• New and updated policies effective November 1, 2019

     

    Policy Title – November 1, 2019   

    Policy#

    Status

    1

    Electromagnetic Navigation Bronchoscopy

    7.01.122

    Major Update

    2

    Ablation of Peripheral Nerves to Treat Pain

    7.01.154

    Minor Update

    3

    Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias

    8.01.22

    Admin Update

    4

    Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms

    8.01.21

    Admin Update

    5

    Amniotic Membrane and Amniotic Fluid

    7.01.149

    Admin Update

    6

    Beta-Amyloid Imaging with Positron Emission Tomography for Alzheimer Disease

    6.01.55

    Minor Update

    7

    Bioengineered Skin and Soft Tissue Substitutes

    7.01.113

    Admin Update

    8

    Cardiovascular Risk Panels

    2.04.100

    Admin Update

    9

    Cellular Immunotherapy for Prostate Cancer

    8.01.53

    Minor Update

    10

    Composite Tissue Allotransplantation of the Hand and Face

    7.03.13

    Minor Update

    11

    Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors

    7.01.92

    Minor Update

    12

    Drug Testing in Pain Management and Substance Use Disorder Treatment

    2.04.98

    Admin Update

    13

    Dynamic Spinal Visualization and Vertebral Motion Analysis

    6.01.46

    Minor Update

    14

    External Insulin Infusion Pump

    BSC1.03

    Minor Update

    15

    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis

    2.04.26

    Admin Update

    16

    Fecal Microbiota Transplantation

    2.01.92

    Admin Update

    17

    Functional Magnetic Resonance Imaging of the Brain

    6.01.47

    Minor Update

    18

    Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer

    2.04.33

    Admin Update

    19

    Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing

    2.04.93

    Admin Update

    20

    Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers

    2.04.02

    Admin Update

    21

    Genetic Testing for Li-Fraumeni Syndrome

    2.04.101

    Admin Update

    22

    Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

    2.04.08

    Admin Update

    23

    Genetic Testing for PTEN Hamartoma Tumor Syndrome

    2.04.88

    Admin Update

    24

    Heart Transplant

    7.03.09

    Minor Update

    25

    Heart/Lung Transplant

    7.03.08

    Minor Update

    26

    Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia

    8.01.32

    Admin Update

    27

    Hematopoietic Cell Transplantation for Acute Myeloid Leukemia

    8.01.26

    Admin Update

    28

    Hematopoietic Cell Transplantation for Autoimmune Diseases

    8.01.25

    Admin Update

    29

    Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma

    8.01.28

    Admin Update

    30

    Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

    8.01.15

    Admin Update

    31

    Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia

    8.01.30

    Admin Update

    32

    Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer

    8.01.23

    Admin Update

    33

    Hematopoietic Cell Transplantation for Hodgkin Lymphoma

    8.01.29

    Admin Update

    34

    Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

    8.01.24

    Admin Update

    35

    Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas

    8.01.20

    Admin Update

    36

    Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome

    8.01.17

    Admin Update

    37

    Hematopoietic Cell Transplantation for Primary Amyloidosis

    8.01.42

    Admin Update

    38

    Hematopoietic Cell Transplantation for Solid Tumors of Childhood

    8.01.34

    Admin Update

    39

    Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia

    8.01.54

    Admin Update

    40

    Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors

    8.01.35

    Admin Update

    41

    Identification of Microorganisms Using Nucleic Acid Probes

    2.04.10

    Admin Update

    42

    Intensity-Modulated Radiotherapy: Central Nervous System Tumors

    8.01.59

    Minor Update

    43

    Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment

    6.01.51

    Minor Update

    44

    Isolated Small Bowel Transplant

    7.03.04

    Minor Update

    45

    KRAS, NRAS, BRAF Variant Analysis (Including Liquid Biopsy) in Metastatic Colorectal Cancer

    2.04.53

    Admin Update

    46

    Laboratory Tests for Heart and Kidney Transplant Rejection

    2.01.68

    Admin Update

    47

    Liver Transplant and Combined Liver-Kidney Transplant

    7.03.06

    Minor Update

    48

    Lung and Lobar Lung Transplant

    7.03.07

    Minor Update

    49

    Magnetic Resonance Imaging to Monitor the Integrity of Silicone Gel-Filled Breast Implants

    6.01.50

    Minor Update

    50

    Magnetic Resonance ImagingTargeted Biopsy of the Prostate

    7.01.152

    Minor Update

    51

    Magnetic Resonance Spectroscopy

    6.01.24

    Minor Update

    52

    Magnetoencephalography/Magnetic Source Imaging

    6.01.21

    Minor Update

    53

    Meniscal Allografts and Other Meniscal Implants

    7.01.15

    Minor Update

    54

    Miscellaneous Genetic and Molecular Diagnostic Tests

    2.04.121

    Minor Update

    55

    Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Breast Cancer Risk discusses genetic testing for the ATM, PALB2, and CHEK2 genes

