Search Results
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Actigraphy
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Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
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Allogeneic Pancreas Transplant
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Ambulance (Emergency)
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Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
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Amniotic Membrane and Amniotic Fluid
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Anesthesia for Dental Procedures
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Antigen Leukocyte Antibody Test
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Aqueous Shunts and Stents for Glaucoma
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Artificial Intervertebral Disc: Cervical Spine
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Artificial Intervertebral Disc: Lumbar Spine
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Artificial Pancreas Device Systems
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Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
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Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
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Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
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Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non-Orthopedic Conditions
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Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure
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Automated Percutaneous and Percutaneous Endoscopic Discectomy
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Autonomic Nervous System Testing
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Axial Lumbosacral Interbody Fusion
B
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Balloon Dilation of the Eustachian Tube
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Balloon Ostial Dilation for Treatment of Chronic and Recurrent Acute Rhinosinusitis
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Bariatric Surgery
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BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
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Bioengineered Skin and Soft Tissue Substitutes
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Biofeedback as a Treatment of Chronic Pain
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Biofeedback as a Treatment of Fecal Incontinence or Constipation
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Biofeedback as a Treatment of Headache
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Biofeedback as a Treatment of Urinary Incontinence in Adults
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Biofeedback for Miscellaneous Indications
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Bioimpedance Devices for Detection and Management of Lymphedema
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Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment and Immunotherapy in Breast Cancer
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Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment and Immunotherapy in Metastatic Colorectal Cancer
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Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
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Blepharoplasty
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Bronchial Thermoplasty
C
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Cardiac Rehabilitation in the Outpatient Setting
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Cardiovascular Risk Panels
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Carrier Screening for Genetic Diseases
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Catheter Ablation as Treatment for Atrial Fibrillation
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Chelation Therapy for Off-Label Uses
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Chromosomal Microarray Testing for the Evaluation of Pregnancy Loss
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Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy)
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Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
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Cochlear Implant
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Cognitive Rehabilitation
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Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies
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Computed Tomography Perfusion Imaging of the Brain
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Computer-Assisted Navigation for Orthopedic Procedure
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Confocal Laser Endomicroscopy
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Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
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Continuous Passive Motion in the Home Setting
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Cooling Devices Used in the Outpatient Setting
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Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy
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Cosmetic vs. Reconstructive Surgery or Services
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Cranial Electrotherapy Stimulation and Auricular Electrostimulation
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Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
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Cryosurgical Ablation of Primary or Metastatic Liver Tumors
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Cytochrome P450 Genotype-Guided Treatment Strategy
D
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Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)
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Deep Brain Stimulation
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Dermatologic Applications of Photodynamic Therapy
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Diagnosis and Management of Idiopathic Environmental Intolerance and Intracellular Micronutrient Analysis
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Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
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Diagnosis and Treatment of Sacroiliac Joint Pain
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Discectomy
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Dopamine Transporter Single-Photon Emission Computed Tomography
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Dynamic Posturography
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Dynamic Spinal Visualization and Vertebral Motion Analysis
E
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Electrical and Electromagnetic Stimulation for the Treatment of Arthritis
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Electrical Bone Growth Stimulation of the Appendicular Skeleton
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Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
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Electromagnetic Navigation Bronchoscopy
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Electrostimulation and Electromagnetic Therapy for Treating Wounds
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Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer
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Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
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Endothelial Keratoplasty
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Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
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Endovascular Stent Grafts for Abdominal Aortic Aneurysms
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Endovascular Therapies for Extracranial Vertebral Artery Disease
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Enhanced External Counterpulsation
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Epidural Steroid Injections for Neck or Back Pain
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Extracorporeal Photopheresis
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Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
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Extracranial Carotid Artery Stenting
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Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome
F
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Facet Arthroplasty
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Facet Joint Denervation
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Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
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Fecal Calprotectin Testing
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Fecal Microbiota Transplantation
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Functional Neuromuscular Electrical Stimulation
G
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Gastric Electrical Stimulation
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Gender Affirmation Surgery
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Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer
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Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
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Gene Expression Profiling for Cutaneous Melanoma
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Gene Expression-Based Assays for Cancers of Unknown Primary
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Gene Variants Associated With Breast Cancer in Individuals at High Breast Cancer Risk
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General Approach to Evaluating the Utility of Genetic Panels
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General Approach to Genetic Testing
