Clinical Policies

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A
B
C
D
E
F
G
H
I
L
M
N
O
P
R
S
T
V
W
X
Z

A
- Acoustic cardiography/heart sound recording
- Actigraphy
- Ambulatory continuous peripheral nerve block for chronic pain
- Art therapy
- Athletic pubalgia (sports hernia) surgery
- Auricular stimulation for abdominal pain from irritable bowel syndrome
- Automated scalp cooling
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B
- Balloon dilation of the Eustachian tube
- Bioimpedance devices for detecting lymphedema
- Blue native polyacrylamide gel electrophoresis for mitochondrial myopathies
- Bone graft substitutes
- Botulinum toxin for constipation
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C
- Cardiac contractility modulation
- Cervical cancer and human papillomavirus screening
- Cervical traction devices for neck pain for home use
- Chronic inflammatory response syndrome
- Computer-aided detection and diagnosis for chest imaging
- Core decompression for avascular necrosis of the hip
- Corneal cross-linking
- Coronary intravascular lithotripsy
- Customized lymphedema garments
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D
- Dermabrasion and chemical peel
- Digestive enzyme cartridge
- Disposable insulin delivery devices
- Drug-eluting sinus implants
- Dynamic splinting
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E
- Electrical muscle stimulation
- Embrace 2 watch for seizure detection.
- Emerg Auto-Emersion Therapy system and Dolphin Fluid Immersion Simulation system for pressure injury
- Endovenous stents.
- Epidermal nerve fiber density testing
- Equine-assisted therapy
- Erectile dysfunction treatments other than pharmaceuticals
- Excimer laser for vitiligo
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F
- Face transplantation
- Flexitouch® pneumatic compression devices for lymphedema after head and neck surgery
- Fluorescence spectroscopy for prostate cancer diagnosis
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G
- Gastrointestinal electrical stimulation for obesity
- Gastroparesis evaluations
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H
- Hand and arm transplants
- Home spirometry
- Home-use light box therapy for seasonal affective disorder
- Hydrogel spacer use during radiotherapy for prostate cancer
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I
- Immune cell function assay
- Intermittent pneumatic compression for peripheral artery disease
- Intracranial hypertension stent
- Intravascular ultrasound
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L
- Latera absorbable nasal implant
- Lipoprotein apheresis
- Low-frequency ultrasound therapy for wound management
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M
- Manipulation under anesthesia (hip and elbow)
- MarginProbe
- Medical three-dimensional printing
- Melody™ transcatheter pulmonary valve replacement
- Microwave thermotherapy for breast cancer
- Microwave thermotherapy for lung and kidney tumors
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N
- Neuroablation for chronic foot pain
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O
- Oral nutritional supplements
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P
- Percutaneous arteriovenous fistula creation
- Percutaneous peripheral nerve stimulators for chronic nerve pain
- Percutaneous sacroplasty
- Peristeen® anal irrigation system
- Pet therapy
- Platelet rich plasma for nonhealing diabetic wounds
- Postural orthostatic tachycardia syndrome — physical therapy
- Prescription digital therapeutics for insomnia
- Prescription digital therapeuticss for contraception
- Prolotherapy
- Prostatic urethral lift/UroLift for benign prostatic hyperplasia
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R
- Radiofrequency ablation for nasal valve collapse
- Radiofrequency ablation of genicular nerves for knee pain
- Re-SET-O
- Renal denervation
- Robotic orthoses – lower limb
- Room humidifiers
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S
- Sacral nerve modulation/stimulation
- Shoe lifts for leg length discrepancy
- Sialendoscopy and lithotripsy for salivary stones
- Skin surgery after massive weight loss
- Smell and taste dysfunction testing
- Speech therapy
- Sphenopalatine ganglion block injections for headache
- Stereotactic navigation in sinus surgery
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T
- Tactile breast imaging
- Three-dimensional imaging and interpretation
- 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 diagnostic testing
- 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
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W
- Wearable dialysis and implantable artificial kidneys
- Wheelchair mounted robotic arm – Kinova Jaco2
- Wireless pulmonary artery pressure monitoring devices for heart failure
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X
- Xen gel stent for glaucoma
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Z
- ZOLL Heart Failure Management System
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