Clinical Policies

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

A
- Abdominoplasty
- Acoustic cardiography/heart sound recording
- Art therapy
- Athletic pubalgia (sports hernia) surgery
- Auricular Stimulation for Abdominal Pain From Irritable Bowel Syndrome
- Autologous fat grafting and injectable soft-tissue fillers
- Automated scalp cooling
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B
- Balloon Spacer Devices for Management of Massive Rotator Cuff Tears
- Balloon dilation of the Eustachian tube
- Blue Native polyacrylamide gel electrophoresis for mitochondrial myopathies
- Botulinum toxin for constipation
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C
- Cardiac contractility modulation
- Cervical Traction Devices for Neck Pain for Home Use
- Computer-aided detection and diagnosis for chest imaging
- Core decompression for avascular necrosis of the hip
- Corneal cross-linking
- Coronary intravascular lithotripsy
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D
- Disposable insulin delivery devices
- Dynamic Splinting
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E
- Embrace 2 watch for seizure detection
- Emerg Auto-Emersion Therapy System and Dolphin Fluid Immersion Simulation System for Pressure Injury
- Endobronchial Valve Placement
- EpiSign Testing for DNA Methylation Analysis
- Equine-assisted therapy
- Erectile dysfunction treatments other than pharmaceuticals
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F
- Face transplantation
- Flexitouch® pneumatic compression devices for lymphedema after head and neck surgery
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G
- Gastrointestinal electrical stimulation for obesity
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H
- Home spirometry
- Home-use Light Box Therapy for Seasonal Affective Disorder
- Hydrogel spacer use during radiotherapy for prostate cancer
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I
- Intermittent pneumatic compression for peripheral artery disease
- Intracranial hypertension stent
- Intravascular ultrasound
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L
- Latera Absorbable Nasal Implant
- Low-frequency ultrasound therapy for wound management
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M
- MarginProbe®
- Medical three-dimensional printing
- Microwave thermotherapy for lung and kidney tumors
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N
- Non-Wheelchair Adaptive Seating
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O
- Oral nutritional supplements
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P
- Pediatric Turbinoplasty
- Pediatric bed enclosures
- Percutaneous arteriovenous fistula creation
- Percutaneous peripheral nerve stimulators for chronic nerve pain
- Pet therapy
- Prescription digital therapeutics for attention deficit hyperactivity disorder
- Prescription digital therapeutics for contraception
- Prescription digital therapeutics for insomnia
- Prostatic urethral lift/UroLift for benign prostatic hyperplasia
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R
- RESET-O
- Radiofrequency ablation for nasal valve collapse
- Robotic orthoses – lower limb
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S
- Sacral nerve modulation/stimulation
- Scoliosis vertebral body tethering and stapling
- Shoe Lifts for Leg Length Discrepancy
- Sialendoscopy and lithotripsy for salivary stones
- Skin Substitutes for Chronic Wounds
- Skin surgery after massive weight loss
- Smell and taste dysfunction testing
- Specialized infant formula
- Stereotactic navigation in sinus surgery
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T
- Transanal radiofrequency for fecal incontinence
- Transcatheter Therapy for Severe Tricuspid Insufficiency
- Transcatheter coronary infusion of supersaturated oxygen therapy in acute myocardial infarction
- Transperineal laser ablation of the prostate for benign prostatic hyperplasia
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V
- Vagus nerve stimulation for post-stroke upper limb rehabilitation
- Vestibular evoked myogenic potential testing
- Virtual colonoscopy – CT colonography
- Vitamin D screening
- Volatile organic compounds for urinary tract infection
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W
- WATS-3D brush biopsy for Barrett’s esophagus
- Wearable dialysis and implantable artificial kidneys
- Wheelchair mounted robotic arm – Kinova Jaco2
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X
- XEN® gel stent for glaucoma
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Z
- ZOLL Heart Failure Management System
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