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Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
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Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing
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Genetic Testing for Alpha1-Antitrypsin Deficiency
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Genetic Testing for Alzheimer Disease
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Genetic Testing for Cardiac Ion Channelopathies
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Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies
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Genetic Testing for Diagnosis and Management of Mental Health Conditions
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Genetic Testing for Duchenne and Becker Muscular Dystrophy
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Genetic Testing for Epilepsy
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Genetic Testing for Familial Cutaneous Malignant Melanoma
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Genetic Testing for FLT3, NPM1, and CEBPA Variants in Cytogenetically Normal Acute Myeloid Leukemia
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Genetic Testing for FMR1 Variants (Including Fragile X Syndrome)
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Genetic Testing for Hereditary Hearing Loss
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Genetic Testing for Hereditary Hemochromatosis
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Genetic Testing for Hereditary Pancreatitis
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Genetic Testing for Idiopathic Dilated Cardiomyopathy
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Genetic Testing for Lactase Insufficiency
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Genetic Testing for Li-Fraumeni Syndrome
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Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
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Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
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Genetic Testing for Mitochondrial Disorders
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Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
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Genetic Testing for PTEN Hamartoma Tumor Syndrome
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Genetic Testing for Rett Syndrome
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Genetic Testing for Statin-Induced Myopathy
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Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
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Genetic Testing of CADASIL Syndrome
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Genotype-Guided Tamoxifen Treatment
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Genotype-Guided Warfarin Dose
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Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment and Immunotherapy in Breast Cancer
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Germline Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers
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Germline Genetic Testing for Pancreatic Cancer Susceptibility Genes
H
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Heart Transplant
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Heart/Lung Transplant
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Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia
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Hematopoietic Cell Transplantation for Acute Myeloid Leukemia
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Hematopoietic Cell Transplantation for Autoimmune Diseases
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Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
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Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
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Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
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Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer
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Hematopoietic Cell Transplantation for Hodgkin Lymphoma
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Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults
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Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas
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Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
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Hematopoietic Cell Transplantation for Primary Amyloidosis
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Hematopoietic Cell Transplantation for Solid Tumors of Childhood
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Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors
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Hip Resurfacing
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Hippotherapy
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Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease and Venous Thromboembolic Disease
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Human Leukocyte Antigen Testing for Celiac Disease
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Hyperbaric Oxygen Therapy
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Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
I
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Image-Guided Minimally Invasive Decompression for Spinal Stenosis
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Immune Cell Function Assay
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Implantable Bone-Conduction and Bone-Anchored Hearing Aids
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Implantable Cardioverter Defibrillators
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Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence
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Intensity-Modulated Radiotherapy: Abdomen and Pelvis
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Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid
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Intensity-Modulated Radiotherapy: Central Nervous System Tumors
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Intensity-Modulated Radiotherapy of the Breast and Lung
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Intensity-Modulated Radiotherapy of the Prostate
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Interspinous and Interbody Fixation (Fusion) Devices
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Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
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Intra-Articular Hyaluronan Injections for Osteoarthritis
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Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain
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Intradialytic Parenteral Nutrition
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Intraoperative Neurophysiologic Monitoring
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Invasive Prenatal (Fetal) Diagnostic Testing
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Islet Transplantation
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Isolated Small Bowel Transplant
J
K
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Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients With Cancer
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Laboratory Tests Post Transplant and for Heart Failure
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Laminectomy
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Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis
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Leadless Cardiac Pacemakers
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Liver Transplant and Combined Liver-Kidney Transplant
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Low Intensity Pulsed Ultrasound Fracture Healing Device
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Low-Level Laser Therapy
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Lumbar Spinal Fusion
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Lung and Lobar Lung Transplant
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Lung Volume Reduction Surgery for Severe Emphysema
M
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Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease
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Magnetic Resonance Imaging‒Targeted Biopsy of the Prostate
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Magnetic Resonance-Guided Focused Ultrasound
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Manipulation Under Anesthesia
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Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
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Measurement of Serum Antibodies to Selected Biologic Agents
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Meniscal Allografts and Other Meniscal Implants
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Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification
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Microprocessor-Controlled Prostheses for the Lower Limb
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Microwave Tumor Ablation
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Miscellaneous Genetic and Molecular Diagnostic Tests
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Molecular Analysis (Including Liquid Biopsy) for Targeted Therapy or Immunotherapy of Non-Small-Cell Lung Cancer
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Molecular Markers in Fine Needle Aspirates of the Thyroid
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Molecular Testing for Germline BRIP1, RAD51C, and RAD51D Variants Associated with Ovarian Cancer