    2.04.126

    Admin Update

    56

    Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreatic Lesions

    2.04.52

    Admin Update

    57

    Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA

    4.01.21

    Admin Update

    58

    Oncologic Applications of Positron Emission Tomography Scanning

    6.01.26

    Minor Update

    59

    Percutaneous Tibial Nerve Stimulation

    7.01.106

    Minor Update

    60

    Placental and Umbilical Cord Blood as a Source of Stem Cells

    7.01.50

    Admin Update

    61

    Polysomnography for Non-Respiratory Sleep Disorders

    2.01.99

    Minor Update

    62

    Positional Magnetic Resonance Imaging

    6.01.48

    Minor Update

    63

    Positron Emission Mammography

    6.01.52

    Minor Update

    64

    Radioembolization for Primary and Metastatic Tumors of the Liver

    8.01.43

    Minor Update

    65

    Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer

    6.01.37

    Minor Update

    66

    Scintimammography and Gamma Imaging of the Breast and Axilla

    6.01.18

    Minor Update

    67

    Steroid-Eluting Sinus Stents

    7.01.134

    Admin Update

    68

    Virtual Colonoscopy/Computed Tomography Colonography

    6.01.32

    Minor Update

     

  • New and updated policies effective September 1, 2019

     

    Policy Title – September 1, 2019

    Policy#

    Status

    1

    Treatment of Varicose Veins/Venous Insufficiency

    7.01.124

    Major Update

    2

    Ablation Procedures for Peripheral Neuromas

    7.01.147

    Minor Update

     3

    Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses

    1.01.11

    Minor Update

    4

    Alcohol Injections for Treatment of Peripheral Neuromas

    2.01.97

    Minor Update

    5

    Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry

    2.02.08

    Admin Update

    6

    Autonomic Nervous System Testing

    2.01.96

    Minor Update

    7

    Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds

    8.01.14

    Minor Update

    8

    BRAF Gene Variant Testing to Select Melanoma or Glioma Patients for Targeted Therapy

    2.04.77

    Minor Update

    9

    Bronchial Thermoplasty

    7.01.127

    Minor Update

    10

    Catheter Ablation as Treatment for Atrial Fibrillation

    2.02.19

    Minor Update

    11

    Electromyography and Nerve Conduction Studies

    2.01.95

    Minor Update

    12

    Electronic Brachytherapy for Nonmelanoma Skin Cancer

    8.01.62

    Minor Update

    13

    Endobronchial Brachytherapy

    8.03.11

    Minor Update

    14

    Genetic Testing for Alpha Thalassemia

    2.04.104

    Minor Update

    15

    Genotype-Guided Tamoxifen Treatment

    2.04.51

    Minor Update

    16

    High-Dose Rate Temporary Prostate Brachytherapy

    8.01.33

    Minor Update

    17

    Home Cardiorespiratory Monitoring

    1.01.06

    Minor Update

    18

    In Vitro Chemoresistance and Chemosensitivity Assays

    2.03.01

    Minor Update

    19

    Intensity-Modulated Radiotherapy of the Breast and Lung

    8.01.46

    Minor Update

    20

    Intensity-Modulated Radiotherapy of the Prostate

    8.01.47

    Minor Update

    21

    Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid

    8.01.48

    Minor Update

    22

    Intraoperative Radiotherapy

    8.01.08

    Minor Update

    23

    Low-Level Laser Therapy

    2.01.56

    Minor Update

    24

    Magnetic Resonance-Guided Focused Ultrasound

    7.01.109

    Minor Update

    25

    Magnetic Resonance Imaging for Detection and Diagnosis of Breast Cancer

    6.01.29 

    Admin Update

    26

    Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreatic Lesions

    2.04.52

    Minor Update

    27

    Navigated Transcranial Magnetic Stimulation

    2.01.90

    Minor Update

    28

    Neurofeedback

    2.01.28

    Minor Update

    29

    Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus

    8.01.06

    Minor Update

    30

    Percutaneous Electrical Nerve Stimulation and Percutaneous Neuromodulation Therapy

    7.01.29

    Minor Update

    31

    Proteogenomic Testing for Patients With Cancer

    2.04.140

    Minor Update

    32

    Radiofrequency Ablation of Primary or Metastatic Liver Tumors

    7.01.91

    Minor Update

    33

    Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer

    7.01.121

    Minor Update

    34

    Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases

    2.04.123

    Minor Update

    35

    Surgical Treatments for Breast Cancer-Related Lymphedema

    7.01.162

    Minor Update

    36

    Synthetic Cartilage Implants for Joint Pain

    7.01.160

    Minor Update

    37

    Three-Dimensional Printed Orthopedic Implants

    7.01.161

    Minor Update

    38

    Transcatheter Pulmonary Valve Implantation

    7.01.131

    Minor Update

     

  • New and updated policies effective August 1, 2019

     

    Policy Title – August 1, 2019

    Policy#

    Status

    1

    Circulating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy)

