Medical policies for providers
See the latest updates to our medical policies.
MP203-Radiofrequency Ablation for Barrett’s Esophagus
The Barrx System consists of a high powered radiofrequency energy generator and balloon. The balloon is entirely bipolar, and provides circumferential ablation to the esophagus to rapidly ablate the abnormal esophageal epithelium, while limiting therma...
Reduction mammaplasty is a surgical procedure to remove substantial breast tissue (skin and underlying glandular tissue).
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. Epiretinal implants posit...
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. Because the therapeutic benefits of ultraviolet light on atopic dermati...
MP156-Robotic Assisted Prostatectomy
Robotic assisted prostatectomy represents a surgical advancement in laparoscopic radical prostatectomy by utilizing semi-active robots called master-slave manipulators. Seated at a remote console with three-dimensional view of the operative field, the ...
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. One use of ultrasonography is in the field of obstetrics and gynecology, where io...
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.
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.
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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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