Insurer medical policies

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Continuing the Insurer medical policies list, 1000 records per page, after united-healthcare-ent-022-14.

1. Category III Codes - Oxford Clinical Policy
2. Home Health, Skilled, and Custodial Care Services - Oxford Clinical Policy
3. Private Duty Nursing Services - Oxford Clinical Policy
4. Tzield® (Teplizumab-Mzwv) - Individual Exchange Medical Benefit Drug Policy
5. Spevigo® (Spesolimab-Sbzo) - Individual Exchange Medical Benefit Drug Policy
6. Hemgenix® (Etranacogene Dezaparvovec-Drlb) - Individual Exchange Medical Benefit Drug…
7. Gene Therapies for Hemophilia B - Individual Exchange Medical Benefit Drug Policy
8. Qalsody® (Tofersen) - Individual Exchange Medical Benefit Drug Policy
9. Rituximab (Riabni®, Rituxan®, Ruxience®, & Truxima®) - Individual Exchange Medical Benefit…
10. Infliximab (Avsola®, Inflectra®, Remicade®, & Renflexis®) - Individual Exchange Medical…
11. Synagis® (Palivizumab) - Individual Exchange Medical Benefit Drug Policy
12. Amondys 45® (Casimersen) - Individual Exchange Medical Benefit Drug Policy
13. Korsuva® (Difelikefalin) - Individual Exchange Medical Benefit Drug Policy
14. Skyrizi® (Risankizumab-Rzaa) - Individual Exchange Medical Benefit Drug Policy
15. Ophthalmologic Complement Inhibitors - Individual Exchange Medical Benefit Drug Policy
16. Briumvi® (Ublituximab-Xiiy) - Individual Exchange Medical Benefit Drug Policy
17. Rebyota® (Fecal Microbiota, Live-Jslm) - Individual Exchange Medical Benefit Drug Policy
18. Leqembi® (Lecanemab-Irmb) - Individual Exchange Medical Benefit Drug Policy
19. Elevidys™ (Delandistrogene Moxparvovec-Rokl) - Individual Exchange Medical Benefit Drug…
20. Vyjuvek® (Beramagene Geperpavec-Svdt) - Individual Exchange Medical Benefit Drug Policy
21. Veopoz® (Pozelimab-Bbfg) - Individual Exchange Medical Benefit Drug Policy
22. Omvoh® (Mirikizumab-Mrkz) - Individual Exchange Medical Benefit Drug Policy
23. Adzynma (ADAMTS13, Recombinant-Krhn) - Individual Exchange Medical Benefit Drug Policy
24. Tremfya® (Guselkumab) - Individual Exchange Medical Benefit Drug Policy
25. Botulinum Toxins A and B - Individual Exchange Medical Benefit Drug Policy
26. Lemtrada® (Alemtuzumab) - Individual Exchange Medical Benefit Drug Policy
27. Tysabri® (Natalizumab) - Individual Exchange Medical Benefit Drug Policy
28. Erythropoiesis-Stimulating Agents - Individual Exchange Medical Benefit Drug Policy
29. Oncology Medication Clinical Coverage - Individual Exchange Medical Benefit Drug Policy
30. Preventive Vaccines (Immunizations) - Individual Exchange Medical Benefit Drug Policy
31. Xolair® (Omalizumab) - Individual Exchange Medical Benefit Drug Policy
32. Maximum Dosage and Frequency - Individual Exchange Medical Benefit Drug Policy
33. Immune Globulin (IVIG and SCIG) - Individual Exchange Medical Benefit Drug Policy
34. Somatostatin Analogs - Individual Exchange Medical Benefit Drug Policy
35. Repository Corticotropin Injections - Individual Exchange Medical Benefit Drug Policy
36. Gonadotropin Releasing Hormone Analogs - Individual Exchange Medical Benefit Drug Policy
37. Orencia® (Abatacept) Injection for Intravenous Infusion - Individual Exchange Medical…
38. 17-Alpha-Hydroxyprogesterone Caproate (Makena® and 17P) - Individual Exchange Medical…
39. Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors - Individual Exchange…
40. Actemra® (Tocilizumab) Injection for Intravenous Infusion - Individual Exchange Medical…
41. Tocilizumab (Actemra®, Tofidence™, & Tyenne®) Injection for Intravenous Infusion…
42. Hereditary Angioedema (HAE), Treatment and Prophylaxis - Individual Exchange Medical…
43. Stelara® (Ustekinumab) - Individual Exchange Medical Benefit Drug Policy
44. Benlysta® (Belimumab) - Individual Exchange Medical Benefit Drug Policy
45. Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease - Individual Exchange…
46. Complement Inhibitors - Individual Exchange Medical Benefit Drug Policy
47. Simponi Aria® (Golimumab) Injection for Intravenous Infusion - Individual Exchange Medical…
48. Medical Therapies for Enzyme Deficiencies - Individual Exchange Medical Benefit Drug…
49. Entyvio® (Vedolizumab) - Individual Exchange Medical Benefit Drug Policy
50. Off-Label/Unproven Specialty Drug Treatment - Individual Exchange Medical Benefit Drug…
51. Respiratory Interleukins (Cinqair®, Fasenra®, & Nucala®) - Individual Exchange Medical…
52. Ocrevus® (Ocrelizumab) and Ocrevus Zunovo™ (Ocrelizumab and Hyaluronidase-Ocsq)…
53. Buprenorphine (Brixadi® & Sublocade®) - Individual Exchange Medical Benefit Drug Policy
54. Exondys 51® (Eteplirsen) - Individual Exchange Medical Benefit Drug Policy
55. Review at Launch for New to Market Medications - Individual Exchange Medical Benefit Drug…
56. White Blood Cell Colony Stimulating Factors - Individual Exchange Medical Benefit Drug…
57. Radicava® (Edaravone) - Individual Exchange Medical Benefit Drug Policy
58. Luxturna® (Voretigene Neparvovec-Rzyl) - Individual Exchange Medical Benefit Drug Policy
59. Brineura® (Cerliponase Alfa) - Individual Exchange Medical Benefit Drug Policy
60. Ilaris® (Canakinumab) - Individual Exchange Medical Benefit Drug Policy
61. Alpha1-Proteinase Inhibitors - Individual Exchange Medical Benefit Drug Policy
62. Denosumab - Individual Exchange Medical Benefit Drug Policy
63. Ketalar® (Ketamine) and Spravato® (Esketamine) - Individual Exchange Medical Benefit Drug…
64. Ryplazim® (Plasminogen, Human-Tvmh) - Individual Exchange Medical Benefit Drug Policy
65. Crysvita® (Burosumab-Twza) - Individual Exchange Medical Benefit Drug Policy
66. RNA-Targeted Therapies (Amvuttra® and Onpattro®) - Individual Exchange Medical Benefit…
67. Self-Administered Medications - Individual Exchange Medical Benefit Drug Policy
68. Ilumya® (Tildrakizumab-Asmn) - Individual Exchange Medical Benefit Drug Policy
69. Parsabiv® (Etelcalcetide) - Individual Exchange Medical Benefit Drug Policy
70. Testosterone Replacement or Supplementation Therapy - Individual Exchange Medical Benefit…
71. Gamifant® (Emapalumab-Lzsg) - Individual Exchange Medical Benefit Drug Policy
72. Subcutaneous Implantable Naltrexone Pellets - Individual Exchange Medical Benefit Drug…
73. Zolgensma® (Onasemnogene Abeparvovec-Xioi) - Individual Exchange Medical Benefit Drug…
74. Zulresso® (Brexanolone) - Individual Exchange Medical Benefit Drug Policy
75. Evenity® (Romosozumab-Aqqg) - Individual Exchange Medical Benefit Drug Policy
76. Krystexxa® (Pegloticase) - Individual Exchange Medical Benefit Drug Policy
77. Cimzia® (Certolizumab Pegol) - Individual Exchange Medical Benefit Drug Policy
78. Reblozyl® (Luspatercept-Aamt) - Individual Exchange Medical Benefit Drug Policy
79. Adakveo® (Crizanlizumab-Tmca) - Individual Exchange Medical Benefit Drug Policy
80. Vyondys 53® (Golodirsen) - Individual Exchange Medical Benefit Drug Policy
81. Givlaari® (Givosiran) - Individual Exchange Medical Benefit Drug Policy
82. Intravenous Iron Replacement Therapy (Feraheme®, Injectafer®, & Monoferric®) - Individual…
83. Tepezza® (Teprotumumab-Trbw) - Individual Exchange Medical Benefit Drug Policy
84. Vyepti® (Eptinezumab-Jjmr) - Individual Exchange Medical Benefit Drug Policy
85. Uplizna® (Inebilizumab-Cdon) - Individual Exchange Medical Benefit Drug Policy
86. Scenesse® (Afamelanotide) - Individual Exchange Medical Benefit Drug Policy
87. Roctavian® (Valoctocogene Roxaparvovec-Rvox) - Individual Exchange Medical Benefit Drug…
88. Viltepso® (Viltolarsen) - Individual Exchange Medical Benefit Drug Policy
89. Enjaymo® (Sutimlimab-Jome) - Individual Exchange Medical Benefit Drug Policy
90. Leqvio® (Inclisiran) - Individual Exchange Medical Benefit Drug Policy
91. Oxlumo® (Lumasiran) and Rivfloza® (Nedosiran) - Individual Exchange Medical Benefit Drug…
92. Long-Acting Injectable Antiretroviral Agents for HIV - Individual Exchange Medical Benefit…
93. Evkeeza® (Evinacumab-Dgnb) - Individual Exchange Medical Benefit Drug Policy
94. Intracanalicular and Intravitreal Corticosteroid Implants - Individual Exchange Medical…
95. Aduhelm® (Aducanumab-Avwa) - Individual Exchange Medical Benefit Drug Policy
96. Saphnelo® (Anifrolumab-Fnia) - Individual Exchange Medical Benefit Drug Policy
97. Tezspire® (Tezepelumab-Ekko) - Individual Exchange Medical Benefit Drug Policy
98. Neonatal Fc Receptor Blockers (Rystiggo®, Vyvgart®, & Vyvgart® Hytrulo) - Individual…
99. Kisunla™ (Donanemab-Azbt) - Individual Exchange Medical Benefit Drug Policy
100. Cosentyx® (Secukinumab) - Individual Exchange Medical Benefit Drug Policy
101. Antiemetics for Oncology - Individual Exchange Medical Benefit Drug Policy
102. Xiaflex® (Collagenase Clostridium Histolyticum) - Individual Exchange Medical Benefit Drug…
103. Home Health, Skilled, and Custodial Care Services (for Individual Exchange Only)…
104. Hospice Care (for Individual Exchange Only) - Individual Exchange Medical Policy
105. Enteral Nutrition (Oral and Tube Feeding) (for Individual Exchange Only) - Individual…
106. Outpatient Surgical Procedures - Site of Service (for Individual Exchange Only)…
107. Infertility Diagnosis, Treatment, and Fertility Preservation - Oxford Clinical Policy
108. In-Office Laboratory Testing and Procedures List - Oxford Administrative Policy
109. Genetic Testing for Cardiac Disease - Oxford Clinical Policy
110. Chromosome Microarray Testing (Non-Oncology Conditions) - Oxford Clinical Policy
111. Carrier Testing Panels for Genetic Diseases - Oxford Clinical Policy
112. Pharmacogenetic Panel Testing - Oxford Clinical Policy
113. Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) - Oxford Clinical Policy
114. Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment…
115. Preimplantation Genetic Testing and Related Services - Oxford Clinical Policy
116. Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing for Infectious Diarrhea…
117. Molecular Oncology Companion Diagnostic Testing - Oxford Clinical Policy
118. FDA Cleared or Approved Companion Diagnostic Testing - Oxford Clinical Policy
119. Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment…
120. Intrauterine Fetal Surgery - Oxford Clinical Policy
121. Cell-Free Fetal DNA Testing - Oxford Clinical Policy
122. united-healthcare-mcs001-03Abortion – Medicare Advantage Coverage Summary
123. united-healthcare-mcs002-04Alcohol, Chemical and/or Substance Abuse: Detoxification and Rehabilitation – Medicare…
124. united-healthcare-mcs003-03Allergy Testing and Allergy Immunotherapy – Medicare Advantage Coverage Summary
125. united-healthcare-mcs004-03Ambulance Services – Medicare Advantage Coverage Summary
126. united-healthcare-mcs007-04Blepharoplasty and Related Procedures - Medicare Advantage Coverage Summary
127. united-healthcare-mcs008-03Blood, Blood Products, and Related Procedures - Medicare Advantage Coverage Summary
128. united-healthcare-mcs012-04Cardiac Procedures: Pacemakers, Pulmonary Artery Pressure Measurements, Ventricular…
129. united-healthcare-mcs013-07Cardiovascular Diagnostic and Therapeutic Procedures - Medicare Advantage Coverage Summary
130. united-healthcare-mcs015-03Change in Membership Status while Hospitalized (Acute, LTC and SNF) or Receiving Home…
131. united-healthcare-mcs017-04Chemotherapy and Associated Drugs and Treatments – Medicare Advantage Coverage Summary
132. united-healthcare-mcs018-03Chiropractic Services – Medicare Advantage Coverage Summary
133. united-healthcare-mcs020-03Complementary and Alternative Medicine – Medicare Advantage Coverage Summary
134. united-healthcare-mcs020-06Complementary and Alternative Medicine & Chiropractic Services - Medicare Advantage…
135. united-healthcare-mcs022-06Cosmetic and Reconstructive Procedures - Medicare Advantage Coverage Summary
136. united-healthcare-mcs023-03Court, Attorney or Agency Requested Services – Medicare Advantage Coverage Summary
137. united-healthcare-mcs025-03Dental Services, Oral Surgery, and Treatment of Temporomandibular Joint (TMJ) - Medicare…
138. united-healthcare-mcs026-07Diabetes Management, Equipment and Supplies – Medicare Advantage Coverage Summary
139. united-healthcare-mcs027-04Dialysis Services – Medicare Advantage Coverage Summary
140. united-healthcare-mcs028-09Durable Medical Equipment (DME), Prosthetics, Orthotics (Non-Foot Orthotics), Nutritional…
141. united-healthcare-mcs029-03Durable Medical Equipment, Prosthetics, Corrective Appliances/Orthotics and Medical…
142. united-healthcare-mcs031-03Emergent/Urgent Services, Post-Stabilization Care and Out-of-Area Services – Medicare…
143. united-healthcare-mcs033-03Experimental Procedures and Items, Investigational Devices and Clinical Trials – Medicare…
144. united-healthcare-mcs038-04Foot Care Services and Supportive Devices – Medicare Advantage Coverage Summary
145. united-healthcare-mcs039-07Gastroesophageal and Gastrointestinal (GI) Services and Procedures - Medicare Advantage…
146. united-healthcare-mcs040-08Genetic Testing – Medicare Advantage Coverage Summary
147. united-healthcare-mcs040-12Molecular Pathology/Molecular Diagnostics/Genetic Testing - Medicare Advantage Coverage…
148. united-healthcare-mcs041-04Glaucoma & Other Ophthalmic Surgical Treatments - Medicare Advantage Coverage Summary
149. united-healthcare-mcs043-06Hearing Services and Devices - Medicare Advantage Coverage Summary
150. united-healthcare-mcs044-06Home Health Services, Home Health Visits, Respite Care, and Hospice Care - Medicare…
151. united-healthcare-mcs045-03Hospice Services – Medicare Advantage Coverage Summary
152. united-healthcare-mcs046-04Hospital, Emergency, and Ambulance Services - Medicare Advantage Coverage Summary
153. united-healthcare-mcs049-04Urinary and Fecal Incontinence: Diagnosis and Treatment - Medicare Advantage Coverage…
154. united-healthcare-mcs051-03Infusion Pump Therapy – Medicare Advantage Coverage Summary
155. united-healthcare-mcs052-03Joints and Joint Procedures – Medicare Advantage Coverage Summary
156. united-healthcare-mcs052-06Joint Procedures - Medicare Advantage Coverage Summary
157. united-healthcare-mcs053-04Laboratory Tests and Services - Medicare Advantage Coverage Summary
158. united-healthcare-mcs056-03Reproductive Services: Infertility, Family Planning, and Maternity Care - Medicare…
159. united-healthcare-mcs057-17Medications/Drugs (Outpatient/Part B) - Medicare Advantage Coverage Summary
160. united-healthcare-mcs058-04Mental Health Services and Procedures – Medicare Advantage Coverage Summary
161. united-healthcare-mcs060-05Nasal and Sinus Procedures – Medicare Advantage Coverage Summary
162. united-healthcare-mcs060-09Ear, Nose, and Throat Procedures - Medicare Advantage Coverage Summary
163. united-healthcare-mcs061-04Neurologic Services and Procedures - Medicare Advantage Coverage Summary
164. united-healthcare-mcs064-02Non-Covered Services (Including Services/Complications Related to Non-Covered Services)…
165. united-healthcare-mcs066-04Obesity: Treatment of Obesity, Non-Surgical and Surgical (Bariatric Surgery) - Medicare…
166. united-healthcare-mcs068-03Orthopedic Procedures, Devices, and Products - Medicare Advantage Coverage Summary
167. united-healthcare-mcs069-04Oxygen for Home Use – Medicare Advantage Coverage Summary
168. united-healthcare-mcs070-03Pain Management - Medicare Advantage Coverage Summary
169. united-healthcare-mcs072-03Physician Services – Medicare Advantage Coverage Summary
170. united-healthcare-mcs073-04Positron Emission Tomography (PET)/Combined PET-CT (Computed Tomography) – Medicare…
171. united-healthcare-mcs074-07Preventive Health Services and Procedures – Medicare Advantage Coverage Summary
172. united-healthcare-mcs075-05Prostate Services and Procedures and Impotence Treatment - Medicare Advantage Coverage…
173. united-healthcare-mcs076-03Radiologic Diagnostic Procedures - Medicare Advantage Coverage Summary
174. united-healthcare-mcs077-05Radiation and Oncologic Procedures - Medicare Advantage Coverage Summary
175. united-healthcare-mcs079-05Rehabilitation: Cardiac and Medical – Medicare Advantage Coverage Summary
176. united-healthcare-mcs079-10Skilled Nursing Facility, Rehabilitation, and Long-Term Acute Care Hospital - Medicare…
177. united-healthcare-mcs081-06Respiratory Therapy, Pulmonary Rehabilitation and Pulmonary Services – Medicare Advantage…
178. united-healthcare-mcs081-11Respiratory Services and Equipment - Medicare Advantage Coverage Summary
179. united-healthcare-mcs083-03Services While Confined/Incarcerated – Medicare Advantage Coverage Summary
180. united-healthcare-mcs085-02Skilled Nursing Facility (SNF) Care and Exhaustion of SNF Benefits – Medicare Advantage…
181. united-healthcare-mcs087-05Sleep Apnea Diagnosis and Treatment - Medicare Advantage Coverage Summary
182. united-healthcare-mcs088-03Speech Generating Devices – Medicare Advantage Coverage Summary
183. united-healthcare-mcs089-04Spine Procedures - Medicare Advantage Coverage Summary
184. united-healthcare-mcs090-08Electrical and Ultrasonic Stimulators - Medicare Advantage Coverage Summary
185. united-healthcare-mcs092-02Telemedicine/Telehealth Services – Medicare Advantage Coverage Summary
186. united-healthcare-mcs094-04Transcatheter Heart Valve Procedures – Medicare Advantage Coverage Summary
187. united-healthcare-mcs096-03Organ and Tissue Transplants - Medicare Advantage Coverage Summary
188. united-healthcare-mcs098-03Uterine Services and Procedures - Medicare Advantage Coverage Summary
189. united-healthcare-mcs099-04Varicose Veins Treatment and Other Vein Embolization Procedures - Medicare Advantage…
190. united-healthcare-mcs103-03Veteran Administration (VA) and Indian Health Services (IHS) – Medicare Advantage Coverage…
191. united-healthcare-mcs104-03Vision Services, Therapy and Rehabilitation – Medicare Advantage Coverage Summary
192. united-healthcare-mcs105-05Wound Treatments - Medicare Advantage Coverage Summary
193. united-healthcare-mcs107-02Omnibus Codes - Medicare Advantage Coverage Summary
194. united-healthcare-mcs109-01Experimental Procedures and Items, Investigational Devices, and Clinical Trials - Medicare…
195. united-healthcare-mmg001-oAblative Treatment for Spinal Pain - UnitedHealthcare West Medical Management Guideline
196. united-healthcare-mmg002-ddAbnormal Uterine Bleeding and Uterine Fibroids - UnitedHealthcare West Medical Management…
197. united-healthcare-mmg003-oApheresis - UnitedHealthcare West Medical Management Guideline
198. united-healthcare-mmg004-oAthletic Pubalgia Surgery - UnitedHealthcare West Medical Management Guideline
199. united-healthcare-mmg007-qBariatric Surgery - UnitedHealthcare West Medical Management Guideline
200. united-healthcare-mmg008-vBrow Ptosis and Eyelid Repair - UnitedHealthcare West Medical Management Guideline
201. united-healthcare-mmg009-rSpinal Fusion and Bone Healing Enhancement Products - UnitedHealthcare West Medical…
202. united-healthcare-mmg010-tBreast Imaging for Screening and Diagnosing Cancer - UnitedHealthcare West Medical…
203. united-healthcare-mmg011-tBreast Reconstruction - UnitedHealthcare West Medical Management Guideline
204. united-healthcare-mmg012-zBreast Reduction Surgery - UnitedHealthcare West Medical Management Guideline
