View Medical Policies

Showing 1– 20 of 294 Results
Title Last Updated Category
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy Open a PDF 7.01.103 2020-5-08 Nervous Systems (Neurology)
Bone Growth Stimulators (e.g., Electrical, Osteogenic, Sonic Accelerated Fracture Healing System - SAFHS, Ultrasonic) Open a PDF 7.01.40 2020-09-21 Bone & Joints (Orthopedic)
Breast Reconstruction Surgery Open a PDF 10.01.01 2020-09-21 Cosmetic / Reconstructive Surgery
Cognitive Rehabilitation, Attention Rehabilitation, Sensory Integration Therapy Open a PDF 8.01.19 2020-09-21 Therapy & Rehabilitation
Disability Determination for Extension of Benefits after Contract Termination Open a PDF 10.01.11 2020-09-21 Miscellaneous
Durable Medical Equipment (DME) - Standard and Non-Standard, Home Medical Equipment Open a PDF 1.01.00 2020-09-21 Durable Medical Equipment & Supplies
Erectile Dysfunction: Caverject, Edex, ErecAid, Intracavernosal Therapy, Intraurethral Therapy, MUSE (Medicated Urethral System for Erection), Penile Prosthesis, Penile Vein Ligation, Vacuum Erection Device, Vascular Revascularization Open a PDF 7.01.30 2020-09-21 Urinary System (Genitourinary)
Foot Care and Treatment of Mycotic Nails Open a PDF 2.01.35 2020-09-21 Feet (Podiatry)
Gender Reassignment/Gender Affirming Surgery and Treatments for Medicaid Managed Care Plan (MMCP) and Health and Recovery Plan (HARP) Members Open a PDF 7.01.105 2020-09-21 Miscellaneous
Medical Response to Contamination from Terrorist Attacks: Biological (e.g., Anthrax, Germ Warfare, Plague, Smallpox), Chemical, Radiation Open a PDF 11.01.09 2020-09-21 Miscellaneous
Out of Area/Out of Network Services Open a PDF 11.01.13 2020-09-21 Miscellaneous
Home Phototherapy for Hyperbilirubinemia (e.g., Biliblanket, Bili Lights) Open a PDF 1.01.33 2020-09-21 Children's Health (Pediatrics)
Positive Airway Pressure Devices: CPAP, BiPAP, APAP, DPAP, C-FLex Open a PDF 1.01.06 2020-09-21 Durable Medical Equipment & Supplies
Partial Hospitalization for Substance Use Disorders, Chemical Dependency Open a PDF 3.01.18 2020-09-21 Behavioral Health (Psychology)
Reduction Mammaplasty/ Breast Reduction Open a PDF 7.01.39 2020-09-21 Cosmetic / Reconstructive Surgery
Sex Offender Treatment Program Open a PDF 3.01.17 2020-09-21 Behavioral Health (Psychology)
Speech/Language Pathology and Therapy (e.g., Fast ForWord, Lee Silverman Voice Therapy [LSVT-LOUD™],Vocal Cord Dysfunction, Voice Therapy Open a PDF 8.01.13 2020-09-21 Therapy & Rehabilitation
Standard Dialectical Behavioral Therapy (DBT) Open a PDF 3.01.10 2020-09-21 Behavioral Health (Psychology)
Surgical Stockings (e.g., Gradient Compression/GCS, Jobst, Sigvaris, TEDs) and Compression Garments (e.g., Arm Assist, Belisse Compressure Bra, Lymphedema, Mastectomy, Circaid, Juzo, Reid Sleeves) Open a PDF 1.01.14 2020-09-21 Durable Medical Equipment & Supplies
Behavioral Health Treatment for Gender Dysphoria: Gender Identity Disorder (GID), Intersex, Transexualism Open a PDF 3.01.15 2020-09-21 Behavioral Health (Psychology)
Showing 1– 20 of 294 Results