    2.04.143

    Major Update

    2

    Closure Devices for Patent Foramen Ovale and Atrial Septal Defects

    2.02.09

    Major Update

     3

    Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA

    4.01.21

    Major Update

    4

    Testing Serum Vitamin D Levels

    2.04.135

    Major Update

    5

    Transcatheter Mitral Valve Repair

    2.02.30

    Major Update

    6

    Hepatitis C Positive Organs for Transplantation to Non-Viremic Patients

    7.03.14

    New

    7

    Transurethral Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia

    2.01.49

    New

    8

    Actigraphy

    2.01.73

    Minor Update

    9

    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure

    1.01.02

    Minor Update

    10

    Automated Point-of-Care Nerve Conduction Tests

    2.01.77

    Minor Update

    11

    Bronchial Valves

    7.01.128

    Minor Update

    12

    Carrier Screening for Genetic Diseases

    2.04.107

    Admin Update

    13

    Catheter Ablation for Cardiac Arrhythmias

    BSC2.12

    Minor Update

    14

    Coronary Computed Tomography Angiography With Selective Noninvasive Fractional Flow Reserve

    6.01.59

    Minor Update

    15

    Cytochrome P450 Genotype-Guided Treatment Strategy

    2.04.38

    Minor Update

    16

    Endovascular Stent Grafts for Abdominal Aortic Aneurysms

    7.01.67

    Minor Update

    17

    Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

    2.04.115

    Admin Update

    18

    Extracorporeal Membrane Oxygenation for Adult Conditions

    8.01.60

    Minor Update

    19

    Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions

    2.01.40

    Minor Update

    20

    Gene Expression Profiling for Cutaneous Melanoma

    2.04.146

    Minor Update

    21

    General Approach to Evaluating the Utility of Genetic Panels

    2.04.92

    Admin Update

    22

    Genetic Testing for Alpha1-Antitrypsin Deficiency

    2.04.79

    Minor Update

    23

    Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers

    2.04.02

    Admin Update

    24

    Genetic Testing for Diagnosis and Management of Mental Health Conditions

    2.04.110

    Minor Update

    25

    Genetic Testing for Hereditary Hemochromatosis

    2.04.80

    Minor Update

    26

    Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

    2.04.08

    Admin Update

    27

    Genetic Testing for Mitochondrial Disorders

    2.04.117

    Minor Update

    28

    Genotype-Guided Warfarin Dosing

    2.04.48

    Minor Update

    29

    Inhaled Nitric Oxide

    8.01.37

    Minor Update

    30

    Interferential Current Stimulation

    1.01.24

    Minor Update

    31

    Intradialytic Parenteral Nutrition

    8.01.44

    Minor Update

    32

    Knee Braces

    BSC1.05

    Minor Update

    33

    Lipid Apheresis

    8.02.04

    Minor Update

    34

    Lung Volume Reduction Surgery for Severe Emphysema

    7.01.71

    Minor Update

    35

    Multibiomarker Disease Activity Blood Test for Rheumatoid Arthritis

    2.04.119

    Minor Update

    36

    Orthognathic Surgery

    BSC7.03

    Minor Update

    37

    Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions

    1.01.15

    Minor Update

    38

    Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain

    2.01.35

    Minor Update

    39

    Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

    2.02.26

    Minor Update

    40

    Power Wheelchairs and Power Operated Vehicles for Permanent Use

    BSC1.02

    Admin Update

    41

    Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia

    2.02.18

    Minor Update

    42

    Quantitative Sensory

    2.01.39

    Minor Update

    43

    Ultrafiltration in Decompensated Heart Failure

    2.02.22

    Minor Update

     

  • New and updated policies effective July 1, 2019

     

    Policy Title – July 1, 2019

    Policy#

    Status

    1

    Genetic Testing for Idiopathic Dilated Cardiomyopathy

    2.04.114

    Major Update

    2

    Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders

    2.04.102

    Major Update

     3

    Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry

    2.02.08

    Minor Update

    4

    Baroreflex Stimulation Devices

    8.01.57

    Minor Update

    5

    Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure

    2.02.10

    Minor Update

    6

    Blepharoplasty, Blepharoptosis Repair (Levator Resection) and Brow Lift (Repair of Brow Ptosis)

    BSC7.01

    Minor Update

    7

    Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting

    2.02.24

    Minor Update

    8

    Cervical Spine Surgery

    BSC_NIA_CG_307

    Admin Update

    9

    Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy)

