Physician Clinical Coverage Policies
Associated Files
Details
- 1A-2, Preventive Medicine Annual Health Assessment
- 1A-3, Noninvasive Pulse Oximetry
- 1A-4, Cochlear and Auditory Brainstem Implants
- 1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment
- 1A-6, Invasive Electrical Bone Growth Stimulation
- 1A-7, Neonatal and Pediatric Critical and Intensive Care Services
- 1A-8, Hyperbaric Oxygenation Therapy
- 1A-9, Blepharoplasty/Blepharoptosis (Eyelid Repair)
- 1A-11, Extracorporeal Shock Wave Lithotripsy
- 1A-12, Breast Surgeries
- 1A-13, Ocular Photodynamic Therapy
- 1A-14, Surgery for Ambiguous Genitalia
- 1A-15, Surgery for Clinically Severe or Morbid Obesity
- 1A-16, Surgery of the Lingual Frenulum
- 1A-17, Stereotactic Pallidotomy
- 1A-19, Transcranial Doppler Studies
- 1A-20, Sleep Studies and Polysomnography Services
- 1A-21, Endovascular Repair of Aortic Aneurysm
- 1A-22, Medically Necessary Circumcision
- 1A-23, Physician Fluoride Varnish Services
- 1A-24, Diabetes Outpatient Self-Management Education
- 1A-25, Spinal Cord Stimulation
- 1A-26, Deep Brain Stimulation
- 1A-27, Electrodiagnostic Studies
- 1A-28, Visual Evoked Potential (VEP)
- 1A-30, Spinal Surgeries
- 1A-31, Wireless Capsule Endoscopy
- 1A-32, Tympanometry and Acoustic Reflex Testing
- 1A-33, Vagus Nerve Stimulation for the Treatment of Seizures
- 1A-34, Dialysis Services
- 1A-36, Implantable Bone Conduction Hearing Aids (BAHA)
- 1A-38, Special Services: After Hours
- 1A-39, Routine Costs in Clinical Trial Services for Life Threatening Conditions
- 1A-40, Fecal Microbiota Transplantation
- 1A-41, Office-Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone
- 1A-42, Balloon Ostial Dilation
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