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Medical policies for providers

See the latest updates to our medical policies. 

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A B C D E F G H I J K L M N O P Q R S T U V W 


MP283-Facet Injections

MP231-Facet or Sacroiliac Joint Denervation
Radiofrequency (RF) facet and/or sacroiliac joint denervation is a percutaneous procedure in which sensory afferent nerve fibers are selectively destroyed by heat produced by radio waves delivered through an electrode.

MP364-Fecal Analysis for Diagnosis of Intestinal Dysbiosis
Intestinal dysbiosis is believed to occur when the microorganisms in the digestive tract are out of balance. This condition is hypothesized to cause diseases of the digestive tract, including but not limited to, poor nutrient absorption, intestinal bacteria overgrowth, and irritable bowel syndrome (IBS). 

MP290-Fecal Microbiota Transplantation
Fecal microbiota transplantation is the transplantation of fecal bacteria from a healthy donor into the gastrointestinal tract of a recipient for the treatment of recurrent Clostridium difficile (C. difficile) infection.

MP059-Fetal Surgery
Fetal surgery involves opening the uterus (either by traditional cesarean surgical incision or through single or multiple fetoscopic port incisions), surgically correcting a fetal abnormality, then returning the fetus to the uterus and closing the uterus.

MP34-Foot Orthotics
A depth shoe is one that: 1) has a full length, heel-to-toe filler that when removed, provides a minimum of 3/16" of additional depth used to accommodate custom-molded or customized inserts; 2) is made from leather or other suitable material of equal quality. 

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Questions? Contact us

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