205. united-healthcare-mmg014-nBronchial Thermoplasty - UnitedHealthcare West Medical Management Guideline
206. united-healthcare-mmg015-pCardiovascular Disease Risk Tests - UnitedHealthcare West Medical Management Guideline
207. united-healthcare-mmg016-lChelation Therapy for Non-Overload Conditions - UnitedHealthcare West Medical Management…
208. united-healthcare-mmg018-rChemotherapy Observation or Inpatient Hospitalization - UnitedHealthcare West Medical…
209. united-healthcare-mmg019-vChromosome Microarray Testing (Non-Oncology Conditions) - UnitedHealthcare West Medical…
210. united-healthcare-mmg020-sClinical Trials - UnitedHealthcare West Medical Management Guideline
211. united-healthcare-mmg021-pCochlear Implants - UnitedHealthcare West Medical Management Guideline
212. united-healthcare-mmg022-rCognitive Rehabilitation - UnitedHealthcare West Medical Management Guideline
213. united-healthcare-mmg023-mCollagen Crosslinks and Biochemical Markers of Bone Turnover - UnitedHealthcare West…
214. united-healthcare-mmg024-mComputed Tomographic Colonography - UnitedHealthcare West Medical Management Guideline
215. united-healthcare-mmg025-oComputerized Dynamic Posturography - UnitedHealthcare West Medical Management Guideline
216. united-healthcare-mmg026-bbContinuous Glucose Monitoring and Insulin Delivery for Managing Diabetes…
217. united-healthcare-mmg027-mCore Decompression for Avascular Necrosis - UnitedHealthcare West Medical Management…
218. united-healthcare-mmg028-oCorneal Hysteresis and Intraocular Pressure Measurement - UnitedHealthcare West Medical…
219. united-healthcare-mmg029-xCosmetic and Reconstructive Procedures - UnitedHealthcare West Medical Management…
220. united-healthcare-mmg030-nHome Health, Skilled, and Custodial Care Services - UnitedHealthcare West Medical…
221. united-healthcare-mmg031-rCytological Examination of Breast Fluids for Cancer Screening or Diagnosis…
222. united-healthcare-mmg032-rDeep Brain and Cortical Stimulation - UnitedHealthcare West Medical Management Guideline
223. united-healthcare-mmg033-pDiscogenic Pain Treatment - UnitedHealthcare West Medical Management Guideline
224. united-healthcare-mmg035-qSurgery of the Elbow - UnitedHealthcare West Medical Management Guideline
225. united-healthcare-mmg036-qElectrical and Ultrasound Bone Growth Stimulators - UnitedHealthcare West Medical…
226. united-healthcare-mmg038-lElectromagnetic Therapy for Wounds - UnitedHealthcare West Medical Management Guideline
227. united-healthcare-mmg039-vElectrical Stimulation for the Treatment of Pain and Muscle Rehabilitation…
228. united-healthcare-mmg041-wEpidural Steroid Injections for Spinal Pain - UnitedHealthcare West Medical Management…
229. united-healthcare-mmg042-nEpiduroscopy, Epidural Lysis of Adhesions, and Discography - UnitedHealthcare West Medical…
230. united-healthcare-mmg043-rExtracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue…
231. united-healthcare-mmg044-nFecal Calprotectin Testing - UnitedHealthcare West Medical Management Guideline
232. united-healthcare-mmg048-oGastrointestinal Motility Disorders, Diagnosis and Treatment - UnitedHealthcare West…
233. united-healthcare-mmg049-qGenetic Testing for Cardiac Disease - UnitedHealthcare West Medical Management Guideline
234. united-healthcare-mmg050-vGenetic Testing for Hereditary Cancer - UnitedHealthcare West Medical Management Guideline
235. united-healthcare-mmg051-sGlaucoma Surgical Treatments - UnitedHealthcare West Medical Management Guideline
236. united-healthcare-mmg052-qGynecomastia Surgery - UnitedHealthcare West Medical Management Guideline
237. united-healthcare-mmg053-rHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable…
238. united-healthcare-mmg054-vHepatitis Screening - UnitedHealthcare West Medical Management Guideline
239. united-healthcare-mmg055-tAirway Clearance Devices - UnitedHealthcare West Medical Management Guideline
240. united-healthcare-mmg057-uSurgery of the Hip - UnitedHealthcare West Medical Management Guideline
241. united-healthcare-mmg059-lHome Hemodialysis - UnitedHealthcare West Medical Management Guideline
242. united-healthcare-mmg060-oHome Traction Therapy - UnitedHealthcare West Medical Management Guideline
243. united-healthcare-mmg062-nUmbilical Cord Blood Harvesting and Storage for Future Use - UnitedHealthcare West Medical…
244. united-healthcare-mmg063-lImplantable Beta-Emitting Microspheres for Treatment of Malignant Tumors…
245. united-healthcare-mmg063-mTransarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the…
246. united-healthcare-mmg064-tImplanted Electrical Stimulator for Spinal Cord - UnitedHealthcare West Medical Management…
247. united-healthcare-mmg065-nIntrauterine Fetal Surgery - UnitedHealthcare West Medical Management Guideline
248. united-healthcare-mmg068-qIntensity-Modulated Radiation Therapy - UnitedHealthcare West Medical Management Guideline
249. united-healthcare-mmg069-mIntensive Behavioral Therapy for Autism Spectrum Disorder - UnitedHealthcare West Medical…
250. united-healthcare-mmg072-uSurgery of the Knee - UnitedHealthcare West Medical Management Guideline
251. united-healthcare-mmg073-qLight and Laser Therapy - UnitedHealthcare West Medical Management Guideline
252. united-healthcare-mmg074-mLithotripsy for Salivary Stones - UnitedHealthcare West Medical Management Guideline
253. united-healthcare-mmg076-oMacular Degeneration Treatment Procedures - UnitedHealthcare West Medical Management…
254. united-healthcare-mmg079-qManipulation Under Anesthesia - UnitedHealthcare West Medical Management Guideline
255. united-healthcare-mmg080-mManipulative Therapy - UnitedHealthcare West Medical Management Guideline
256. united-healthcare-mmg082-mMechanical Stretching Devices - UnitedHealthcare West Medical Management Guideline
257. united-healthcare-mmg084-uMinimally Invasive Procedures for Gastric and Esophageal Diseases - UnitedHealthcare West…
258. united-healthcare-mmg085-nMotorized Spinal Traction - UnitedHealthcare West Medical Management Guideline
259. united-healthcare-mmg086-mNerve Graft to Restore Erectile Function During Radical Prostatectomy - UnitedHealthcare…
260. united-healthcare-mmg087-sNeurophysiologic Testing and Monitoring - UnitedHealthcare West Medical Management…
261. united-healthcare-mmg088-pNeuropsychological Testing Under the Medical Benefit - UnitedHealthcare West Medical…
262. united-healthcare-mmg089-yCell-Free Fetal DNA Testing - UnitedHealthcare West Medical Management Guideline
263. united-healthcare-mmg091-hhObstructive and Central Sleep Apnea Treatment - UnitedHealthcare West Medical Management…
264. united-healthcare-mmg092-yOccipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache)…
265. united-healthcare-mmg093-ssOmnibus Codes - UnitedHealthcare West Medical Management Guideline
266. united-healthcare-mmg094-zOncology Medication Clinical Coverage - UnitedHealthcare West Medical Management Guideline
267. united-healthcare-mmg095-sOrthognathic (Jaw) Surgery - UnitedHealthcare West Medical Management Guideline
268. united-healthcare-mmg099-tCardiac Event Monitoring - UnitedHealthcare West Medical Management Guideline
269. united-healthcare-mmg100-uPanniculectomy and Body Contouring Procedures - UnitedHealthcare West Medical Management…
270. united-healthcare-mmg101-qPectus Deformity Repair - UnitedHealthcare West Medical Management Guideline
271. united-healthcare-mmg102-tPlagiocephaly and Craniosynostosis Treatment - UnitedHealthcare West Medical Management…
272. united-healthcare-mmg104-pPneumatic Compression Devices - UnitedHealthcare West Medical Management Guideline
273. united-healthcare-mmg105-uSleep Studies - UnitedHealthcare West Medical Management Guideline
274. united-healthcare-mmg108-wwPreventive Care Services - UnitedHealthcare West Medical Management Guideline
275. united-healthcare-mmg111-qProlotherapy and Platelet Rich Plasma Therapies - UnitedHealthcare West Medical Management…
276. united-healthcare-mmg113-rProton Beam Radiation Therapy - UnitedHealthcare West Medical Management Guideline
277. united-healthcare-mmg115-ccRhinoplasty and Other Nasal Procedures - UnitedHealthcare West Medical Management…
278. united-healthcare-mmg116-mSensory Integration Therapy and Auditory Integration Training - UnitedHealthcare West…
279. united-healthcare-mmg117-uSurgery of the Shoulder - UnitedHealthcare West Medical Management Guideline
280. united-healthcare-mmg118-ySodium Hyaluronate - UnitedHealthcare West Medical Management Guideline
281. united-healthcare-mmg119-oDiagnostic Spinal Ultrasonography - UnitedHealthcare West Medical Management Guideline
282. united-healthcare-mmg121-xSurgical and Ablative Procedures for Venous Insufficiency and Varicose Veins…
283. united-healthcare-mmg124-xTreatment of Temporomandibular Joint Disorders - UnitedHealthcare West Medical Management…
284. united-healthcare-mmg127-wTotal Artificial Disc Replacement for the Spine - UnitedHealthcare West Medical Management…
285. united-healthcare-mmg128-pTotal Artificial Heart and Ventricular Assist Devices - UnitedHealthcare West Medical…
286. united-healthcare-mmg129-vTranscatheter Heart Valve Procedures - UnitedHealthcare West Medical Management Guideline
287. united-healthcare-mmg130-mTranscranial Magnetic Stimulation - UnitedHealthcare West Medical Management Guideline
288. united-healthcare-mmg134-mUnicondylar Spacer Devices for Treatment of Pain or Disability - UnitedHealthcare West…
289. united-healthcare-mmg135-pVagus and External Trigeminal Nerve Stimulation - UnitedHealthcare West Medical Management…
290. united-healthcare-mmg136-mVirtual Upper Gastrointestinal Endoscopy - UnitedHealthcare West Medical Management…
