Physician Clinical Coverage Policies

Associated Files

1A-2.pdf

1A-2, Preventive Medicine Annual Health Assessment

PDF291.79 KB

1A-5.pdf

1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment

PDF585.74 KB

1A-6.pdf

1A-6, Invasive Electrical Bone Growth Stimulation

PDF310.98 KB

1A-7.pdf

1A-7, Neonatal and Pediatric Critical and Intensive Care Services

PDF302.29 KB

1A-9.pdf

1A-9, Blepharoplasty/Blepharoptosis (Eyelid Repair)

PDF299.8 KB

1A-15.pdf

1A-15, Surgery for Clinically Severe or Morbid Obesity

PDF397.21 KB

1A-24.pdf

1A-24, Diabetes Outpatient Self-Management Education

PDF312.53 KB

1A-33.pdf

1A-33, Vagus Nerve Stimulation for the Treatment of Seizures

PDF290.89 KB

1A-36.pdf

1A-36, Implantable Bone Conduction Hearing Aids (BAHA)

PDF306.45 KB

1A-39.pdf

1A-39, Routine Costs in Clinical Trial Services for Life Threatening Conditions

PDF318.74 KB

1A-41.pdf

1A-41, Office-Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone

PDF391.71 KB

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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