    2.04.141

    Admin Update

    10

    Electrical Bone Growth Stimulation of the Appendicular Skeleton

    7.01.07

    Minor Update

    11

    Endovascular Stent Grafts for Disorders of the Thoracic Aorta

    7.01.86

    Minor Update

    12

    Endovascular Therapies for Extracranial Vertebral Artery Disease

    7.01.148

    Minor Update

    13

    Enhanced External Counterpulsation

    2.02.06

    Minor Update

    14

    Epidural Spine Injections

    BSC_NIA_CG_300

    Admin Update

    15

    Extracranial Carotid Artery Stenting

    7.01.68

    Minor Update

    16

    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis

    2.04.26

    Admin Update

    17

    Functional Neuromuscular Electrical Stimulation

    8.03.01

    Minor Update

    18

    Gender Reassignment Surgery

    BSC7.02

    Admin Update

    19

    General Approach to Genetic Testing

    2.04.91

    Minor Update

    20

    Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing

    2.04.93

    Admin Update

    21

    Genetic Testing for Alzheimer Disease

    2.04.13

    Minor Update

    22

    Genetic Testing for Hereditary Hearing Loss

    2.04.87

    Minor Update

    23

    Genetic Testing for Inherited Thrombophilia

    2.04.82

    Minor Update

    24

    Genetic Testing for Lactase Insufficiency

    2.04.94

    Minor Update

    25

    Genetic Testing for Rett Syndrome

    2.04.81

    Minor Update

    26

    Genetic Testing of CADASIL Syndrome

    2.04.75

    Minor Update

    27

    Identification of Microorganisms Using Nucleic Acid Probes

    2.04.10

    Admin Update

    28

    Implantable Cardioverter Defibrillators

    7.01.44

    Minor Update

    29

    Interspinous Fixation (Fusion) Devices

    7.01.138

    Minor Update

    30

    Interventions for Progressive Scoliosis

    2.01.83

    Minor Update

    31

    KIF6 Genotyping for Predicting Cardiovascular Risk and/or Effectiveness of Statin Therapy

    2.04.67

    Minor Update

    32

    Laboratory Tests for Heart and Kidney Transplant Rejection

    2.01.68

    Admin Update

    33

    Low-Level Laser Therapy

    2.01.56

    Admin Update

    34

    Lumbar Spine Surgery

    BSC_NIA_CG_304

    Admin Update

    35

    Manipulation Under Anesthesia

    8.01.40

    Minor Update

    36

    Molecular Testing in the Management of Pulmonary Nodules

    2.04.142

    Minor Update

    37

    Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)

    7.01.14

    Minor Update

    38

    Orthopedic Applications of Platelet-Rich Plasma

    2.01.98

    Minor Update

    39

    Panniculectomy, Abdominoplasty, and Surgical Management of Diastasis Recti

    BSC7.04

    Minor Update

    40

    Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis)

    BSC_NIA_CG_302

    Admin Update

    41

    Paravertebral Facet Joint Injections or Blocks

    BSC_NIA_CG_301

    Admin Update

    42

    Partial Thickness Rotator Cuff Tears and Acromioplasty/Subacromial Decompression

    BSC7.14

    Admin Update

    43

    Phrenic Nerve Stimulation For Central Sleep Apnea

    2.02.33

    New

    44

    Reconstructive Services

    BSC7.08

    Minor Update

    45

    Reduction Mammaplasty for Breast-Related Symptoms

    7.01.21

    Admin Update

    46

    Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy

    7.01.143

    Minor Update

    47

    Sacroiliac Joint Injections

    BSC_NIA_CG_305

    Admin Update

    48

    ST2 Assay for Chronic Heart Failure and Heart Transplant Rejection

    2.04.130

    Minor Update

    49

    Thoracic Spine Surgery

    BSC_NIA_CG_308

    Admin Update

    50

    Three-Dimensional Printed Orthopedic Implants

    7.01.161

    Admin Update

    51

    Trigger Point and Tender Point Injections

    2.01.103

    Minor Update

    52

    Ultrasonographic Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Atherosclerosis

    2.02.16

    Minor Update

    53

    Wearable Cardioverter Defibrillators

    2.02.15

    Minor Update

  • New and updated policies effective June 1, 2019

     

    Policy Title – June 1, 2019

    Policy#

    Status

    1

    Spinal Cord and Dorsal Root Ganglion Stimulation

    7.01.25

    Major Update

    2

    Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening

    2.04.29

    Minor Update

     3

    Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions

    7.01.78

    Minor Update

    4

    Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions

    7.01.48

    Minor Update

    5

    Behavioral Health Treatment for Autism Spectrum Disorders

    BSC3.01

    Minor Update

    6

    Bone Morphogenetic Protein

    7.01.100

    Minor Update

    7

    Computer-Assisted Navigation for Orthopedic Procedure

    7.01.96

    Minor Update

    8

    Cooling Devices Used in the Outpatient Setting

    1.01.26

    Minor Update

    9

    Corneal Collagen Cross-Linking

    9.03.28

    Minor Update

    10

    Deep Brain Stimulation

    7.01.63

    Minor Update

    11

    Diabetes Prevention Program

    BSC2.11

    Minor Update

    12

    Discography

    BSC6.01

    Minor Update

    13

    Drug Testing in Pain Management and Substance Abuse Treatment

    2.04.98  

    Admin Update

    14

    Dry Needling of Myofascial Trigger Points

    2.01.100

    Minor Update

    15

    Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

    7.01.85

    Minor Update

    16

    Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

    2.01.54

    Minor Update

    17

    Facet Arthroplasty

    7.01.120

    Minor Update

    18

    Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease

    2.04.72

    Minor Update

    19

    Gene Expression-Based Assays for Cancers of Unknown Primary

    2.04.54

    Minor Update

    20

    Genetic Testing for Cystic Fibrosis

    BSC2.04

    Minor Update

    21

    Genetic Testing for Familial Cutaneous Malignant Melanoma

    2.04.44

    Minor Update

    22

    Genetic Testing for Limb-Girdle Muscular Dystrophies

    2.04.132

    Minor Update

    23

    Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy

    2.02.28

    Minor Update

    24

    Hip Resurfacing

    7.01.80

    Minor Update

    25

    Image-Guided Minimally Invasive Decompression for Spinal Stenosis

    7.01.126

    Minor Update

    26

    Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)