291. united-healthcare-mmg137-oVisual Information Processing Evaluation and Orthoptic and Vision Therapy…
292. united-healthcare-mmg138-mNoncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds…
293. united-healthcare-mmg139-nTranspupillary Thermotherapy - UnitedHealthcare West Medical Management Guideline
294. united-healthcare-mmg141-afProvider Administered Drugs - Site of Care - UnitedHealthcare West Medical Management…
295. united-healthcare-mmg142-sSoliris® (Eculizumab) - UnitedHealthcare West Medical Management Guideline
296. united-healthcare-mmg143-mBalloon Sinus Ostial Dilation - UnitedHealthcare West Medical Management Guideline
297. united-healthcare-mmg143-nSinus Surgeries and Interventions - UnitedHealthcare West Medical Management Guideline
298. united-healthcare-mmg144-sHysterectomy - UnitedHealthcare West Medical Management Guideline
299. united-healthcare-mmg147-lIntraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) - UnitedHealthcare West…
300. united-healthcare-mmg148-oEmbolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome…
301. united-healthcare-mmg150-mFunctional Endoscopic Sinus Surgery (FESS) - UnitedHealthcare West Medical Management…
302. united-healthcare-mmg152-jElectric Tumor Treatment Field Therapy - UnitedHealthcare West Medical Management…
303. united-healthcare-mmg153-nGender Dysphoria Treatment Excluding California and Washington - UnitedHealthcare West…
304. united-healthcare-mmg155-lCarrier Testing Panels for Genetic Diseases - UnitedHealthcare West Medical Management…
305. united-healthcare-mmg156-ddMolecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment…
306. united-healthcare-mmg157-pPharmacogenetic Panel Testing - UnitedHealthcare West Medical Management Guideline
307. united-healthcare-mmg158-oWhole Exome and Whole Genome Sequencing (Non-Oncology Conditions) - UnitedHealthcare West…
308. united-healthcare-mmg159-uSkin and Soft Tissue Substitutes - UnitedHealthcare West Medical Management Guideline
309. united-healthcare-mmg160-iNegative Pressure Wound Therapy - UnitedHealthcare West Medical Management Guideline
310. united-healthcare-mmg162-jVideo Electroencephalographic (vEEG) Monitoring and Recording - UnitedHealthcare West…
311. united-healthcare-mmg163-hPreimplantation Genetic Testing and Related Services - UnitedHealthcare West Medical…
312. united-healthcare-mmg164-kLower Extremity Endovascular Procedures - UnitedHealthcare West Medical Management…
313. united-healthcare-mmg165-gGenetic Testing for Neuromuscular Disorders - UnitedHealthcare West Medical Management…
314. united-healthcare-mmg166-fComputer-Assisted Surgical Navigation for Musculoskeletal Procedures - UnitedHealthcare…
315. united-healthcare-mmg167-gGastrointestinal Pathogen Nucleic Acid Detection Panel Testing for Infectious Diarrhea…
316. united-healthcare-mmg168-fVertebral Body Tethering for Scoliosis - UnitedHealthcare West Medical Management…
317. united-healthcare-mmg169-fInhaled Nitric Oxide Therapy - UnitedHealthcare West Medical Management Guideline
318. united-healthcare-mmg171-ePercutaneous Patent Foramen Ovale (PFO) Closure - UnitedHealthcare West Medical Management…
319. united-healthcare-mmg172-kCatheter Ablation for Atrial Fibrillation - UnitedHealthcare West Medical Management…
320. united-healthcare-mmg173-eAutologous Cellular Therapy - UnitedHealthcare West Medical Management Guideline
321. united-healthcare-mmg176-fFacet Joint and Medial Branch Block Injections for Spinal Pain - UnitedHealthcare West…
322. united-healthcare-mmg179-hProstate Surgeries and Interventions - UnitedHealthcare West Medical Management Guideline
323. united-healthcare-mmg180-gSacroiliac Joint Interventions - UnitedHealthcare West Medical Management Guideline
324. united-healthcare-mmg182-eElective Inpatient Services - UnitedHealthcare West Medical Management Guideline
325. united-healthcare-mmg183-gSurgery of the Foot - UnitedHealthcare West Medical Management Guideline
326. united-healthcare-mmg184-fImplanted Spinal Drug Delivery Systems - UnitedHealthcare West Medical Management…
327. united-healthcare-mmg185-fSurgery of the Ankle - UnitedHealthcare West Medical Management Guideline
328. united-healthcare-mmg186-dSympathetic Blockade - UnitedHealthcare West Medical Management Guideline
329. united-healthcare-mmg187-dPercutaneous Neuroablation for Pancreatic Cancer Pain, Severe Cancer Pain, and Trigeminal…
330. united-healthcare-mmg188-dLiposuction for Lipedema - UnitedHealthcare West Medical Management Guideline
331. united-healthcare-mmg189-eSurgery of the Hand or Wrist - UnitedHealthcare West Medical Management Guideline
332. united-healthcare-mmg190-bDiagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis - UnitedHealthcare…
333. united-healthcare-mmg191-bHospital Services: Observation and Inpatient - UnitedHealthcare West Medical Management…
334. united-healthcare-mmg192-bSurgical Treatment of Lymphedema - UnitedHealthcare West Medical Management Guideline
335. united-healthcare-mmg193-eHabilitation and Rehabilitation Therapy (Occupational, Physical, and Speech)…
336. united-healthcare-mmg194-bPercutaneous Vertebroplasty and Kyphoplasty - UnitedHealthcare West Medical Management…
337. united-healthcare-mmg195-bSacral Nerve Stimulation for Urinary and Fecal Indications - UnitedHealthcare West Medical…
338. united-healthcare-mmg196-iCategory III Codes - UnitedHealthcare West Medical Management Guideline
339. united-healthcare-mmg197-bMinimally Invasive Spine Surgery Procedures - UnitedHealthcare West Medical Management…
340. united-healthcare-mmg198-cSpinal Fusion and Decompression - UnitedHealthcare West Medical Management Guideline
341. united-healthcare-mmg199-bInterspinous Fusion and Decompression Devices - UnitedHealthcare West Medical Management…
342. united-healthcare-mmg200-bCorneal Collagen Cross-Linking - UnitedHealthcare West Medical Management Guideline
343. united-healthcare-mmg201-bFecal Microbiota Transplantation - UnitedHealthcare West Medical Management Guideline
344. united-healthcare-mmg202-bTransanal Minimally Invasive Surgical Procedures - UnitedHealthcare West Medical…
345. united-healthcare-mmg203-aMolecular Oncology Companion Diagnostic Testing - UnitedHealthcare West Medical Management…
346. united-healthcare-mmg204-aMolecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment…
347. united-healthcare-mmg205-aElectroretinography - UnitedHealthcare West Medical Management Guideline
348. united-healthcare-mmg206-aInjectables for Reconstructive Procedures - UnitedHealthcare West Medical Management…
349. united-healthcare-mmg207-aStereotactic Body Radiation Therapy and Stereotactic Radiosurgery - UnitedHealthcare West…
350. united-healthcare-mmg208-aEnteral Nutrition (Oral and Tube Feeding) - UnitedHealthcare West Medical Management…
351. united-healthcare-mmg209-aSpevigo® (Spesolimab-Sbzo) - IV and Subcutaneous Formulations (for UHCWest Only)…
352. united-healthcare-mmp007-07Brow Ptosis and Eyelid Repair - Medicare Advantage Medical Policy
353. united-healthcare-mmp013-13Cardiovascular Diagnostic and Therapeutic Procedures - Medicare Advantage Medical Policy
354. united-healthcare-mmp022-11Cosmetic and Reconstructive Procedures - Medicare Advantage Medical Policy
355. united-healthcare-mmp025-09Treatment of Temporomandibular Joint (TMJ) - Medicare Advantage Medical Policy
356. united-healthcare-mmp028-19Durable Medical Equipment (DME), Prosthetics, Orthotics (Non-Foot Orthotics), Nutritional…
357. united-healthcare-mmp036-12Capsule Endoscopy - Medicare Advantage Medical Policy
358. united-healthcare-mmp039-13Gastroesophageal and Gastrointestinal (GI) Services and Procedures - Medicare Advantage…
359. united-healthcare-mmp043-11Hearing Services and Devices - Medicare Advantage Medical Policy
360. united-healthcare-mmp043-41Category III CPT Codes - Medicare Advantage Medical Policy
361. united-healthcare-mmp044-12Home Health Services, Home Health Visits, Respite Care, and Hospice Care - Medicare…
362. united-healthcare-mmp046-09Hospital, Emergency, and Ambulance Services - Medicare Advantage Medical Policy
363. united-healthcare-mmp049-10Urinary and Fecal Incontinence: Diagnosis and Treatment - Medicare Advantage Medical…
364. united-healthcare-mmp052-07Joint Procedures - Medicare Advantage Medical Policy
365. united-healthcare-mmp057-38Medications/Drugs (Outpatient/Part B) - Medicare Advantage Medical Policy
366. united-healthcare-mmp060-10Ear, Nose, and Throat Procedures - Medicare Advantage Medical Policy
367. united-healthcare-mmp061-10Neurologic Services and Procedures - Medicare Advantage Medical Policy
368. united-healthcare-mmp062-13Corneal Topography - Medicare Advantage Medical Policy
369. united-healthcare-mmp068-06Orthopedic Procedures, Devices, and Products - Medicare Advantage Medical Policy
370. united-healthcare-mmp070-09Pain Management - Medicare Advantage Medical Policy
371. united-healthcare-mmp075-10Prostate Services and Procedures and Impotence Treatment - Medicare Advantage Medical…
372. united-healthcare-mmp076-10Radiologic Diagnostic Procedures - Medicare Advantage Medical Policy
373. united-healthcare-mmp077-11Radiation and Oncologic Procedures - Medicare Advantage Medical Policy
374. united-healthcare-mmp079-12Skilled Nursing Facility, Rehabilitation, and Long-Term Acute Care Hospital - Medicare…
375. united-healthcare-mmp087-11Sleep Apnea Surgical Treatments - Medicare Advantage Medical Policy
376. united-healthcare-mmp089-11Spine Procedures - Medicare Advantage Medical Policy
377. united-healthcare-mmp090-15Electrical Stimulators - Medicare Advantage Medical Policy
