Medicine (Medical Treatments/Diagnostic Tests)

Document Title Document Type Document Size Effective Date
Airway Clearance Devices in the Ambulatory Setting - (0069)  PDF 293kB 01/15/2025
Allergy Testing and Non-Pharmacologic Treatment - (0070)  PDF 366kB 04/15/2025
Amplitude-Modulated Radiofrequency Electromagnetic Fields (AM RF-EMF) Therapy - (0581)  PDF 202kB 07/15/2025
Attention-Deficit/Hyperactivity Disorder (ADHD): Assessment and Treatment - (0231)  PDF 339kB 01/15/2025
Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]) - (0507)  PDF 489kB 10/15/2024
Bone Mineral Density Measurement - (0300)  PDF 204kB 04/15/2025
Cardiac Rehabilitation (Phase II Outpatient) - (0073)  PDF 361kB 05/15/2025
Cell-Based Therapy for Cardiac and Peripheral Arterial Disease - (0287)  PDF 329kB 05/15/2025
Cervical Plexus Block - (0579) ---- future effective policy  PDF 288kB 09/15/2025
Chromoendoscopy - (0148)  PDF 262kB 12/15/2024
COVID-19: In Vitro Diagnostic Testing - (0557)  PDF 365kB 05/15/2025
Donor Lymphocyte Infusion and Hematopoietic Progenitor Cell (HPC) Boost - (0261)  PDF 233kB 05/15/2025
Electroencephalography - (0521)  PDF 280kB 01/15/2025
Excimer Laser, Dermabrasion and Chemical Peels for Dermatologic Conditions - (0505)  PDF 407kB 07/15/2025
Gait Analysis - (0315)  PDF 217kB 04/15/2025
Gastric Pacing/Gastric Electrical Stimulation (GES) - (0103)  PDF 289kB 12/15/2024
Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD)  Online Resource
Headache, Occipital, and/or Trigeminal Neuralgia Treatment - (0063)  PDF 443kB 06/15/2025
Head and Neck Ultrasound - (0549)  PDF 407kB 07/15/2025
Inhaled Nitric Oxide (INO) - (0453) ---- future effective policy  PDF 550kB 09/15/2025
Laser Interstitial Thermal Therapy - (0528)  PDF 344kB 08/15/2025
Mucosal Integrity Testing - (0577)  PDF 192kB 10/15/2024
Nutritional Support - (0136)  PDF 250kB 03/15/2025
Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation - (0539)  PDF 368kB 05/15/2025
Plantar Fasciitis Treatments - (0097)  PDF 453kB 02/15/2025
Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028)  PDF 338kB 05/15/2025
Radiofrequency Ablation (RFA) Thyroid Nodules - (0575)  PDF 318kB 02/15/2025
Radiofrequency Therapy for Fecal Incontinence - (0576)  PDF 193kB 10/15/2024
Serum Folate and Red Blood Cell Folate Testing - (0567)  PDF 366kB 12/15/2024
Surgical Treatments for Obstructive Sleep Apnea - (0158)  PDF 444kB 12/15/2024
Tilt Table Testing - (0270)  PDF 673kB 12/15/2024
Transthoracic Echocardiography in Children - (0523)  PDF 861kB 02/15/2025
Transvaginal Ultrasound, Non-Obstetrical - (0398)  PDF 318kB 06/15/2025