Medical policies for providers

See the latest updates to our medical policies. 

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MP164-Laser Treatment of Acne
Acne (Acne Vulgaris) is a multifactorial disease that involves the pilosebaceous unit, which is composed of the hair follicle and the sebaceous gland. Inflammation generally occurs when excess oil, dirt and/ or bacteria blocks the gland ducts. The puls...

MP19 -Laser Treatment of Cutaneous Vascular lesions
Cutaneous vascular lesions are the most common pediatric birthmarks. They are classified as either hemangiomas or vascular malformations . Pulsed Dye Lasers are most commonly used to treat hemangiomas and vascular malformations.  Pulsed dye lasers use ...

MP152-Low-Level Laser Therapy (LLLT) aka: Cold Laser Therapy, low-power laser therapy (LPLT), low intensity laser light therapy and low-energy laser therapy.
Low Level Laser Therapy (LLLT), also referred to as Cold Laser therapy, low-power laser therapy (LPLT), low intensity laser light therapy, photomodulation, photobiomodulation and low-energy laser therapy, is a light source treatment that generates ligh...

MP60-Lung Volume Reduction Surgery
Lung volume reduction surgery is a surgical treatment for severe emphysema. The surgical intent of lung volume reduction is to reduce airway obstruction by improving lung elastic recoil and by providing more effective diaphragmatic function by reducing...

MP138-Lysis of Epidural Adhesions (Racz Procedure)
Percutaneous lysis of epidural adhesions (also known as epidural neuroplasty or epidural adhesiolysis) has been investigated as an interventional pain management  treatment of chronic back pain thought to be caused by epidural adhesions. Theoretically,...

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