378. united-healthcare-mmp098-07Uterine Services and Procedures - Medicare Advantage Medical Policy
379. united-healthcare-mmp099-07Varicose Veins Treatment and Other Vein Embolization Procedures - Medicare Advantage…
380. united-healthcare-mmp105-13Skin Substitutes Grafts/Cellular and Tissue-Based Products (Injections and/or…
381. united-healthcare-mmp107-04Omnibus Codes - Medicare Advantage Medical Policy
382. united-healthcare-mmp108-02Surgical Procedures - Medicare Advantage Medical Policy
383. united-healthcare-mmp109-02Experimental Procedures and Items, Investigational Devices, and Clinical Trials - Medicare…
384. united-healthcare-mmp109-17Ambulatory Electrocardiographic (AECG) Monitoring - Medicare Advantage Medical Policy
385. united-healthcare-mmp185-38Clinical Diagnostic Laboratory Services - Medicare Advantage Medical Policy
386. united-healthcare-mmp210-30Molecular Pathology/Molecular Diagnostics/Genetic Testing - Medicare Advantage Medical…
387. united-healthcare-mmp222-12Implantable Miniature Telescope (IMT) - Medicare Advantage Medical Policy
388. united-healthcare-mmp227-11Osteopathic Manipulations (OMT) - Medicare Advantage Medical Policy
389. united-healthcare-mmp235-13Percutaneous Coronary Interventions - Medicare Advantage Medical Policy
390. united-healthcare-mmp240-15Percutaneous Ventricular Assist Device - Medicare Advantage Medical Policy
391. united-healthcare-mmp242-16Positron Emission Tomography (PET) Scan for Myocardial Imaging - Medicare Advantage…
392. united-healthcare-mmp258-10Computerized Dynamic Posturography - Medicare Advantage Medical Policy
393. united-healthcare-mmp365-10Gender Dysphoria and Gender Reassignment Surgery - Medicare Advantage Medical Policy
394. united-healthcare-mmp368-11Spinal Cord Stimulators for Chronic Pain - Medicare Advantage Medical Policy
395. united-healthcare-mmp372-10Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease - Medicare Advantage…
396. united-healthcare-mmp373-30Urogenital/Anogenital (UG/AG) Panels - Medicare Advantage Medical Policy
397. united-healthcare-mmp377-10Vitamin D Testing - Medicare Advantage Medical Policy
398. united-healthcare-mmp379-10Ambulatory EEG Monitoring - Medicare Advantage Medical Policy
399. united-healthcare-mmp381-20Tier 2 Molecular Pathology Procedures - Medicare Advantage Medical Policy
400. united-healthcare-mmp383-22Molecular Pathology/Genetic Testing Reported with Unlisted Codes - Medicare Advantage…
401. united-healthcare-mmp389-06Minimally Invasive Procedures for Gastric and Esophageal Diseases - Medicare Advantage…
402. united-healthcare-mmp391-13Pharmacogenomics Testing - Medicare Advantage Medical Policy
403. united-healthcare-mmp392-03Platelet Rich Plasma Therapies - Medicare Advantage Medical Policy
404. united-healthcare-mp-002-20Brow Ptosis and Eyelid Repair - Commercial and Individual Exchange Medical Policy
405. united-healthcare-mp-003-20Breast Reconstruction - Commercial and Individual Exchange Medical Policy
406. united-healthcare-mp-004-23Breast Reduction Surgery - Commercial and Individual Exchange Medical Policy
407. united-healthcare-mp-006-18Clinical Trials - Commercial and Individual Exchange Medical Policy
408. united-healthcare-mp-007-24Cosmetic and Reconstructive Procedures - Commercial and Individual Exchange Medical Policy
409. united-healthcare-mp-012-13Gynecomastia Surgery - Commercial and Individual Exchange Medical Policy
410. united-healthcare-mp-013-17Orthognathic (Jaw) Surgery - Commercial and Individual Exchange Medical Policy
411. united-healthcare-mp-014-19Panniculectomy Surgery - Commercial and Individual Exchange Medical Policy
412. united-healthcare-mp-015-15Pectus Deformity Repair - Commercial and Individual Exchange Medical Policy
413. united-healthcare-mp-019-25Rhinoplasty and Other Nasal Procedures - Commercial and Individual Exchange Medical Policy
414. united-healthcare-mp-02-12Chemotherapy Observation or Inpatient Hospitalization - Commercial and Individual Exchange…
415. united-healthcare-mp-028-07Beds and Mattresses - Commercial and Individual Exchange Medical Policy
416. united-healthcare-mp-030-09Mobility Devices, Options, and Accessories - Commercial and Individual Exchange Medical…
417. united-healthcare-mp-031-04Patient Lifts - Commercial and Individual Exchange Medical Policy
418. united-healthcare-mp-038-04Pediatric Gait Trainers and Standing Systems - Commercial and Individual Exchange Medical…
419. united-healthcare-mp-038-06Speech Generating Devices - Commercial and Individual Exchange Medical Policy
420. united-healthcare-mp-10-11Immune Globulin – Site of Care – Commercial Medical Policy
421. united-healthcare-mp-13-09Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan - Site of Service…
422. united-healthcare-mp-15-04Screening Colonoscopy Procedures - Site of Service - Commercial and Individual Exchange…
423. united-healthcare-mp-9-26Provider Administered Drugs - Site of Care - Commercial Medical Benefit Drug Policy
424. united-healthcare-mpg002-08Abortion (NCD 140.1) – Medicare Advantage Policy Guideline
425. united-healthcare-mpg003-11Acupuncture – Medicare Advantage Policy Guideline
426. united-healthcare-mpg011-12Anterior Segment Aqueous Drainage Device - Medicare Advantage Policy Guideline
427. united-healthcare-mpg023-12Avastin® (Bevacizumab) - Medicare Advantage Policy Guideline
428. united-healthcare-mpg024-09Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity (NCD…
429. united-healthcare-mpg025-08Biofeedback Therapy – Medicare Advantage Policy Guideline
430. united-healthcare-mpg028-09Blepharoplasty, Blepharoptosis, and Brow Lift - Medicare Advantage Policy Guideline
431. united-healthcare-mpg032-09Blood-Derived Products for Chronic Non-Healing Wounds (NCD 270.3) - Medicare Advantage…
432. united-healthcare-mpg033-12Bone (Mineral) Density Studies (NCD 150.3) – Medicare Advantage Policy Guideline
433. united-healthcare-mpg036-07Capsule Endoscopy - Medicare Advantage Policy Guideline
434. united-healthcare-mpg039-09Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (NCD…
435. united-healthcare-mpg040-10Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs - Medicare…
436. united-healthcare-mpg043-33Category III CPT Codes - Medicare Advantage Policy Guideline
437. united-healthcare-mpg050-08Chiropractic Services – Medicare Advantage Policy Guideline
438. united-healthcare-mpg052-10Cochlear Implantation (NCD 50.3) – Medicare Advantage Policy Guideline
439. united-healthcare-mpg057-09Computed Tomography (NCD 220.1) – Medicare Advantage Policy Guideline
440. united-healthcare-mpg062-10Corneal Topography - Medicare Advantage Policy Guideline
441. united-healthcare-mpg065-11Cosmetic and Reconstructive Services and Procedures - Medicare Advantage Policy Guideline
442. united-healthcare-mpg070-08Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease (NCD 160.24)…
443. united-healthcare-mpg081-08Dimethyl Sulfoxide (DMSO) (NCD 230.12) – Medicare Advantage Policy Guideline
444. united-healthcare-mpg083-11Durable Medical Equipment Reference List – Medicare Advantage Policy Guideline
445. united-healthcare-mpg093-08Electrotherapy for Treatment of Facial Nerve Paralysis (Bell's Palsy) (NCD 160.15)…
446. united-healthcare-mpg096-08Endothelial Cell Photography (NCD 80.8) – Medicare Advantage Policy Guideline
447. united-healthcare-mpg099-10Enteral and Parenteral Nutritional Therapy (Formerly NCD 180.2) – Medicare Advantage…
448. united-healthcare-mpg101-08Erbitux® (Cetuximab) - Medicare Advantage Policy Guideline
449. united-healthcare-mpg103-08Erythropoiesis Stimulating Agents (ESA) – Medicare Advantage Policy Guideline
450. united-healthcare-mpg109-12Long-Term Wearable Electrocardiographic Monitoring - Medicare Advantage Policy Guideline
451. united-healthcare-mpg111-08Extracorporeal Photopheresis (NCD 110.4) – Medicare Advantage Policy Guideline
452. united-healthcare-mpg114-11Eylea® (Aflibercept) - Medicare Advantage Policy Guideline
453. united-healthcare-mpg125-08Halaven® (Eribulin Mesylate) - Medicare Advantage Policy Guideline
454. united-healthcare-mpg130-12Hemophilia Clotting Factors and Products - Medicare Advantage Policy Guideline
455. united-healthcare-mpg136-07Home Blood Glucose Monitors (NCD 40.2) – Medicare Advantage Policy Guideline
456. united-healthcare-mpg141-11Home Use of Oxygen – Medicare Advantage Policy Guideline
457. united-healthcare-mpg144-08Hospital Beds (NCD 280.7) – Medicare Advantage Policy Guideline
458. united-healthcare-mpg145-08Human Tumor Stem Cell Drug Sensitivity Assays (NCD 190.7) – Medicare Advantage Policy…
459. united-healthcare-mpg151-14Implantable Automatic Defibrillators (NCD 20.4) – Medicare Advantage Policy Guideline
460. united-healthcare-mpg153-08Incontinence Control Devices (NCD 230.10) – Medicare Advantage Policy Guideline
461. united-healthcare-mpg157-13Infusion Pumps (NCD 280.14) – Medicare Advantage Policy Guideline
462. united-healthcare-mpg171-09Intraocular Photography (NCD 80.6) – Medicare Advantage Policy Guideline
463. united-healthcare-mpg176-14Intravenous Immune Globulin (IVIG) – Medicare Advantage Policy Guideline
464. united-healthcare-mpg176-19Immune Globulin - Medicare Advantage Policy Guideline
465. united-healthcare-mpg182-08Jevtana® (Cabazitaxel) - Medicare Advantage Policy Guideline
466. united-healthcare-mpg184-07Knee Orthoses – Medicare Advantage Policy Guideline
467. united-healthcare-mpg185-29Clinical Diagnostic Laboratory Services - Medicare Advantage Policy Guideline
468. united-healthcare-mpg193-09Lucentis® (Ranibizumab) - Medicare Advantage Policy Guideline