    7.01.107

    Minor Update

    27

    Intraoperative Neurophysiologic Monitoring

    7.01.58

    Minor Update

    28

    Microprocessor-Controlled Prostheses for the Lower Limb

    1.04.05

    Minor Update

    29

    Myoelectric Prosthetic and Orthotic Components for the Upper Limb

    1.04.04

    Minor Update

    30

    Nerve Graft with Radical Prostatectomy

    7.01.81

    Minor Update

    31

    Occipital Nerve Stimulation

    7.01.125

    Minor Update

    32

    Outpatient Pulmonary Rehabilitation

    8.03.05

    Minor Update

    33

    Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty

    7.01.144

    Minor Update

    34

    Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation

    6.01.38

    Minor Update

    35

    Percutaneous Vertebroplasty and Sacroplasty

    6.01.25

    Minor Update

    36

    Peripheral Subcutaneous Field Stimulation

    7.01.139

    Minor Update

    37

    Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis

    1.01.28

    Minor Update

    38

    Sacral Nerve Neuromodulation/Stimulation

    7.01.69

    Minor Update

    39

    Speech Therapy

    BSC8.02

    Minor Update

    40

    Subtalar Arthroereisis

    7.01.104

    Minor Update

    41

    Surgical Treatment of Femoroacetabular Impingement

    7.01.118

    Minor Update

    42

    Vertebral Axial Decompression

    8.03.09

    Minor Update

    43

    Vertical Expandable Prosthetic Titanium Rib

    7.01.110

    Minor Update

  • New and updated policies effective May 1, 2019

     