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Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreaticobiliary Lesions
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Multibiomarker Disease Activity Blood Test for Rheumatoid Arthritis
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Multimarker Serum Testing Related to Ovarian Cancer
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Myocardial Strain Imaging
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Myoelectric Prosthetic and Orthotic Components for the Upper Limb
N
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Negative Pressure Wound Therapy in the Outpatient Setting
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Nerve Graft With Radical Prostatectomy
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Neurofeedback
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Noninvasive Prenatal Screening for Fetal Aneuploidies, Microdeletions, and Twin Zygosity Using Cell-Free Fetal DNA
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Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease
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Novel Biomarkers in Risk Assessment and Management of Hyperlipidemia in Cardiovascular Disease
O
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Occipital Nerve Stimulation
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Office-Based Orthoptic Training for the Treatment of Vision or Learning Disabilities
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Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus
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Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
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Optical Coherence Tomography of the Anterior Eye Segment
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Orthognathic Surgery
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Orthopedic Applications of Platelet-Rich Plasma
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Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used With Autologous Bone Marrow)
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Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions
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Outpatient Pulmonary Rehabilitation
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Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome
P
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Panniculectomy, Abdominoplasty, and Excision of Redundant Skin
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Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
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Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation
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Percutaneous Electrical Nerve Stimulation and Percutaneous Neuromodulation Therapy
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Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty
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Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
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Percutaneous Tibial Nerve Stimulation
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Percutaneous Vertebroplasty and Sacroplasty
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Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
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Pharmacogenetic Testing for Pain Management
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Pharmacogenomic and Metabolite Markers for Patients Treated With Thiopurines
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Photodynamic Therapy for Choroidal Neovascularization
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Plugs for Anal Fistula Repair
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Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers
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Polysomnography for Non-respiratory Sleep Disorders
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Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
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Preimplantation Genetic Testing
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Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia
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Prolotherapy
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Prostatic Urethral Lift
Q
R
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Radioembolization for Primary and Metastatic Tumors of the Liver
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Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
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Radiofrequency Ablation of Primary or Metastatic Liver Tumors
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Reconstructive Breast Surgery/Management of Breast Implants
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Reduction Mammaplasty for Breast-Related Symptoms
S
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Sacral Nerve Neuromodulation/Stimulation
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Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
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Scintimammography and Gamma Imaging of the Breast and Axilla
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Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
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Sensory Integration Therapy and Auditory Integration Therapy
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Serologic Genetic and Molecular Screening for Colorectal Cancer
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Small Bowel/Liver and Multivisceral Transplant
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Sphenopalatine Ganglion Block for Headache
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Spinal Cord and Dorsal Root Ganglion Stimulation
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Stem Cell Therapy for Peripheral Arterial Disease
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Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
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Steroid-Eluting Sinus Stents
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Subtalar Arthroereisis
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Surgical Treatment of Bilateral Gynecomastia
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Surgical Treatment of Femoroacetabular Impingement
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Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
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Surgical Ventricular Restoration
T
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Targeted Phototherapy and Psoralen with Ultraviolet A for Vitiligo
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Technology Assessment and Medically Necessary Services
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Temporomandibular Joint Dysfunction
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Thermography
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Total Artificial Hearts and Implantable Ventricular Assist Devices
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Transcatheter Aortic Valve Implantation for Aortic Stenosis
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Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
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Transcatheter Mitral Valve Repair
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Transcatheter Pulmonary Valve Implantation
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Transcutaneous Electrical Nerve Stimulation
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Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
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Transmyocardial Revascularization
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Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hyperplasia
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Treatment of Hyperhidrosis
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Treatment of Tinnitus
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Treatment of Varicose Veins/Venous Insufficiency
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Tumor Treating Fields Therapy
U
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Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance
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Use of Common Genetic Variants (Single Nucleotide Variants) to Predict Risk of Nonfamilial Breast Cancer
V
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Vagus Nerve Stimulation
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Vertebral Axial Decompression
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Vestibular Function Testing
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Viscocanalostomy and Canaloplasty
W
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Protocol Cover Letters
Protocol cover letters prior to the dates shown can be obtained by contacting the Provider Call Center.
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July 1, 2022
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November 1, 2020
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January 1, 2020
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March 1, 2018
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February 28, 2017
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March 2, 2015
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June 2, 2014
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March 3, 2014
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December 2, 2013
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September 3, 2013
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May 31, 2013
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March 1, 2013
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November 30, 2012
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September 1, 2012
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