| Ablative Treatment for Malignant Breast Tumor - (0540) |
PDF |
238kB |
03/15/2024 |
| Angioplasty (Extracranial, Intracranial) and Intracranial Aneurysm Repair - (0545) ---- retired |
PDF |
|
11/01/2024 |
| Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation - (0480) |
PDF |
374kB |
04/15/2024 |
| Bariatric Surgery and Procedures - (0051) |
PDF |
1299kB |
07/15/2023 |
| Bariatric Surgery and Procedures - (0051) ---- future effective policy |
PDF |
1260kB |
01/15/2025 |
| Benign Prostatic Hyperplasia (BPH) Surgical Treatments - (0159) |
PDF |
309kB |
11/01/2024 |
| Blepharoplasty, Reconstructive Eyelid Surgery, and Brow Lift - (0045) |
PDF |
291kB |
04/15/2024 |
| Bone Graft Substitutes - (0118) |
PDF |
296kB |
11/01/2024 |
| Breast Implant Removal - (0048) |
PDF |
291kB |
04/01/2024 |
| Breast Reconstruction Following Mastectomy or Lumpectomy - (0178) |
PDF |
622kB |
09/15/2024 |
| Breast Reduction - (0152) |
PDF |
270kB |
08/15/2024 |
| Cardiac Resynchronization Therapy (CRT) and Advanced Cardiac Pacing Technologies - (0174) |
PDF |
589kB |
09/01/2024 |
| Cell-Based Therapy for Cardiac and Peripheral Arterial Disease - (0287) |
PDF |
313kB |
05/15/2024 |
| Cervical Fusion - (0527) ---- retired |
PDF |
|
11/01/2024 |
| Cochlear and Auditory Brainstem Implants - (0190) |
PDF |
539kB |
11/15/2023 |
| Corneal Remodeling for Refractive Errors - (0141) |
PDF |
412kB |
10/15/2023 |
| Deep Brain, Motor Cortex and Responsive Cortical Stimulation - (0184) |
PDF |
555kB |
04/01/2024 |
| Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy - (0554) |
PDF |
514kB |
06/16/2024 |
| Diaphragmatic/Phrenic Nerve Stimulation - (0391) |
PDF |
429kB |
07/15/2024 |
| Discography - (0393) ---- retired |
PDF |
|
11/01/2024 |
| Endometrial Ablation - (0013) |
PDF |
265kB |
02/15/2024 |
| Evernorth Coverage Policy - Transcranial Magnetic Stimulation - (EN0383) |
PDF |
547kB |
10/15/2024 |
| Fetal Surgery - (0175) |
PDF |
257kB |
07/15/2024 |
| Gender Dysphoria Treatment - (0266) |
PDF |
345kB |
10/15/2024 |
| Gender Dysphoria Treatment - State Guidelines |
PDF |
184kB |
01/01/2024 |
| Glaucoma Surgical Procedures - (0035) |
PDF |
426kB |
10/15/2024 |
| Gynecomastia Surgery - (0195) |
PDF |
222kB |
08/15/2024 |
| Headache, Occipital, and/or Trigeminal Neuralgia Treatment - (0063) |
PDF |
462kB |
11/01/2024 |
| High Intensity Focused Ultrasound (HIFU) - (0274) |
PDF |
474kB |
01/15/2024 |
| Interspinous Process Spacer Devices - (0448) ---- retired |
PDF |
|
11/01/2024 |
| Intraocular Lens Implant - (0125) |
PDF |
274kB |
09/15/2024 |
| Intraoperative Monitoring - (0509) |
PDF |
644kB |
09/15/2024 |
| Lymphedema and Lipedema Surgical Treatments - (0531) |
PDF |
497kB |
10/15/2023 |
| Male Sexual Dysfunction Treatment: Non-pharmacologic - (0403) |
PDF |
463kB |
08/15/2024 |
| Mammary Ductoscopy, Aspiration and Lavage - (0057) |
PDF |
315kB |
01/15/2024 |
| Manipulation Under Anesthesia - (0276) |
PDF |
289kB |
10/15/2024 |
| Metatarsophalangeal Joint Replacement - (0446) |
PDF |
281kB |
09/15/2024 |
| Orthognathic Surgery - (0209) |
PDF |
247kB |
10/15/2024 |
| Otoplasty and External Ear Reconstruction - (0335) |
PDF |
229kB |
04/15/2024 |
| Panniculectomy and Abdominoplasty - (0027) |
PDF |
218kB |
03/15/2024 |
| Pelvic Denervation Procedures - (0368) |
PDF |
229kB |
06/15/2024 |
| Percutaneous Revascularization of the Lower Extermities in Adults - (0537) ---- retired |
PDF |
|
11/01/2024 |
| Percutaneous Vertebroplasty, Kyphoplasty and Sacroplasty - (0040) ---- retired |
PDF |
|
11/01/2024 |
| Peripheral Nerve Destruction for Pain Conditions - (0525) |
PDF |
621kB |
02/15/2024 |
| Redundant Skin Surgery - (0470) |
PDF |
216kB |
06/15/2024 |
| Rhinoplasty, Vestibular Stenosis Repair and Septoplasty - (0119) |
PDF |
455kB |
06/15/2024 |
| Stem Cell Therapy for Orthopaedic Applications - (0552) |
PDF |
340kB |
11/01/2024 |
| Subtalar Joint Implantation (Subtalar Arthroereisis) - (0486) |
PDF |
231kB |
10/15/2024 |
| Surgical Treatment for Chest Wall Deformities - (0309) |
PDF |
254kB |
04/15/2024 |
| Surgical Treatment for Hyperhidrosis - (0037) |
PDF |
256kB |
01/15/2024 |
| Surgical Treatments for Obstructive Sleep Apnea - (0158) |
PDF |
383kB |
10/15/2023 |
| Temporomandibular Joint (TMJ) Disorder Surgery - (0156) |
PDF |
273kB |
12/15/2023 |
| Tissue Engineered Skin Substitutes - (0068) |
PDF |
1682kB |
10/18/2024 |
| Tissue-Engineered Skin Substitutes - (0068) ---- future effective policy |
PDF |
1687kB |
01/15/2025 |
| Total Ankle Arthroplasty/Replacement - (0285) |
PDF |
254kB |
04/01/2024 |
| Transcatheter Ablation for the Treatment of Supraventricular Tachycardia in Adults - (0529) |
PDF |
315kB |
04/15/2024 |
| Transcatheter Closure of Cardiovascular Defects - (0011) |
PDF |
119kB |
11/15/2023 |
| Transcatheter Heart Valve Procedures - (0501) |
PDF |
917kB |
12/03/2023 |
| Treatment of Cutaneous and/or Deep Tissue Hemangioma, Port Wine Stain and Other Vascular Lesions - (0313) |
PDF |
300kB |
11/01/2024 |
| Vagus Nerve Stimulation (VNS) - (0350) |
PDF |
429kB |
04/01/2024 |
| Varicose Vein Treatments - (0234) ---- retired |
PDF |
|
11/01/2024 |
| Venous Angioplasty and/or Stent Placement in Adults - (0541) ---- retired |
PDF |
|
11/01/2024 |
| Ventricular Assist Devices (VADs), Percutaneous Cardiac Support Systems and Total Artificial Heart - (0054) |
PDF |
652kB |
04/01/2024 |