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Final Policies - Medical

Policy # Policy Title Print View
MP-009 Light Therapy for Psoriasis
MP-020 Computerized Pulse Waveform Analysis
MP-050 Dermatologic Applications of Photodynamic Therapy
MP-059 Enhanced External Counterpulsation (EECP)
MP-060 Hyperbaric Oxygen Therapy
MP-066 Quantitative Sensory Testing (QST)
MP-076 Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
MP-081 Allergy Immunotherapy
MP-105 Adoptive Immunotherapy
MP-113 Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy
MP-128 Automated Ambulatory Blood Pressure
MP-138 Ambulatory Esophageal pH Monitoring
MP-143 Electrostimulation and Electromagnetic Therapy for Treating Wounds
MP-152 Inpatient Intestinal Rehabilitation Therapy
MP-163 Transanal Radiofrequency Treatment of Fecal Incontinence
MP-170 Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
MP-176 Analysis of Proteomic Patterns in Serum to Identify Cancer
MP-179 Acoustic Cardiography
MP-181 Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
MP-198 Cardiopulmonary Exercise Stress Test (CPET/CPX)
MP-214 Monitoring of Regional Cerebral Blood Flow Using an Implanted Cerebral Thermal Perfusion Probe
MP-216 Dermal Fillers and Bulking Agents for Vocal Cord Insufficiency
MP-228 Neuromuscular and Electrodiagnostic Testing (EDX):  Nerve Conduction Studies (NCS) and Electromyography (EMG) Studies
MP-238 Intratympanic Dexamethasone for the Treatment of Ménière’s Disease and/or Sudden Hearing Loss
MP-245 Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis
MP-258 Helicobacter Pylori Testing
MP-262 Bispectral Index Monitoring During General Anesthesia
MP-267 Diagnosis and Management of Idiopathic Environmental Intolerance (i.e., Multiple Chemical Sensitivities)
MP-268 Dynamic Posturography
MP-280 Antineoplaston Cancer Therapy
MP-283 Transcatheter Ablation as a Treatment of Atrial Fibrillation
MP-286 Percutaneous and Subcutaneous Tibial Nerve Stimulation
MP-296 Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence
MP-301 Phototherapy for the Treatment of Skin Disorders
MP-304 Automated Nerve Conduction Testing
MP-305 Diagnosis of Obstructive Sleep Apnea Syndrome
MP-309 Electrocardiographic Body Surface Mapping
MP-310 Non-Contact Ultrasound Treatment for Wounds
MP-315 Urodynamic Testing to Evaluate Urinary Incontinence
MP-318 Signal-Averaged Electrocardiography
MP-329 Vestibular Autorotation Test (VAT)
MP-332 Oral Lesion Identification Systems
MP-337 Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus
MP-356 Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
MP-362 Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
MP-379 Ingestible pH and Pressure Capsule
MP-381 Immune Cell Function Assay
MP-392 Nerve Fiber Density Measurement
MP-395 Evoked Potential Studies
MP-409 Gait Analysis
MP-433 Non-Genetic Urinary Biomarker for Cancer Screening, Diagnosis and Surveillance
MP-435 Ultrafiltration in Decompensated Heart Failure
MP-438 Bioimpedance Devices for Detection of Lymphedema
MP-441 Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
MP-448 Serum Holotranscobalamin as a Marker of Vitamin B12 (Cobalamin) Status
MP-459 Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease
MP-461 Holter Monitoring (Ambulatory Electrocardiography)
MP-477 Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis
MP-482 Treatment of Tinnitus
MP-490 Percutaneous Endovascular Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
MP-526 Peripheral Subcutaneous Field Stimulation
MP-528 Laser Treatment of Onychomycosis
MP-556 Navigated Transcranial Magnetic Stimulation (nTMS)
MP-572 Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder
MP-573 Autonomic Nervous System Testing
MP-603 Chronic Intermittent Intravenous Insulin Therapy
MP-615 Magnetic Resonance Imaging (MRI) Targeted Biopsy of the Prostate
MP-616 Multispectral Digital Skin Lesion Analysis
MP-619 Polysomnography for Non‒Respiratory Sleep Disorders
MP-626 Ablative Procedures of Peripheral Nerves for Treatment of Musculoskeletal Conditions
MP-714 Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing
MP-721 Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
MP-724 Hydrogel Spacer use During Radiotherapy for Prostate Cancer
MP-725 Treatment of Benign Prostatic Hyperplasia
MP-743 Adjunctive Techniques for Screening and Surveillance of Barrett Esophagus and Esophageal Dysplasia
MP-748 Remote Electrical Neuromodulation for Migraines
MP-756 Sphenopalatine Ganglion Block for Headache