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Medical policies for providers

See the latest updates to our medical policies. 

Choose a letter to view policies by first letter.

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


MP203-Radiofrequency Ablation for Barrett’s Esophagus
The Barrx System consists of a high powered radiofrequency energy generator and balloon. 

MP68-Reduction Mammaplasty
Reduction mammaplasty is a surgical procedure to remove substantial breast tissue (skin and underlying glandular tissue).

MP169-Retinal Prosthesis
Two types of microelectronic implanted retinal prosthetics are currently in development as a means of restoring vision in patients blinded by retinal degenerative diseases such as retinitis pigmentosa and macular degeneration. 

Rhinophototherapy involves the use of a special instrument to deliver visible and non-visible light to the nasal cavities to suppress the immune effects of allergic rhinitis. 

MP106-Routine Ultrasonography in Uncomplicated Pregnancy
Ultrasonography is a radiological technique in which deep structures of the body are visualized by recording the reflection of ultrasonic waves directed into the tissues. 

MP312-Routine Care in Clinical Trials
Routine care during participation in an approved clinical trial is defined as being those items and services that are consistent with the coverage typically provided to a qualified member who is not otherwise enrolled in a clinical trial. Coverage is consistent with Centers for Medicare & Medicaid Services policy and Patient Protection and Affordable Care Act requirements.

MP330-Responsive Neurostimulation
The responsive neurostimulation system (RNS) is used to treat adult members with partial onset epilepsy who have failed treatment with at least 2 seizure medications and who are not candidates for resection of their seizure focus.

Related information

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Prior authorizations

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Clinical guidelines

Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases.

Terms and conditions

View GHP’s terms and conditions.

Questions? Contact us

If you have questions or need more information, contact Geisinger Health Plan.

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