynamic Monitoring for Heart Failure Commercial - Medical 317

Implantable Hemodynamic Monitoring for Heart Failure Medicaid - Medical 317

Implantable Hemodynamic Monitoring for Heart Failure Medicare - Medical 317

Infrared Light Therapy and Low-Level Laser Therapy Commercial - Medical 109

Infrared Light Therapy and Low-Level Laser Therapy Medicaid - Medical 109

Ingestible Devices Commercial - Medical 344

Ingestible Devices Medicaid Medical 344.pdf

Ingestible Devices Medicare - Medical 344

Ingestion Challenge Test or Double Blind Food Challenge Commercial - Medical 140

Injectable Hormone Pellets Commercial - Medical 157

Injectable Hormone Pellets Medicaid - Medical 157

Intensive Cardiac Rehabilitation Programs Commercial - Medical 52

Intensive Cardiac Rehabilitation Programs Medicaid - Medical 52

Intra-arterial (IA) Chemotherapy Commercial - Medical 254

Intra-arterial (IA) Chemotherapy Medicaid - Medical 254

Keratoconus Lenses and Interventions-Piggyback Contact Lenses Commercial - Medical 03

Keratoconus Lenses and Interventions-Piggyback Contact Lenses Medicaid - Medical 03

Lodging and Meal Reimbursement Medicaid Medical 169

Lodging and Meal Reimbursement Medicare - Medical 169

Long-Term Care Hospital (LTACH) Services Medicaid - Medical 337

Long-Term Care Hospital (LTACH) Services Medicare - Medical 335

Mitochondrial Antibody Testing Commercial - Medical 180.

Mitochondrial Antibody Testing Medicaid - Medical 180

Mitochondrial Antibody Testing Medicare - Medical 180

Mobile Cardiac Telemetry Commercial - Medical 112

Mobile Cardiac Telemetry Medicaid - Medical 112

Muscle Pain Detector Commercial - Medical 247

Muscle Pain Detector Medicaid - Medical 247

Muscle Pain Detector Medicare - Medical 247

Near-infrared Spectroscopy Commercial - Medical 330

Near-infrared Spectroscopy Medicaid - Medical 330

Nonemergent Air and Water Ambulance Services Medicaid - Medical 105

Non-Invasive Assessment of the Vasculature for Cardiovascular Risk Commercial - Medical 334

Non-Invasive Assessment of the Vasculature for Cardiovascular Risk Medicaid - Medical 334

Phase II Cardiac Rehabilitation Commercial - Medical 51

Phase II Cardiac Rehabilitation Medicaid - Medical 51

Photodynamic Therapy for Oncologic and Dermatologic Conditions Commercial - Medical 77

Photodynamic Therapy for Oncologic and Dermatologic Conditions Medicaid - Medical 77

Physical Therapy for Treating Obesity Commercial - Medical 252

Physical Therapy for Treating Obesity Medicaid - Medical 252

Physical Therapy for Treating Obesity Medicare - Medical 252

Platelet Rich-Plasma Commercial - Medical 246

Platelet Rich-Plasma Medicaid - Medical 246

Proton Beam Radiation Therapy (PBRT) Commercial - Medical 101

Proton Beam Radiation Therapy (PBRT) Medicaid - Medical 101.pdf

Sclerotherapy and Prolotherapy for Joints and Tendons Commercial - Medical 108

Sclerotherapy and Prolotherapy for Joints and Tendons Medicaid - Medical 108

Subacute Care Medicaid - Medical 346

Telemonitoring Services Medicaid - Medical 160

Telemonitoring Services Commercial - Medical 160

Telemonitoring Services Medicare - Medical 160

Transanal Double Balloon Enteroscopy Commercial - Medical 293

Transanal Double Balloon Enteroscopy Medicaid - Medical 293

Transarterial Embolization Direct Therapies (TAE, TACE and DEB-TACE) Commercial - Medical 139

Transarterial Embolization Direct Therapies (TAE, TACE and DEB-TACE) Medicaid - Medical 139

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) Commercial - Medical 256

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) Medicaid - Medical 256

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) Medicare - Medical 256

Transplant Rejection Testing Commercial - Medical 99

Transplant Rejection Testing Medicaid - Medical 99

Tumor Treating Fields Therapy Commercial - Medical 166

Tumor Treating Fields Therapy Medicaid - Medical 166

Urinary Incontinence Treatments Commercial - Medical 130

Urinary Incontinence Treatments Medicaid - Medical 130

Vestibular Evoked Myogenic Potential (VEMP) Commercial - Medical 174

Vestibular Evoked Myogenic Potential (VEMP) Medicaid - Medical 174

Vestibular Rehabilitation Commercial - Medical 91

Vestibular Rehabilitation Medicaid - Medical 91

Vision Therapy for Convergence Insufficiency Commercial - Medical 324

Vision Therapy for Convergence Insufficiency Medicaid - Medical 324

Vision Therapy for Convergence Insufficiency Medicare Medical 324

Wound Treatment and Care Supplies (i.e. dressings, barriers and fillers) Commercial - Medical 343

Wound Treatment and Care Supplies (i.e. dressings, barriers and fillers) Medicaid - Medical 343

Wound Treatment and Care Supplies (i.e. dressings, barriers and fillers) Medicare - Medical 343