Clinical Policies
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A
- Acoustic cardiography/heart sound recording
- Actigraphy
- Acupuncture
- Afirma® thyroid FNA analysis for indeterminate thyroid nodules
- Air ambulance transport
- Altered auditory feedback devices for speech dysfluency (stuttering)
- Ambulatory blood pressure monitoring
- Ambulatory surgery center optimization
- Apnea monitors for infants-in home use
- Aquatic therapy
- Artificial pancreas device system
- Athletic pubalgia (sports hernia) surgery
- Auricular stimulation for abdominal pain from irritable bowel syndrome
- Autologous chondrocyte implantation
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B
- Balloon dilation of the Eustachian tube
- Biofeedback for chronic pain
- Bioimpedance devices for detecting lymphedema
- Blue Native polyacrylamide gel electrophoresis for mitochondrial myopathies
- Bone graft substitutes
- Brachytherapy for cancers other than prostate
- Bronchial thermoplasty for severe asthma
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C
- Cecostomy for fecal incontinence
- Cell-free DNA prenatal screening
- Cervical traction devices for neck pain for home use
- Chromosomal microarray analysis
- Chronic inflammatory response syndrome
- Circulating tumor DNA and circulating tumor cells for cancer management (liquid biopsy)
- Computer-aided detection and diagnosis for chest imaging
- Computerized gait analysis
- Core decompression for avascular necrosis of the hip
- Corneal cross-linking
- Coronary intravascular lithotripsy
- Cosmetic and plastic reconstructive surgery
- Cryopreservation of reproductive tissue, gametes, and embryos
- ccp1427-smell-taste-dysfunction-testing.pdf
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D
- Dermabrasion and chemical peel
- Digestive enzyme cartridge
- Disposable insulin delivery devices
- Donor human milk
- Drug-eluting sinus implants
- Dynamic movement orthoses (suit therapy)
- Dynamic splinting
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E
- Electrical muscle stimulation
- Embrace 2 watch for seizure detection.
- EndeavorRx video for ADHD
- Epidermal nerve fiber density testing
- Equine-assisted therapy
- Erectile dysfunction treatments other than pharmaceuticals
- Excimer laser for vitiligo
- Expanded carrier screening by genomic sequencing
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F
- Face transplantation
- Fetal surgeries in utero
- Flexitouch® pneumatic compression devices for lymphedema after head and neck surgery
- Fluorescence in situ hybridization for cervical cancer screening
- Fluorescence spectroscopy for prostate cancer diagnosis
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G
- Gastrointestinal electrical stimulation for obesity
- Gastroparesis evaluations
- Gene expression profile testing for breast cancer
- Genetic testing for Alzheimer’s disease
- Genetic testing for Duchenne muscular dystrophy
- Genetic testing for G1691A polymorphism factor V Leiden
- Genetic testing for cystic fibrosis
- Genetic testing for epilepsy and seizure disorders
- Genetic testing for hereditary cancer susceptibility
- Genetic testing for hereditary cardiomyopathy
- Genetic testing for long QT syndrome
- Genetic testing for maple syrup urine disease
- Genetic testing for prostate cancer prognosis
- Genetic testing in sensorineural hearing loss
-
H
- Hand and arm transplants
- Home invasive positive pressure ventilation
- Home uterine activity monitoring
- Home-use light box therapy for seasonal affective disorder
- Hydrogel spacer use during radiotherapy for prostate cancer
- Hypoglossal nerve stimulation
-
I
- IFuse implant system
- Immune cell function assay
- Inhaled nitric oxide
- Injectable bulking agents — fecal incontinence
- Intermittent pneumatic compression for peripheral artery disease
- Intracranial hypertension stent
- Intravascular ultrasound
-
K
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L
- Laser thermal ablation for seizures refractory to medical management
- Latera absorbable nasal implant
- Lipoprotein apheresis
- Low-frequency ultrasound therapy for wound management
- Lung cancer screening
- Lung transplants
- Lymphedema garments
-
M
- MarginProbe
- Measurement of serum antibodies to Infliximab and Adalimumab
- Mechanical scalp cooling
- Medical alert devices
- Medical three-dimensional printing
- Microwave thermotherapy for breast cancer
- Molecular analysis for targeted therapy for breast cancer
- Molecular analysis for targeted therapy for colorectal cancer
- Molecular analysis for targeted therapy for esophageal cancer
- Molecular analysis for targeted therapy for ovarian cancer
- Molecular analysis for targeted therapy of non-small cell lung cancer
- Molecular analysis for targeted treatment for hepatobiliary cancer
- Molecular analysis for targeted treatment in cervical cancer
- Molecular analysis for treatment of primary brain tumors
- Molecular testing for sarcoma
- Myocardial strain imaging
-
N
- Neuroablation for chronic foot pain
- Noninvasive blood tests for rejection surveillance after heart transplant
- Nonpharmacologic treatments for chronic vertigo
-
O
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P
- Pancreas transplantation
- Pediatric bed enclosures and sensory beds
- Pediatric intensive feeding programs
- Pediatric rhinoplasty
- Pediatric turbinectomy and turbinoplasty
- Percutaneous arteriovenous fistula creation using EverlinQ and Ellipsys techniques
- Percutaneous sacroplasty
- Peripheral nerve stimulators for chronic nerve pain
- Peristeen® anal irrigation system
- Peroral endoscopic myotomy
- Pharmacogenetic testing for cardiac meds
- Phototherapy and photochemotherapy for skin conditions
- Phrenic (diaphragmatic) nerve stimulation
- Platelet rich plasma
- Port-wine stain and infantile hemangioma treatment
- Postural orthostatic tachycardia syndrome treatment with physical therapy
- Prescription digital therapeuticss for contraception
- Prolotherapy
-
R
- Radiofrequency ablation for nasal valve collapse
- Radiofrequency ablation of genicular nerves for knee pain
- Renal denervation
- Robotic orthoses – lower limb
- Robotic orthoses – upper limb
- Room humidifiers
-
S
- Sacral nerve modulation/stimulation
- Scoliosis vertebral body tethering and stapling
- Serum proteomic cancer risk classification of indeterminate pulmonary nodules
- Shoe lifts for leg length discrepancy
- Sialendoscopy and lithotripsy for salivary stones
- Skin surgery after massive weight loss
- Smartwatch for detection of atrial fibrillation
- Specialized infant formula
- Speech therapy
- Sphenopalatine ganglion block injections for headache
- Stereotactic navigation in sinus surgery
- Supraglottoplasty and laryngoplasty
-
T
- Tactile breast imaging
- Therapeutic contact lenses
- Three-dimensional imaging and interpretation
- Topical oxygen therapy
- Total artificial heart
- Transanal radiofrequency for fecal incontinence
- Transcatheter coronary infusion of supersaturated oxygen therapy in acute myocardial infarction
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V
- Vaginitis diagnosis
- Vagus nerve stimulation for post-stroke upper limb rehabilitation
- Vestibular evoked myogenic potential testing
- Video head impulse testing
- Virtual colonoscopy – CT colonography
- Vitamin D screening
- Volatile organic compounds for urinary tract infection
- V‐Go® disposable insulin pump
-
W
- Wearable dialysis and implantable artificial kidneys
- Wheelchair mounted robotic arm – Kinova Jaco2
- Whole genome sequencing and whole exome sequencing
- Wireless pulmonary artery pressure monitoring devices for heart failure
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X
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