View Medical Policies

Showing 1– 20 of 294 Results
Title Last Updated Category
Alopecia (e.g., Areata, Androgenic, Scarring), Baldness, Hair Loss Open a PDF 2.01.36 2020-02-19 Cosmetic / Reconstructive Surgery
Auditory Processing Disorder (APD) Testing Open a PDF 2.01.39 2020-02-19 Ear, Nose & Throat (Otorhinolaryngology)
Coverage for Ambulatory Surgery Unit (ASU) and Anesthesia for Dental Surgery Open a PDF 7.03.01 2020-02-19 Anesthesiology
Comfort, Convenience, Custodial or Cosmetic Services Open a PDF 11.01.11 2020-02-19 Miscellaneous
Clinical Trials Open a PDF 11.01.10 2020-02-19 Miscellaneous
Lumbar Decompression Open a PDF 7.01.97 2020-02-20 Bone & Joints (Orthopedic)
Developmental Evaluation and Testing Open a PDF 2.01.54 2020-02-20 Children's Health (Pediatrics)
Group Therapy for Mental Health Open a PDF 3.01.08 2020-02-20 Behavioral Health (Psychology)
Treatment of Hirsutism/Hypertrichosis (Hair Removal) (e.g., Electrolysis, Epilation) Open a PDF 2.01.38 2020-02-20 Cosmetic / Reconstructive Surgery
Home Exercise/Physical Therapy Equipment (e.g., Home Gym, Jacuzzi) Open a PDF 1.01.12 2020-02-20 Home Care
Medication Assisted Therapy (e.g., Buprenorphine, LAAM, Methadone Maintenance Treatment, Ultra-rapid Detoxification), Opioid treatment Open a PDF 3.01.04 2020-02-20 Behavioral Health (Psychology)
Medically Necessary Services Open a PDF 11.01.15 2020-02-20 Miscellaneous
Neuropsychological Testing Open a PDF 2.01.50 2020-02-20 Nervous Systems (Neurology)
Private Rooms Open a PDF 12.01.06 2020-02-20 Miscellaneous
Psychological Testing Open a PDF 3.01.02 2020-02-20 Behavioral Health (Psychology)
Temporomandibular Joint (TMJ) Disease Open a PDF 11.01.17 2020-02-20 Bone & Joints (Orthopedic)
Vision/Eye Therapy: Optometric Phototherapy, Occlusion Therapy, Orthoptics, Pleoptics Open a PDF 9.01.04 2020-02-20 Eyes (Ophthalmology)
Low Level Laser Therapy (LLLT) Open a PDF 8.01.23 2020-02-24 Skin (Dermatology)
Transcranial Magnetic Stimulation: Deep TMS device, MagVita TMS, NeuroStar TMS device, rTMS, TMS Open a PDF 3.01.09 2020-02-24 Behavioral Health (Psychology)
Sacroiliac Joint Fusion, IFUSE® Implant System ,SI-FIX, SImmetry® Sacroiliac Joint Fusion System, Silex™ Sacroiliac Joint Fusion System, SI-LOK® Sacroiliac Joint Fixation System Open a PDF 7.01.93 2020-02-24 Bone & Joints (Orthopedic)
Showing 1– 20 of 294 Results