    Policy Title – May 1, 2019

    Policy#

    Status

    1

    Dopamine Transporter Imaging With Single-Photon Emission Computed Tomography

    6.01.54

    Major Update

    2

    Fecal Calprotectin Testing

    2.04.69

    Major Update

    3

    Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers

    2.04.02

    Major Update

    4

    Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

    2.04.08

    Major Update

    5

    Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Breast Cancer Risk

    2.04.126

    Major Update

    6

    Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome

    7.01.101

    Major Update

    7

    Aqueous Shunts and Stents for Glaucoma

    9.03.21

    Minor Update

    8

    Balloon Dilation of the Eustachian Tube

    7.01.158

    Minor Update

    9

    Balloon Ostial Dilation for Treatment of Chronic Rhinosinusitis

    7.01.105

    Minor Update

    10

    Cardiac Rehabilitation in the Outpatient Setting

    8.03.08

    Minor Update

    11

    Chelation Therapy for Off-Label Uses

    8.01.02

    Minor Update

    12

    Cognitive Rehabilitation

    8.03.10

    Minor Update

    13

    Continuous Passive Motion in the Home Setting

    1.01.10

    Minor Update

    14

    Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy

    9.03.05

    Minor Update

    15

    Cranial Electrotherapy Stimulation and Auricular Electrostimulation

    8.01.58

    Minor Update

    16

    Dental Anesthesia

    BSC2.02

    Minor Update

    17

    Electrical Stimulation for the Treatment of Arthritis

    1.01.27

    Minor Update

    18

    Endothelial Keratoplasty

    9.03.22

    Minor Update

    19

    Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome

    9.03.29

    Minor Update

    20

    Gastric Electrical Stimulation

    7.01.73

    Minor Update

    21

    General Approach to Evaluating the Utility of Genetic Panels

    2.04.92

    Minor Update

    22

    Genetic Testing for Duchenne and Becker Muscular Dystrophy

    2.04.86

    Minor Update

    23

    Genetic Testing for Epilepsy

    2.04.109

    Minor Update

    24

    Genetic Testing for Macular Degeneration

    2.04.103

    Minor Update

    25

    Hippotherapy

    8.03.12

    Minor Update

    26

    Hysterectomy Surgery for Benign Conditions

    BSC7.09

    Minor Update

    27

    Implantable Infusion Pump for Pain and Spasticity

    7.01.41

    Minor Update

    28

    Implantable Infusion Pump for Pain and Spasticity

    7.01.41

    Minor Update

    29

    Implantation of Intrastromal Corneal Ring Segments

    9.03.14

    Minor Update

    30

    Injectable Clostridial Collagenase for Fibroproliferative Disorders

    5.01.19

    Archived

    31

    Intraocular Radiotherapy for Age-Related Macular Degeneration

    9.03.20

    Minor Update

    32

    Keratoprosthesis

    9.03.01

    Minor Update

    33

    Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients with Cancer

    2.04.68

    Minor Update

    34

    Myocardial Strain Imaging

    2.02.31

    New

    35

    Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma

    9.03.06

    Minor Update

    36

    Optical Coherence Tomography of the Anterior Eye Segment

    9.03.18

    Minor Update

    37

    Orthoptic Training for the Treatment of Vision or Learning Disabilities

    9.03.03

    Minor Update

    38

    Patient-Controlled End of Range Motion Stretching Devices

    1.03.05

    Minor Update

    39

    Personalized Breast Cancer Screening Clinical Trial

    BSC2.08

    Minor Update

    40

    Photodynamic Therapy for Choroidal Neovascularization

    9.03.08

    Minor Update

    41

    Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers

    1.01.18

    Minor Update

    42

    Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities

    1.03.04

    Minor Update

    43

    Retinal Prosthesis

    9.03.15

    Minor Update

    44

    Retinal Telescreening for Diabetic Retinopathy

    9.03.13

    Minor Update

    45

    Sensory Integration Therapy and Auditory Integration Therapy

    8.03.13

    Minor Update

    46

    Surgical Treatments for Breast Cancer-Related Lymphedema

    7.01.162

    Minor Update

    47

    Synthetic Cartilage Implants for Joint Pain

    7.01.160

    Minor Update

    48

    Transcatheter Aortic Valve Implantation for Aortic Stenosis

    7.01.132

    Minor Update

    49

    Treatment of Tinnitus

    8.01.39

    Minor Update

    50

    Ultrasound Accelerated Fracture Healing Device

    1.01.05

    Minor Update

    51

    Viscocanalostomy and Canaloplasty

    9.03.26

    Minor Update

     

  • New and updated policies effective April 1, 2019
    1. Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias

    2. Amniotic Membrane and Amniotic Fluid

    3. Auditory Brainstem Implant

    4. Bariatric Surgery

    5. Bioimpedance Devices for Detection and Management of Lymphedema

    6. Chronic Intermittent Intravenous Insulin Therapy

    7. Cochlear Implant

    8. Dynamic Posturography

    9. Elective Percutaneous Coronary Intervention (PCI)

    10. Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis

    11. Gene Expression Profiling for Uveal Melanoma

    12. Genetic Testing for Cardiac Ion Channelopathies

    13. Genetic Testing for CHARGE Syndrome

    14. Genetic Testing for Facioscapulohumeral Muscular Dystrophy

    15. Genetic Testing for FLT3, NPM1, and CEBPA Variants in Cytogenetically Normal Acute Myeloid Leukemia

    16. Genetic Testing for Hereditary Pancreatitis

    17. Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders

    18. Genetic Testing for PTEN Hamartoma Tumor Syndrome

    19. Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies

    20. Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery

    21. Hematopoietic Cell Transplantation for Hodgkin Lymphoma

    22. Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas

    23. Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia

    24. Implantable Bone-Conduction and Bone-Anchored Hearing Aids

    25. Negative Pressure Wound Therapy in the Outpatient Setting

    26. Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow)

