| Adoptive Immunotherapy - (0225) |
PDF |
213kB |
11/15/2020 |
| Allergy Testing and Non-Pharmacologic Treatment - (0070) |
PDF |
315kB |
07/15/2020 |
| Ambulatory Electrocardiographic Monitoring - (0547) |
PDF |
319kB |
02/15/2021 |
| Ambulatory External and Implantable Electrocardiographic Monitoring - (0547) ----future effective policy |
PDF |
475kB |
05/15/2021 |
| Anesthesia and Facility Services for Dental Treatment - (0415) |
PDF |
131kB |
08/15/2020 |
| Atherosclerotic Cardiovascular Disease Risk Assessment: Emerging Laboratory Evaluations - (0137) |
PDF |
422kB |
08/15/2020 |
| Attention-Deficit/Hyperactivity Disorder (ADHD): Assessment and Treatment - (0231) |
PDF |
287kB |
01/15/2021 |
| Autologous Cell Therapy for Cardiac and Peripheral Arterial Disease - (0287) |
PDF |
219kB |
04/15/2020 |
| Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]) - (0507) |
PDF |
307kB |
11/15/2020 |
| Bone Mineral Density Measurement - (0300) |
PDF |
178kB |
08/15/2020 |
| Cardiac Rehabilitation (Phase II Outpatient) - (0073) |
PDF |
212kB |
11/15/2020 |
| Colorectal Cancer Screening and Surveillance - (0148) |
PDF |
377kB |
11/15/2020 |
| Complementary and Alternative Medicine - (0086) |
PDF |
589kB |
02/15/2021 |
| Computerized Dynamic Posturography (CDP) - (0270) |
PDF |
89kB |
12/15/2020 |
| COVID-19: In Vitro Diagnostic Testing - (0557) |
PDF |
220kB |
04/01/2021 |
| Dermabrasion and Chemical Peels - (0505) |
PDF |
131kB |
05/15/2020 |
| Diabetes Equipment and Supplies - (0106) |
PDF |
537kB |
01/15/2021 |
| Donor Lymphocyte Infusion and Hematopoietic Progenitor Cell (HPC) Boost - (0261) |
PDF |
121kB |
06/15/2020 |
| Drug Testing - (0513) |
PDF |
150kB |
02/15/2021 |
| Electroencephalography - (0521) |
PDF |
140kB |
01/15/2021 |
| Exhaled Nitric Oxide in the Management of Respiratory Disorders - (0439) |
PDF |
287kB |
12/15/2020 |
| External Counterpulsation - (0058) |
PDF |
163kB |
05/15/2020 |
| Extracorporeal Photopheresis - (0320) |
PDF |
104kB |
05/15/2020 |
| Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds - (0004) |
PDF |
311kB |
12/15/2020 |
| Fecal Bacteriotherapy - (0516) |
PDF |
277kB |
09/15/2020 |
| Foot Care Services - (0277) |
PDF |
97kB |
03/15/2021 |
| Gait Analysis - (0315) |
PDF |
105kB |
04/15/2020 |
| Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD) |
Online Resource |
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| Headache and Occipital Neuralgia Treatment - (0063) |
PDF |
203kB |
07/15/2020 |
| Head and Neck Ultrasound - (0549) |
PDF |
239kB |
07/15/2020 |
| Helicobacter Pylori Serology Testing –(0308) |
PDF |
92kB |
05/15/2020 |
| Hospitalization for the Initiation of a Ketogenic Diet - (0359) |
PDF |
92kB |
06/15/2020 |
| Hyperbaric and Topical Oxygen Therapies - (0053) |
PDF |
328kB |
05/15/2020 |
| Inhaled Nitric Oxide (INO) - (0453) |
PDF |
417kB |
07/15/2020 |
| Injectable Fillers - (0511) |
PDF |
195kB |
05/15/2020 |
| Lyme Disease Treatment - Antibiotic Treatment - (0400) |
PDF |
340kB |
07/15/2020 |
| Malignant Melanoma Surveillance Technologies - (0240) |
PDF |
221kB |
10/15/2020 |
| Neuropsychological Testing - (0258) |
PDF |
361kB |
08/15/2020 |
| Nucleic Acid Pathogen Testing - (0530) |
PDF |
324kB |
08/15/2020 |
| Nutritional Support - (0136) |
PDF |
240kB |
09/15/2020 |
| Pediatric Intensive Feeding Programs - (0422) |
PDF |
114kB |
12/15/2020 |
| Percutaneous Revascularization of the Lower Extremities in Adults - (0537) |
PDF |
264kB |
03/15/2021 |
| Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation - (0539) |
PDF |
143kB |
03/15/2021 |
| Phototherapy, Photochemotherapy, and Excimer Laser Therapy for Dermatologic Conditions - (0031) |
PDF |
236kB |
09/15/2020 |
| Plantar Fasciitis Treatments - (0097) |
PDF |
311kB |
02/15/2021 |
| Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028) |
PDF |
206kB |
05/15/2020 |
| Preoperative Inpatient Admissions - (0402) |
PDF |
83kB |
08/15/2020 |
| Scrotal Ultrasound - (0548) |
PDF |
182kB |
10/15/2020 |
| Serological Testing for Inflammatory Bowel Disease - (0121) |
PDF |
291kB |
12/15/2020 |
| Staff-Assisted Home Hemodialysis - (0229) |
PDF |
93kB |
11/15/2020 |
| Suit Therapy - (0353) |
PDF |
119kB |
04/15/2020 |
| Surgical Treatments for Obstructive Sleep Apnea - (0158) |
PDF |
334kB |
02/01/2021 |
| Tilt Table Testing - (0066) |
PDF |
121kB |
03/15/2021 |
| Transthoracic Echocardiography in Adults - (0510) |
PDF |
592kB |
02/15/2021 |
| Transthoracic Echocardiography in Children - (0523) |
PDF |
592kB |
02/15/2021 |
| Transvaginal Ultrasound, Non-Obstetrical - (0398) |
PDF |
216kB |
01/15/2021 |