Clinical Policies
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A
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B
- Balloon dilation of the Eustachian tube
- Biofeedback for chronic pain
- Bone graft substitutes
- Bone marrow transplant for children with hyper IgM disorder
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C
- Cecostomy for fecal incontinence
- Cervical cancer and human papillomavirus screening
- Computer-aided detection and diagnosis for chest imaging
- Computerized gait analysis
- Core decompression for avascular necrosis of the hip
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D
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E
- Emerg Auto-Emersion Therapy system and Dolphin Fluid Immersion Simulation system for pressure injury
- Endovenous stents
- Epidermal nerve fiber density testing
- Equine-assisted therapy
- Excimer laser for vitiligo
- External counterpulsation therapy
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F
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G
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H
- Hidradenitis suppurativa surgery
- Home-use light box therapy for seasonal affective disorder
- Hypoglossal nerve stimulation
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I
- IFuse implant system
- Inhaled nitric oxide
- Injectable bulking agents — fecal incontinence
- Intermittent pneumatic compression for peripheral artery disease
- Intracranial hypertension stent
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K
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L
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M
- Manipulation under anesthesia (hip and elbow)
- Medical three-dimensional printing
- Melody™ transcatheter pulmonary valve replacement
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N
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P
- Pediatric bed enclosures and sensory beds
- Pediatric intensive feeding programs
- Pediatric turbinoplasty
- Percutaneous arteriovenous fistula creation
- Percutaneous sacroplasty
- Peroral endoscopic myotomy
- Pet therapy
- Phototherapy and photochemotherapy for skin conditions
- Phrenic (diaphragmatic) nerve stimulation
- Physician’s Drug Program
- Platelet rich plasma for nonhealing diabetic wounds
- Postural orthostatic tachycardia syndrome treatment with physical therapy
- Prescription digital therapeuticss for contraception
- Prostatic urethral lift/UroLift for benign prostatic hypertrophy
- Pulsed dye laser for port-wine stain and infantile hemangioma
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R
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S
- Sacral nerve modulation/stimulation
- Shoe lifts for leg length discrepancy
- Sialendoscopy and lithotripsy for salivary stones
- Smell and taste dysfunction testing
- Specialized infant formula
- Sphenopalatine ganglion block injections for headache
- Stereotactic navigation in sinus surgery
- Supraglottoplasty and laryngoplasty
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T
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V
- Vaginitis diagnostic testing
- Video head impulse testing
- Vitamin D screening
- Volatile organic compounds for urinary tract infection
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W
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X
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