Medical policies for providers
See the latest updates to our medical policies.
MP204-Nasal and Sinus Surgery
Septoplasty: A surgical revision of the nasal septum performed to improve breathing, relieve nasal obstruction, reconstruct the septum following extensive surgery or traumatic injury or remove benign or malignant tumors.
MP058-Negative Pressure Wound Therapy
Vacuum-assisted wound closure is a technique used to promote healing of chronic wounds. It can be used as an adjunct to surgery or as an alternative to surgery for patients who are debilitated or are non-surgical candidates.
MP001-Neuromuscular Electrical Stimulation (NMES)
Neuromuscular electrical stimulation (NMES) involves the use of a device which transmits an electrical impulse to the skin over selected muscle groups by way of electrodes.
MP006-Nocturnal Enuresis Alarm
Primary nocturnal enuresis is defined as involuntary loss of urine during sleep in members who have never achieved a sustained period of nighttime continence.
MP212-Non-contact Low-frequency Ultrasound for Wound Management (MIST Therapy)
The MIST Therapy® System utilizes non-contact, low frequency ultrasound driven atomized mist to produce a non-thermal, mechanical cleansing action thought to create surface tension at the cellular level.
MP362-Non-Invasive Home Ventilator
A non-invasive home ventilator is a device capable of providing pressurized air with or without supplemental oxygen, and an array of features including pressure support; rate support; volume support; or various combinations of those features. The device delivers the air via a tightly sealed non-invasive nasal interface or mask.
MP241-Non-invasive Measurement of Advanced Glycation Endproducts
Advanced glycation endproducts (AGE) are metabolic byproducts from non-enzymatic glycation of proteins and amino acids. They have been proposed as a biomarker for disease severity and risk prediction.
MP077-Non-invasive Mechanical Treatments for Low Back Pain
Vertebral axial decompression (Vax-D) and MedX lumbar/cervical extension machines are devices designed for the purpose of isokinetic testing and rehabilitation in the treatment of back pain.
MP271-Non-Invasive Testing for Fetal Aneuploidy
Circulating cell-free DNA purified from maternal blood plasma is analyzed to detect aneuploidies at chromosome 21 (Down syndrome), chromosome 18 (Edwards syndrome), and chromosome 13 (Patau syndrome).
MP168-Non-invasive Testing for Organ Transplant Rejection
The Heartsbreath test assesses heart transplant rejection by measuring the amount of methylated alkanes, a marker of oxidative stress, in the patient’s breath.
MP342-Non-Wearable Automatic External Defibrillator
Food additives: Commercially available products such as fiber, calorie, and/or protein supplements, thickeners, vitamins, minerals and products to aid in lactose digestion.
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Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases.
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