    27. Physical Therapy

    28. Reduction Mammaplasty for Breast-Related Symptoms

    29. Semi-Implantable and Fully Implantable Middle Ear Hearing Aids

    30. Stem Cell Therapy for Peripheral Arterial Disease

    31. Stereotactic Radiosurgery and Stereotactic Body Radiotherapy

    32. Steroid-Eluting Sinus Stents

    33. Surgery for Groin Pain in Athletes

    34. Surgical Deactivation of Headache Trigger Sites

    35. Surgical Treatment of Gynecomastia

    36. Surgical Ventricular Restoration

    37. Temporomandibular Joint Disorder

    38. Transmyocardial Revascularization

    39. Transtympanic Micropressure Applications as a Treatment of Meniere Disease

    40. Treatment of Varicose Veins/Venous Insufficiency

    41. Vagus Nerve Blocking Therapy for Treatment of Obesity

    42. Vagus Nerve Stimulation

    43. Vestibular Function Testing

  • New and updated policies effective March 1, 2019
    1. Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast 
    2. Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
    3. Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non‒Orthopedic Conditions
    4. Bioengineered Skin and Soft Tissue Substitutes
    5. Bone Mineral Density Studies
    6. Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
    7. Breast Implant Management 
    8. Carrier Screening for Genetic Diseases
    9. Chemical Peels
    10. Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy) 
    11. Cleft Palate - Dental Related Services
    12. DNA-Based Testing for Adolescent Idiopathic Scoliosis
    13. Electrostimulation and Electromagnetic Therapy for Treating Wounds
    14. Gender Reassignment Surgery
    15. Genetic Testing for Alpha1-Antitrypsin Deficiency
    16. Genetic Testing for FMR1 Variants (Including Fragile X Syndrome)
    17. Genetic Testing for Neurofibromatosis 
    18. Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia
    19. Hematopoietic Cell Transplantation for Acute Myeloid Leukemia 
    20. Hematopoietic Cell Transplantation for Autoimmune Diseases
    21. Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
    22. Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
    23. Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
    24. Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer
    25. Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults
    26. Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
    27. Hematopoietic Cell Transplantation for Primary Amyloidosis
    28. Hematopoietic Cell Transplantation for Solid Tumors of Childhood
    29. Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors
    30. Hydrogel Spacer Use During Radiotherapy for Prostate Cancer
    31. Hyperbaric Oxygen Therapy
    32. Immune Cell Function Assay
    33. Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
    34. Laboratory Testing for HIV Tropism
    35. Lifestyle Modification Program for Reversing Heart Disease
    36. Magnetic Resonance Imaging to Monitor the Integrity of Silicone Gel-Filled Breast Implants 
    37. Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Breast Cancer Risk
    38. Multimarker Serum Testing Related to Ovarian Cancer
    39. Noncontact Ultrasound Treatment for Wounds
    40. Placental and Umbilical Cord Blood as a Source of Stem Cells
    41. Power Morcellation for the Treatment of Uterine Fibroids
    42. Quantitative Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers
    43. Reconstructive Services
    44. Serum Biomarker Human Epididymis Protein 4
    45. Surgical Treatment of Femoroacetabular Impingement
    46. Total Hip Arthroplasty for Adults
    47. Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance
  • New and updated policies effective February 1, 2019
    1. Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
    2. Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
    3. Amniotic Membrane and Amniotic Fluid
    4. Aqueous Shunts and Stents for Glaucoma
    5. Bioengineered Skin and Soft Tissue Substitutes
    6. Biofeedback as a Treatment of Headache
    7. Biofeedback for Miscellaneous Indications
    8. Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
    9. Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
    10. Cardiovascular Risk Panels
    11. Carrier Screening for Genetic Diseases
    12. Cerebrospinal Fluid and Urinary Biomarkers of Alzheimer Disease
    13. Chromoendoscopy as an Adjunct to Colonoscopy
    14. Confocal Laser Endomicroscopy
    15. Cooling Devices Used in the Outpatient Setting
    16. Dermatologic Applications of Photodynamic Therapy
    17. Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
    18. Digital Breast Tomosynthesis
    19. Drug Testing in Pain Management and Substance Abuse Treatment
    20. Elective Percutaneous Coronary Intervention (PCI)
    21. Electromagnetic Navigation Bronchoscopy
    22. Esophageal pH Monitoring
    23. Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
    24. Focal Treatments for Prostate Cancer
    25. Gene Expression Profiling for Cutaneous Melanoma
    26. Gene Expression Profiling for Uveal Melanoma
    27. Genetic Testing for Epilepsy
    28. Genetic Testing for Familial Cutaneous Malignant Melanoma
    29. Genetic Testing for Fanconi Anemia
    30. Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease and Venous Thromboembolic Disease
    31. Identification of Microorganisms Using Nucleic Acid Probes
    32. Intracellular Micronutrient Analysis
    33. Intraoperative Neurophysiologic Monitoring
    34. Invasive Prenatal (Fetal) Diagnostic Testing
    35. Laser Treatment of Onychomycosis
    36. Light Therapy for Psoriasis
    37. Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
    38. Measurement of Lipoprotein-Associated Phospholipase A2 in the Assessment of Cardiovascular Risk
    39. Molecular Markers in Fine Needle Aspirates of the Thyroid
    40. Molecular Testing in the Management of Pulmonary Nodules
    41. Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis
    42. Myoelectric Prosthetic and Orthotic Components for the Upper Limb
    43. Nerve Fiber Density Measurement
    44. Neuropsychological Testing
    45. Nonpharmacologic Treatment of Rosacea
    46. Novel Biomarkers in Risk Assessment and Management of Cardiovascular Disease
    47. Nutrient/Nutritional Panel Testing
    48. Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions
    49. Power Wheelchairs and Power Operated Vehicles for Permanent Use
    50. Retinal Prosthesis
    51. Subtalar Arthroereisis
    52. Targeted Phototherapy and Psoralen with Ultraviolet A for Vitiligo
    53. Testing Serum Vitamin D Levels
    54. Total Artificial Hearts and Implantable Ventricular Assist Devices
    55. Transcutaneous Electrical Nerve Stimulation
    56. Treatment of Varicose Veins/Venous Insufficiency
  • New and updated policies effective January 1, 2019
    1. Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening
    2. Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
    3. Behavioral Health Treatment for Autism Spectrum Disorders
    4. Biofeedback as a Treatment of Chronic Pain
    5. Biofeedback as a Treatment of Fecal Incontinence or Constipation
    6. Circulating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy)
