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OB/GYN (Includes Reproduction and Infertility)

Document Title Document Type Document Size Effective Date
Breast Reconstruction Following Mastectomy or Lumpectomy - (0178)  PDF 626kB 04/15/2025
Breast Reduction - (0152)  PDF 270kB 08/15/2024
Cervical Cancer Screening Visualization Technologies - (0127)  PDF 177kB 10/15/2024
High Intensity Focused Ultrasound (HIFU) - (0274) ----future effective policy  PDF 389kB 09/15/2025
Tests for the Evaluation of Preterm Labor and Premature Rupture of Membranes - (0099)  PDF 404kB 07/15/2025
Ultrasound in Pregnancy (including 3D, 4D and 5D Ultrasound) - (0142)  PDF 234kB 07/15/2025
Aug 29, 2025