469. united-healthcare-mpg194-07Lumbar Artificial Disc Replacement (LADR) (NCD 150.10) – Medicare Advantage Policy…
470. united-healthcare-mpg200-10Magnetic Resonance Imaging (NCD 220.2) – Medicare Advantage Policy Guideline
471. united-healthcare-mpg208-07Mobility Devices (Ambulatory) – Medicare Advantage Policy Guideline
472. united-healthcare-mpg209-11Mobility Devices (Non-Ambulatory) and Accessories – Medicare Advantage Policy Guideline
473. united-healthcare-mpg210-21Molecular Pathology/Molecular Diagnostics/Genetic Testing - Medicare Advantage Policy…
474. united-healthcare-mpg211-07Nebulizers – Medicare Advantage Policy Guideline
475. united-healthcare-mpg212-07Negative Pressure Wound Therapy Pumps – Medicare Advantage Policy Guideline
476. united-healthcare-mpg215-08Neuromuscular Electrical Stimulation (NMES) (NCD 160.12) – Medicare Advantage Policy…
477. united-healthcare-mpg222-08Ocular Telescope - Medicare Advantage Policy Guideline
478. united-healthcare-mpg226-08Osteogenic Stimulators (NCD 150.2) – Medicare Advantage Policy Guideline
479. united-healthcare-mpg227-08Osteopathic Manipulations (OMT) - Medicare Advantage Policy Guideline
480. united-healthcare-mpg233-08Partial Ventriculectomy (NCD 20.26) – Medicare Advantage Policy Guideline
481. united-healthcare-mpg235-09Percutaneous Coronary Interventions - Medicare Advantage Policy Guideline
482. united-healthcare-mpg238-07Percutaneous or Minimally Invasive Surgical Fusion of the Sacroiliac Joint - Medicare…
483. united-healthcare-mpg239-09Percutaneous Transluminal Angioplasty (PTA) (NCD 20.7) – Medicare Advantage Policy…
484. united-healthcare-mpg240-11Percutaneous Ventricular Assist Device - Medicare Advantage Policy Guideline
485. united-healthcare-mpg242-10Positron Emission Tomography (PET) Scan - Medicare Advantage Policy Guideline
486. united-healthcare-mpg245-08Photodynamic Therapy – Medicare Advantage Policy Guideline
487. united-healthcare-mpg251-09Pneumatic Compression Devices (NCD 280.6) - Medicare Advantage Policy Guideline
488. united-healthcare-mpg252-09Podiatry – Medicare Advantage Policy Guideline
489. united-healthcare-mpg253-09Porcine Skin and Gradient Pressure Dressings - Medicare Advantage Policy Guideline
490. united-healthcare-mpg258-08Posturography - Medicare Advantage Policy Guideline
491. united-healthcare-mpg259-09Pressure Reducing Support Surfaces – Medicare Advantage Policy Guideline
492. united-healthcare-mpg268-09Routine Costs in Clinical Trials (NCD 310.1) – Medicare Advantage Policy Guideline
493. united-healthcare-mpg269-09Sacral Nerve Stimulation for Urinary Incontinence (NCD 230.18) – Medicare Advantage Policy…
494. united-healthcare-mpg270-08Scalp Hypothermia During Chemotherapy to Prevent Hair Loss (NCD 110.6) – Medicare…
495. united-healthcare-mpg280-11Self-Administered Drug(s) (SAD) - Medicare Advantage Policy Guideline
496. united-healthcare-mpg287-08Sleep Testing for Obstructive Sleep Apnea (OSA) (NCD 240.4.1) - Medicare Advantage Policy…
497. united-healthcare-mpg294-07Sterilization (NCD 230.3) – Medicare Advantage Policy Guideline
498. united-healthcare-mpg301-07Testosterone Pellets (Testopel®) - Medicare Advantage Policy Guideline
499. united-healthcare-mpg304-08Thermal Intradiscal Procedures (TIPs) (NCD 150.11) – Medicare Advantage Policy Guideline
500. united-healthcare-mpg310-09Transcatheter Aortic Valve Replacement (TAVR) (NCD 20.32) – Medicare Advantage Policy…
501. united-healthcare-mpg311-10Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve Regurgitation (NCD 20.33)…
502. united-healthcare-mpg314-09Transcutaneous Electrical Nerve Stimulation (TENS) - Medicare Advantage Policy Guideline
503. united-healthcare-mpg320-09Transportation Services - Medicare Advantage Policy Guideline
504. united-healthcare-mpg330-08Tumor Treatment Field Therapy – Medicare Advantage Policy Guideline
505. united-healthcare-mpg335-08Facet Joint Interventions for Pain Management – Medicare Advantage Policy Guideline
506. united-healthcare-mpg336-10Ultrasound Diagnostic Procedures (NCD 220.5) – Medicare Advantage Policy Guideline
507. united-healthcare-mpg341-16Vaccination (Immunization) - Medicare Advantage Policy Guideline
508. united-healthcare-mpg342-14Vagus Nerve Stimulation (VNS) (NCD 160.18) – Medicare Advantage Policy Guideline
509. united-healthcare-mpg343-11Ventricular Assist Devices (NCD 20.9.1) – Medicare Advantage Policy Guideline
510. united-healthcare-mpg354-08Wrong Surgical or Other Invasive Procedure – Medicare Advantage Policy Guideline
511. united-healthcare-mpg355-09Xgeva®, Prolia® (Denosumab) - Medicare Advantage Policy Guideline
512. united-healthcare-mpg356-07Xofigo® Radioactive Therapeutic Agent - Medicare Advantage Policy Guideline
513. united-healthcare-mpg357-08Zoledronic Acid (Zometa® & Reclast®) - Medicare Advantage Policy Guideline
514. united-healthcare-mpg359-09Urological Supplies – Medicare Advantage Policy Guideline
515. united-healthcare-mpg360-08KX Modifier – Medicare Advantage Policy Guideline
516. united-healthcare-mpg361-08Percutaneous Left Atrial Appendage Closure (LAAC) (NCD 20.34) – Medicare Advantage Policy…
517. united-healthcare-mpg362-09Stem Cell Transplantation (Formerly 110.8.1) (NCD 110.23) – Medicare Advantage Policy…
518. united-healthcare-mpg363-17Continuous Glucose Monitors – Medicare Advantage Policy Guideline
519. united-healthcare-mpg365-07Gender Dysphoria and Gender Reassignment Surgery (NCD 140.9) - Medicare Advantage Policy…
520. united-healthcare-mpg367-07Leadless Pacemakers (NCD 20.8.4) – Medicare Advantage Policy Guideline
521. united-healthcare-mpg368-08Spinal Cord Stimulators for Chronic Pain - Medicare Advantage Policy Guideline
522. united-healthcare-mpg370-08Biomarkers in Cardiovascular Risk Assessment - Medicare Advantage Policy Guideline
523. united-healthcare-mpg371-14Cytogenetic Studies (NCD 190.3) – Medicare Advantage Policy Guideline
524. united-healthcare-mpg372-07Coronary Fractional Flow Reserve Using Computed Tomography (FFR-ct) - Medicare Advantage…
525. united-healthcare-mpg373-22Molecular Diagnostic Infectious Disease Testing - Medicare Advantage Policy Guideline
526. united-healthcare-mpg375-05Prostate Rectal Spacers – Medicare Advantage Policy Guideline
527. united-healthcare-mpg376-07Dental Services – Medicare Advantage Policy Guideline
528. united-healthcare-mpg377-05Vitamin D Testing - Medicare Advantage Policy Guideline
529. united-healthcare-mpg379-07Ambulatory EEG Monitoring - Medicare Advantage Policy Guideline
530. united-healthcare-mpg380-05Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing – Medicare…
531. united-healthcare-mpg381-09Tier 2 Molecular Pathology Procedures - Medicare Advantage Policy Guideline
532. united-healthcare-mpg383-11Molecular Pathology/Genetic Testing Reported with Unlisted Codes - Medicare Advantage…
533. united-healthcare-mpg386-04Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea – Medicare…
534. united-healthcare-mpg388-03Blood Product Molecular Antigen Typing - Medicare Advantage Policy Guideline
535. united-healthcare-mpg389-02Minimally Invasive Gastroesophageal Reflux Disease (GERD) Procedures - Medicare Advantage…
536. united-healthcare-mpg390-02Genetic Testing for Cardiovascular Disease - Medicare Advantage Policy Guideline
537. united-healthcare-mpg391-02Pharmacogenomics Testing - Medicare Advantage Policy Guideline
538. united-healthcare-mpg392-01Platelet Rich Plasma Injections for Non-Wound Injections - Medicare Advantage Policy…
539. united-healthcare-mpg393-01Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease…
540. united-healthcare-mpg394-01Genetic Testing for Hereditary Cancer - Medicare Advantage Policy Guideline
541. united-healthcare-mpg394-02Intravitreal Corticosteroid Implants - Medicare Advantage Policy Guideline
542. united-healthcare-mpg395-05Diagnostic Radiology Services - Medicare Advantage Policy Guideline
543. Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins - Oxford…
544. Obstructive and Central Sleep Apnea Treatment - Oxford Clinical Policy
545. Discogenic Pain Treatment - Oxford Clinical Policy
546. Umbilical Cord Blood Harvesting and Storage for Future Use - Oxford Clinical Policy
547. Apheresis - Oxford Clinical Policy
548. Fecal Microbiota Transplantation - Oxford Clinical Policy
549. Injectables for Reconstructive Procedures - Oxford Clinical Policy
550. Injectable Dermal Fillers and Bulking Agents - Oxford Clinical Policy
551. Epiduroscopy, Epidural Lysis of Adhesions, and Discography - Oxford Clinical Policy
552. Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache)…
553. Epidural Steroid Injections for Spinal Pain - Oxford Clinical Policy
554. Ablative Treatment for Spinal Pain - Oxford Clinical Policy
555. Implanted Electrical Stimulator for the Spinal Cord - Oxford Clinical Policy
556. Percutaneous Vertebroplasty and Kyphoplasty - Oxford Clinical Policy
557. united-healthcare-pain-024-7Facet Joint and Medial Branch Block Injections for Spinal Pain - Oxford Clinical Policy
558. united-healthcare-pain-025-4Percutaneous Neuroablation for Pancreatic Cancer Pain, Severe Cancer Pain, and Trigeminal…
559. united-healthcare-pain-026-5Sympathetic Blockade - Oxford Clinical Policy
560. united-healthcare-pain-027-7Sacroiliac Joint Interventions - Oxford Clinical Policy
561. Assisted Administration of Clotting Factors, Coagulant Blood Products & Other Hemostatics…
562. Eloctate® [Antihemophilic Factor (Recombinant), FC Fusion Protein] for Connecticut Lines…
563. Implanted Spinal Drug Delivery Systems - Oxford Clinical Policy
564. Preventive Care Services - Oxford Clinical Policy
