Medical Policies for Providers
See the latest updates to our medical policies.
Hearing aids are devices that amplify and deliver speech and other sounds at levels equivalent to that of normal speech and conversation. Hearing aids can be categorized as air conduction, bone conduction and middle ear hearing aids. They are also cate...
MP245-Helicobacter pylori Infection Testing
It is thought that Helicobacter pylori (H. pylori ) causes more than half of peptic ulcers worldwide. The bacterium causes peptic ulcers by damaging the mucous coating that protects the stomach and duodenum. Damage to the mucous coating allows stomach ...
MP123-High Dose Rate (HDR) Temporary Brachytherapy for Treatment of Prostate Cancer
Temporary brachytherapy with iridium-192, also known as high dose rate (HDR) brachytherapy differs from conventional Iodine-125 or Palladium-103 brachytherapy by using high intensity radioactive seeds implanted temporarily as opposed to lower intensity...
MP45 -High Frequency Chest Percussion Vest
High frequency chest wall percussion is a machine that delivers chest physiotherapy by means of pulsed pressure, helping the patient to mobilize airway secretions. This bronchial drainage system includes a vest connected to a pulse generator and enable...
High intensity focused ultrasound (HIFU) uses an acoustic lens to concentrate multiple intersecting beams of ultrasound on a target. High intensity ultrasound energy is focused at a specific location. At the focal point where the beams converge, HIFU destroys tissue with rapid heat elevation.
Hippotherapy is a form of therapeutic horseback riding or equestrian therapy in which the multidimensional swinging motion of a walking horse is passively conveyed to the patient, providing tactile, vestibular, olfactory, proprioceptive and visual stim...
MP186-Hip Resurfacing Arthroplasty
Hip resurfacing arthroplasty involves the removal and replacement of the surface of the femoral head. This technique attempts to preserve femoral bone composition and structure, while maintaining normal femoral loading and stresses. The procedure has b...
MP76-Home Health and DME Related to Hyperbilirubinemia
Home phototherapy for neonatal jaundice is a treatment that involves continually applying ultraviolet light by means of a lamp to an infant in the home for a prescribed period of time. Application of the ultraviolet light helps reduce elevated bilirubi...
MP37-Home Phlebotomy Program
Home Phlebotomy services are designed as an adjunct to skilled home health services which phlebotomy collection occurs in the insured individual’s home. In limited situations, as defined in criteria 2-4 below, insured individuals not receiving concurr...
MP39 -Home Uterine Activity Monitor
The home uterine activity monitor is a device intended to provide early detection of pre-term labor in women at high risk of developing pre-term labor or pre-term birth.
MP228-Human Papillomavirus (HPV) DNA Testing
The human papillomavirus (HPV) DNA test is done on a sample of cells collected from the cervix and checks for the genetic material of the human papillomavirus. The test is used to identify whether a high-risk type of HPV (types 16, 18, 31, and 45) is p...
MP047-Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy (HBO) is a systemic treatment in which the patient is placed inside a pressurized chamber and breathes 100% oxygen under increased atmospheric pressure.
Hyperhidrosis is a medical condition in which a person perspires excessively and unpredictably. The condition is classified as primary or secondary, depending on if it is a congenital or acquired. Primary hyperhidrosis, (essential or idiopathic hyperhi...
MP278-Hyperthermia in Cancer Therapy (e.g., HIPEC)
According to the National Cancer Institute, research has shown that high temperature can damage and kill cancer cells usually with minimal injury to normal tissues. The treatment may also cause shrinkage of the tumor since the treatment kills cancer ce...
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