    7. Computer-Aided Evaluation as an Adjunct to Magnetic Resonance Imaging of the Breast
    8. Deep Brain Stimulation
    9. Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
    10. Fecal Microbiota Transplantation
    11. Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
    12. General Approach to Evaluating the Utility of Genetic Panels
    13. General Approach to Genetic Testing
    14. Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
    15. Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing
    16. Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers
    17. Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
    18. Genetic Testing for Statin-Induced Myopathy
    19. Human Leukocyte Antigen Testing for Celiac Disease
    20. Implantable Sinus Stents for Postoperative Use Following Endoscopic Sinus Surgery and for Recurrent Sinus Disease
    21. Ingestible pH and Pressure Capsule
    22. Interferential Current Stimulation
    23. Intraocular Radiotherapy for Age-Related Macular Degeneration
    24. Intravenous Anesthetics for the Treatment of Chronic Pain
    25. Lumbar Spine Surgery
    26. Lysis of Epidural Adhesions
    27. Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease
    28. Magnetic Resonance Imaging for Detection and Diagnosis of Breast Cancer
    29. Magnetic Resonance Imaging to Monitor the Integrity of Silicone Gel-Filled Breast Implants
    30. Magnetoencephalography/Magnetic Source Imaging
    31. Measurement of Serum Antibodies to Infliximab and Adalimumab
    32. Monitored Anesthesia Care
    33. Neural Therapy
    34. Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease
    35. Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
    36. Personalized Breast Cancer Screening Clinical Trial
    37. Pharmacogenetic Testing for Pain Management
    38. Pharmacogenomic and Metabolite Markers for Patients Treated With Thiopurines
    39. Plugs for Anal Fistula Repair
    40. Prolotherapy
    41. Proteomic Testing for Systemic Therapy in Non-Small-Cell Lung Cancer
    42. Sphenopalatine Ganglion Block for Headache
    43. Transanal Endoscopic Microsurgery
    44. Transanal Radiofrequency Treatment of Fecal Incontinence
    45. Transcutaneous Electrical Nerve Stimulation
    46. Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
    47. Vagus Nerve Stimulation
    48. Wireless Capsule Endoscopy to Diagnose Disorders of the Small Bowel, Esophagus, and Colon
  • New and updated policies effective December 1, 2018
    1. Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
    2. Antigen Leukocyte Antibody Test
    3. Artificial Pancreas Device Systems
    4. BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
    5. Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions
    6. Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy)
    7. Circulating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy)
    8. Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
    9. Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography
    10. Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies
    11. External Insulin Infusion Pump
    12. Extracorporeal Photopheresis
    13. Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing
    14. Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies
    15. Genetic Testing for Heterozygous Familial Hypercholesterolemia
    16. Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
    17. Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
    18. Injectable Clostridial Collagenase for Fibroproliferative Disorders
    19. Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
    20. Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease
    21. Knee Arthroscopy in Knee Osteoarthritis
    22. Laboratory Tests for Heart and Kidney Transplant Rejection
    23. Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease
    24. Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification
    25. Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer
    26. Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreatic Lesions
    27. Next-Generation Sequencing for the Assessment of Measurable Residual Disease
    28. Partial Thickness Rotator Cuff Tears and Acromioplasty/Subacromial Decompression
    29. Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder
    30. Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
    31. Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
    32. Use of Common Genetic Variants (Single Nucleotide Variants) to Predict Risk of Nonfamilial Breast Cancer
    33. Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
  • New and updated policies effective November 1, 2018
    • Ablation of Peripheral Nerves to Treat Pain
    • Acute and Maintenance Tocolysis
    • Bariatric Surgery
    • Beta-Amyloid Imaging with Positron Emission Tomography for Alzheimer Disease
    • Bone Mineral Density Studies
    • Cardiac Applications of Positron Emission Tomography Scanning
    • Computed Tomography Perfusion Imaging of the Brain
    • Computed Tomography to Detect Coronary Artery Calcification
    • Computer-Aided Evaluation as an Adjunct to Magnetic Resonance Imaging of the Breast
    • Contrast-Enhanced Coronary Computed Tomography Angiography for Coronary Artery Evaluation
    • Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
    • Digital Breast Tomosynthesis
    • Dynamic Spinal Visualization and Vertebral Motion Analysis
    • Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer
    • Endometrial Ablation
    • Focal Treatments for Prostate Cancer
    • Functional Magnetic Resonance Imaging of the Brain
    • Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
    • Genetic Testing for Diagnosis and Management of Mental Health Conditions
    • Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
    • Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment
    • Magnetic Resonance Imaging for Detection and Diagnosis of Breast Cancer
    • Magnetic Resonance Imaging to Monitor the Integrity of Silicone Gel-Filled Breast Implants
    • Magnetic Resonance Spectroscopy
    • Magnetic Resonance-Guided Focused Ultrasound
    • Magnetoencephalography/Magnetic Source Imaging
    • Microwve and Locoregional Laser Tumor Ablation
    • Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography
    • Myocardial Sympathetic Innervation Imaging in Patients With Heart Failure
    • Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA
    • Oncologic Applications of Positron Emission Tomography Scanning
    • Plasma Exchange
    • Positional Magnetic Resonance Imaging
    • Positron Emission Mammography
    • Radioactive Seed Localization of Nonpalpable Breast Lesions
    • Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
    • Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension
    • Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
    • Scintimammography and Gamma Imaging of the Breast and Axilla
    • Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
    • Thermography
    • Tumor Treating Fields Therapy
    • Vertebral Fracture Assessment with Densitometry
    • Virtual Colonoscopy/Computed Tomography Colonography
    • Whole Body Dual X-Ray Absorptiometry to Determine Body Composition