565. Collagen Crosslinks and Biochemical Markers of Bone Turnover - Oxford Clinical Policy
566. Obstetrical Ultrasonography - Oxford Clinical Policy
567. Oxford's Outpatient Imaging Self-Referral Policy - Oxford Clinical Policy
568. Radiopharmaceuticals and Contrast Media - Oxford Clinical Policy
569. Radiology Procedures for eviCore healthcare Arrangement - Oxford Clinical Policy
570. Credentialing Guidelines: Participation in the eviCore healthcare Network - Oxford…
571. Lower Extremity Endovascular Procedures - Oxford Clinical Policy
572. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan - Site of Service…
573. Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery - Oxford Clinical Policy
574. Intensity-Modulated Radiation Therapy - Oxford Clinical Policy
575. Radiation Therapy: Fractionation, Image-Guidance, and Special Services - Oxford Clinical…
576. Proton Beam Radiation Therapy - Oxford Clinical Policy
577. Home Traction Therapy - Oxford Clinical Policy
578. Sensory Integration Therapy and Auditory Integration Training - Oxford Clinical Policy
579. Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds…
580. Chelation Therapy - Oxford Clinical Policy
581. Motorized Spinal Traction - Oxford Clinical Policy
582. Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) - Oxford…
583. Bronchial Thermoplasty - Oxford Clinical Policy
584. Facet Joint and Medial Branch Block Injections for Spinal Pain - Rocky Mountain Health…
585. Genetic Testing for Hereditary Cancer - Rocky Mountain Health Plans Medical Policy
586. Plagiocephaly and Craniosynostosis Treatment - Rocky Mountain Health Plans Medical Policy
587. Intrauterine Fetal Surgery - Rocky Mountain Health Plans Medical Policy
588. Chelation Therapy for Non-Overload Conditions - Rocky Mountain Health Plans Medical Policy
589. Airway Clearance Devices- Rocky Mountain Health Plans Medical Policy
590. Visual Information Processing Evaluation and Orthoptic and Vision Therapy - Rocky Mountain…
591. Treatment of Temporomandibular Joint Disorders - Rocky Mountain Health Plans Medical…
592. Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache)…
593. Vagus and External Trigeminal Nerve Stimulation - Rocky Mountain Health Plans Medical…
594. Discogenic Pain Treatment - Rocky Mountain Health Plans Medical Policy
595. Ablative Treatment for Spinal Pain - Rocky Mountain Health Plans Medical Policy
596. Umbilical Cord Blood Harvesting and Storage for Future Use - Rocky Mountain Health Plans…
597. Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation - Rocky…
598. Proton Beam Radiation Therapy - Rocky Mountain Health Plans Medical Policy
599. Apheresis - Rocky Mountain Health Plans Medical Policy
600. Cognitive Rehabilitation - Rocky Mountain Health Plans Medical Policy
601. Neuropsychological Testing Under the Medical Benefit - Rocky Mountain Health Plans Medical…
602. Epiduroscopy, Epidural Lysis of Adhesions, and Discography - Rocky Mountain Health Plans…
603. Computerized Dynamic Posturography - Rocky Mountain Health Plans Medical Policy
604. Core Decompression for Avascular Necrosis - Rocky Mountain Health Plans Medical Policy
605. Lithotripsy for Salivary Stones - Rocky Mountain Health Plans Medical Policy
606. Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue…
607. Infertility Diagnosis, Treatment, and Fertility Preservation - Rocky Mountain Health Plans…
608. Sensory Integration Therapy and Auditory Integration Training - Rocky Mountain Health…
609. Deep Brain and Cortical Stimulation - Rocky Mountain Health Plans Medical Policy
610. Minimally Invasive Procedures for Gastric and Esophageal Diseases - Rocky Mountain Health…
611. Sleep Studies - Rocky Mountain Health Plans Medical Policy
612. Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis - Rocky…
613. Light and Laser Therapy - Rocky Mountain Health Plans Medical Policy
614. Athletic Pubalgia Surgery - Rocky Mountain Health Plans Medical Policy
615. Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes - Rocky Mountain…
616. Bariatric Surgery - Rocky Mountain Health Plans Medical Policy
617. Nerve Graft to Restore Erectile Function During Radical Prostatectomy - Rocky Mountain…
618. Breast Imaging for Screening and Diagnosing Cancer - Rocky Mountain Health Plans Medical…
619. Cardiovascular Disease Risk Tests - Rocky Mountain Health Plans Medical Policy
620. Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable - Rocky…
621. Virtual Upper Gastrointestinal Endoscopy - Rocky Mountain Health Plans Medical Policy
622. Macular Degeneration Treatment Procedures - Rocky Mountain Health Plans Medical Policy
623. Intensity-Modulated Radiation Therapy - Rocky Mountain Health Plans Medical Policy
624. Unicondylar Spacer Devices for Treatment of Pain or Disability - Rocky Mountain Health…
625. Spinal Fusion and Bone Healing Enhancement Products - Rocky Mountain Health Plans Medical…
626. Gastrointestinal Motility Disorders, Diagnosis and Treatment - Rocky Mountain Health Plans…
627. Collagen Crosslinks and Biochemical Markers of Bone Turnover - Rocky Mountain Health Plans…
628. Total Artificial Disc Replacement for the Spine - Rocky Mountain Health Plans Medical…
629. Abnormal Uterine Bleeding and Uterine Fibroids - Rocky Mountain Health Plans Medical…
630. Glaucoma Surgical Treatments - Rocky Mountain Health Plans Medical Policy
631. Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the…
632. Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins - Rocky…
633. Diagnostic Spinal Ultrasonography - Rocky Mountain Health Plans Medical Policy
634. Home Hemodialysis - Rocky Mountain Health Plans Medical Policy
635. Mechanical Stretching Devices - Rocky Mountain Health Plans Medical Policy
636. Cardiac Event Monitoring - Rocky Mountain Health Plans Medical Policy
637. Neurophysiologic Testing and Monitoring - Rocky Mountain Health Plans Medical Policy
638. Prolotherapy and Platelet Rich Plasma Therapies - Rocky Mountain Health Plans Medical…
639. Surgery of the Hip - Rocky Mountain Health Plans Medical Policy
640. Manipulation Under Anesthesia - Rocky Mountain Health Plans Medical Policy
641. Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds…
642. Obstructive and Central Sleep Apnea Treatment - Rocky Mountain Health Plans Medical Policy
643. Electromagnetic Therapy for Wounds - Rocky Mountain Health Plans Medical Policy
644. Omnibus Codes - Rocky Mountain Health Plans Medical Policy
645. Transcranial Magnetic Stimulation - Rocky Mountain Health Plans Medical Policy
646. Manipulative Therapy - Rocky Mountain Health Plans Medical Policy
647. Bronchial Thermoplasty - Rocky Mountain Health Plans Medical Policy
648. Home Traction Therapy - Rocky Mountain Health Plans Medical Policy
649. Motorized Spinal Traction - Rocky Mountain Health Plans Medical Policy
650. Surgery of the Elbow - Rocky Mountain Health Plans Medical Policy
651. Genetic Testing for Cardiac Disease - Rocky Mountain Health Plans Medical Policy
652. Surgery of the Knee - Rocky Mountain Health Plans Medical Policy
653. Surgery of the Shoulder - Rocky Mountain Health Plans Medical Policy
654. Transcatheter Heart Valve Procedures - Rocky Mountain Health Plans Medical Policy
655. Chromosome Microarray Testing (Non-Oncology Conditions) - Rocky Mountain Health Plans…
656. Cell-Free Fetal DNA Testing - Rocky Mountain Health Plans Medical Policy
657. Electrical and Ultrasound Bone Growth Stimulators - Rocky Mountain Health Plans Medical…
658. Pneumatic Compression Devices - Rocky Mountain Health Plans Medical Policy
659. Implanted Electrical Stimulator for the Spinal Cord - Rocky Mountain Health Plans Medical…
660. Transpupillary Thermotherapy - Rocky Mountain Health Plans Medical Policy
661. Sinus Surgeries and Interventions - Rocky Mountain Health Plans Medical Policy
662. Hysterectomy - Rocky Mountain Health Plans Medical Policy
663. Gender Dysphoria Treatment - Rocky Mountain Health Plans Medical Policy
664. Percutaneous Vertebroplasty and Kyphoplasty - Rocky Mountain Health Plans Medical Policy
665. Electric Tumor Treatment Field Therapy - Rocky Mountain Health Plans Medical Policy
666. Carrier Testing Panels for Genetic Diseases - Rocky Mountain Health Plans Medical Policy
667. Pharmacogenetic Panel Testing- Rocky Mountain Health Plans Medical Policy
668. Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment…
669. Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) - Rocky Mountain Health…
670. Skin and Soft Tissue Substitutes - Rocky Mountain Health Plans Medical Policy
671. Negative Pressure Wound Therapy - Rocky Mountain Health Plans Medical Policy
672. Video Electroencephalographic (vEEG) Monitoring and Recording - Rocky Mountain Health…
673. Preimplantation Genetic Testing and Related Services - Rocky Mountain Health Plans Medical…
674. Genetic Testing for Neuromuscular Disorders - Rocky Mountain Health Plans Medical Policy
675. Computer-Assisted Surgical Navigation for Musculoskeletal Procedures - Rocky Mountain…
676. Lower Extremity Endovascular Procedures - Rocky Mountain Health Plans Medical Policy
677. Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing for Infectious Diarrhea…
678. Vertebral Body Tethering for Scoliosis - Rocky Mountain Health Plans Medical Policy
679. Percutaneous Patent Foramen Ovale (PFO) Closure - Rocky Mountain Health Plans Medical…
680. Inhaled Nitric Oxide Therapy - Rocky Mountain Health Plans Medical Policy
681. Catheter Ablation for Atrial Fibrillation - Rocky Mountain Health Plans Medical Policy
682. Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery - Rocky Mountain Health…
683. Autologous Cellular Therapy - Rocky Mountain Health Plans Medical Policy
