Clinical Policies

Navigate directly to a letter:

A
B
C
D
E
F
G
H
I
K
L
M
N
P
R
S
T
V
W
X

A
- Ambulatory continuous peripheral nerve block for chronic pain
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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
- Dermabrasion and chemical peel
- Donor human milk
- Dynamic splinting
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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
- Fetal surgeries in utero
- Fluorescence spectroscopy for prostate cancer diagnosis
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G
- Gastrointestinal electrical stimulation for obesity
- Gastroparesis evaluations
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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
- Inhaled nitric oxide
- Injectable bulking agents — fecal incontinence
- Intermittent pneumatic compression for peripheral artery disease
- Intracranial hypertension stent
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K
- Ketone monitor for ketogenic diet in epilepsy
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L
- Lipoprotein apheresis
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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
- Nonpharmacologic treatments for chronic vertigo
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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 — 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
- Radiofrequency ablation for nasal valve collapse
- Radiofrequency ablation of genicular nerves for knee pain
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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
- Three-dimensional imaging and interpretation
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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
- Wheelchair mounted robotic arm – Kinova Jaco2
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X
- XEN® gel stent for glaucoma
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