684. Radiation Therapy: Fractionation, Image-Guidance, and Special Services - Rocky Mountain…
685. Epidural Steroid Injections for Spinal Pain - Rocky Mountain Health Plans Medical Policy
686. Prostate Surgeries and Interventions - Rocky Mountain Health Plans Medical Policy
687. Sacroiliac Joint Interventions - Rocky Mountain Health Plans Medical Policy
688. Surgery of the Ankle - Rocky Mountain Health Plans Medical Policy
689. Surgery of the Hand or Wrist - Rocky Mountain Health Plans Medical Policy
690. Surgery of the Foot - Rocky Mountain Health Plans Medical Policy
691. Liposuction for Lipedema - Rocky Mountain Health Plans Medical Policy
692. Implanted Spinal Drug Delivery Systems - Rocky Mountain Health Plans Medical Policy
693. Sympathetic Blockade - Rocky Mountain Health Plans Medical Policy
694. Percutaneous Neuroablation for Pancreatic Cancer Pain, Severe Cancer Pain, and Trigeminal…
695. Sacral Nerve Stimulation for Urinary and Fecal Indications - Rocky Mountain Health Plans…
696. Hyperbaric Oxygen Therapy and Topical Oxygen Therapy - Rocky Mountain Health Plans Medical…
697. Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis - Rocky Mountain…
698. Surgery for the Prevention and Treatment of Lymphedema - Rocky Mountain Health Plans…
699. Left Atrial Appendage Closure (Occlusion) - Rocky Mountain Health Plans Medical Policy
700. Interspinous Fusion and Decompression Devices - Rocky Mountain Health Plans Medical Policy
701. Spinal Fusion and Decompression - Rocky Mountain Health Plans Medical Policy
702. Minimally Invasive Spine Surgery Procedures - Rocky Mountain Health Plans Medical Policy
703. Upper Extremity Prosthetic Devices - Rocky Mountain Health Plans Medical Policy
704. Walkers - Rocky Mountain Health Plans Medical Policy
705. Hospital Services: Observation and Inpatient - Rocky Mountain Health Plans Medical Policy
706. Category III Codes - Rocky Mountain Health Plans Medical Policy
707. Lower Extremity Prosthetics - Rocky Mountain Health Plans Medical Policy
708. Fecal Microbiota Transplantation - Rocky Mountain Health Plans Medical Policy
709. Transanal Minimally Invasive Surgical Procedures - Rocky Mountain Health Plans Medical…
710. Injectable Dermal Fillers and Bulking Agents - Rocky Mountain Health Plans Medical Policy
711. Electroretinography - Rocky Mountain Health Plans Medical Policy
712. Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment…
713. FDA Cleared or Approved Companion Diagnostic Testing - Rocky Mountain Health Plans Medical…
714. Ocular Photoscreening - Rocky Mountain Health Plans Medical Policy
715. Ambulance Services - Rocky Mountain Health Plans Medical Policy
716. Brow Ptosis and Eyelid Repair - Rocky Mountain Health Plans Medical Policy
717. Breast Reconstruction - Rocky Mountain Health Plans Medical Policy
718. Breast Reduction Surgery - Rocky Mountain Health Plans Medical Policy
719. Clinical Trials - Rocky Mountain Health Plans Medical Policy
720. Cosmetic and Reconstructive Procedures - Rocky Mountain Health Plans Medical Policy
721. Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements - Rocky…
722. Gynecomastia Surgery - Rocky Mountain Health Plans Medical Policy
723. Orthognathic (Jaw) Surgery - Rocky Mountain Health Plans Medical Policy
724. Panniculectomy and Body Contouring Procedures - Rocky Mountain Health Plans Medical Policy
725. Pectus Deformity Repair - Rocky Mountain Health Plans Medical Policy
726. Preventive Care Services - Rocky Mountain Health Plans Medical Policy
727. Private Duty Nursing Services - Rocky Mountain Health Plans Medical Policy
728. Rhinoplasty and Other Nasal Procedures - Rocky Mountain Health Plans Medical Policy
729. Chemotherapy Observation or Inpatient Hospitalization - Rocky Mountain Health Plans…
730. Home Health, Skilled, and Custodial Care Services - Rocky Mountain Health Plans Medical…
731. Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) - Rocky…
732. Enteral Nutrition (Oral and Tube Feeding) - Rocky Mountain Health Plans Medical Policy
733. Beds and Mattresses - Rocky Mountain Health Plans Medical Policy
734. Patient Lifts - Rocky Mountain Health Plans Medical Policy
735. Pediatric Gait Trainers and Standing Systems - Rocky Mountain Health Plans Medical Policy
736. Speech Generating Devices - Rocky Mountain Health Plans Medical Policy
737. Hospice Care - Rocky Mountain Health Plans Medical Policy
738. Outpatient Surgical Procedures - Site of Service - Rocky Mountain Health Plans Medical…
739. Office-Based Procedures - Site of Service - Rocky Mountain Health Plans Medical Policy
740. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan - Site of Service…
741. Screening Colonoscopy Procedures - Site of Service - Rocky Mountain Health Plans Medical…
742. Elective Inpatient Services - Rocky Mountain Health Plans Medical Policy
743. Mobility Devices, Options, and Accessories - Rocky Mountain Health Plans Medical Policy
744. Brow Ptosis and Eyelid Repair - Oxford Clinical Policy
745. Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue…
746. Minimally Invasive Procedures for Gastric and Esophageal Diseases - Oxford Clinical Policy
747. Bariatric Surgery - Oxford Clinical Policy
748. Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis - Oxford…
749. Breast Reduction Surgery - Oxford Clinical Policy
750. Cosmetic and Reconstructive Procedures - Oxford Clinical Policy
751. Total Artificial Heart and Ventricular Assist Devices - Oxford Clinical Policy
752. Nerve Graft to Restore Erectile Function During Radical Prostatectomy - Oxford Clinical…
753. Athletic Pubalgia Surgery - Oxford Clinical Policy
754. Lithotripsy for Salivary Stones - Oxford Clinical Policy
755. Gastrointestinal Motility Disorders, Diagnosis and Treatment - Oxford Clinical Policy
756. Spinal Fusion and Bone Healing Enhancement Products - Oxford Clinical Policy
757. Abnormal Uterine Bleeding and Uterine Fibroids - Oxford Clinical Policy
758. Prolotherapy and Platelet Rich Plasma Therapies - Oxford Clinical Policy
759. Core Decompression for Avascular Necrosis - Oxford Clinical Policy
760. Pectus Deformity Repair - Oxford Clinical Policy
761. Plagiocephaly and Craniosynostosis Treatment - Oxford Clinical Policy
762. Orthognathic (Jaw) Surgery - Oxford Clinical Policy
763. Vagus and External Trigeminal Nerve Stimulation - Oxford Clinical Policy
764. Surgery of the Hip - Oxford Clinical Policy
765. Deep Brain and Cortical Stimulation - Oxford Clinical Policy
766. Breast Reconstruction - Oxford Clinical Policy
767. Surgery of the Knee - Oxford Clinical Policy
768. Surgery of the Elbow - Oxford Clinical Policy
769. Surgery of the Shoulder - Oxford Clinical Policy
770. Gender Dysphoria Treatment - Oxford Clinical Policy
771. Hysterectomy - Oxford Clinical Policy
772. Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome - Oxford…
773. Outpatient Surgical Procedures - Site of Service - Oxford Clinical Policy
774. Office-Based Procedures - Site of Service - Oxford Clinical Policy
775. Skin and Soft Tissue Substitutes - Oxford Clinical Policy
776. Negative Pressure Wound Therapy - Oxford Clinical Policy
777. Computer-Assisted Surgical Navigation for Musculoskeletal Procedures - Oxford Clinical…
778. Vertebral Body Tethering for Scoliosis - Oxford Clinical Policy
779. Percutaneous Patent Foramen Ovale (PFO) Closure - Oxford Clinical Policy
780. Catheter Ablation for Atrial Fibrillation - Oxford Clinical Policy
781. Autologous Cellular Therapy - Oxford Clinical Policy
782. Screening Colonoscopy Procedures - Site of Service - Oxford Clinical Policy
783. Elective Inpatient Services - Oxford Clinical Policy
784. Prostate Surgeries and Interventions - Oxford Clinical Policy
785. Liposuction for Lipedema - Oxford Clinical Policy
786. Surgery of the Ankle - Oxford Clinical Policy
787. Surgery of the Hand or Wrist - Oxford Clinical Policy
788. Left Atrial Appendage Closure (Occlusion) - Oxford Clinical Policy
789. Sacral Nerve Stimulation for Urinary and Fecal Indications - Oxford Clinical Policy
790. Spinal Fusion and Decompression - Oxford Clinical Policy
791. Minimally Invasive Spine Surgery Procedures - Oxford Clinical Policy
792. Interspinous Fusion and Decompression Devices - Oxford Clinical Policy
793. Transanal Minimally Invasive Surgical Procedures - Oxford Clinical Policy
794. Corneal Collagen Cross-Linking - Oxford Clinical Policy
795. Ambulance Services - Oxford Clinical Policy
796. Abnormal Uterine Bleeding and Uterine Fibroids - UMR Medical Policy
797. Electrical Stimulation for Wounds - UMR Medical Policy
798. Environmental Allergen Immunotherapy - UMR Medical Policy
799. Genitourinary Pathogen Nucleic Acid Detection Testing - UMR Medical Policy
800. Obstetrical Ultrasound - UMR Medical Policy
801. Corneal Collagen Cross-Linking - UMR Medical Policy
802. Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome - UMR Medical…
803. Fecal Microbiota Transplantation - UMR Medical Policy
804. Breast Reconstruction - UMR Medical Policy
805. united-healthcare-urg-11-16Outpatient Surgical Procedures - Site of Service - Commercial and Individual Exchange…
806. united-healthcare-urg-12-12Office-Based Procedures - Site of Service - Commercial and Individual Exchange Medical…
807. united-healthcare-urg-19-03Elective Inpatient Services - Commercial and Individual Exchange Medical Policy
808. Visual Information Processing Evaluation and Orthoptic and Vision Therapy - Oxford…
809. Glaucoma Surgical Treatments - Oxford Clinical Policy
810. Macular Degeneration Treatment Procedures - Oxford Clinical Policy
811. Transpupillary Thermotherapy - Oxford Clinical Policy