Medical Policies - Excellus Providers

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Showing 1– 25 of 291 Results
Title Last Updated Category
Wireless Capsule Endoscopy/Imaging for Examination of the Gastrointestinal (GI) Tract: AGILE Patency Capsule, Given® Capsule Camera, PillCam SB, PillCam ESO Open a PDF 6.01.27 2019-07-18 Digestive System (Gastroenterology)
Whole Exome and Whole Genome Sequencing for the Diagnosis of Genetic Disorders Open a PDF 2.02.46 2019-07-18 Genetic Disease (Inherited Disease)
Wheelchairs and Power Operated Vehicles (POVs) (e.g., Scooters) Open a PDF 1.01.16 2019-08-09 Durable Medical Equipment & Supplies
Vitrectomy Chair/ Face-Down Positioning System Open a PDF 1.01.52 2019-06-03 Durable Medical Equipment & Supplies
Vision/Eye Therapy: Optometric Phototherapy, Occlusion Therapy, Orthoptics, Pleoptics Open a PDF 9.01.04 2019-01-17 Eyes (Ophthalmology)
Ventricular Assist Devices (VAD, LVAD) Open a PDF 7.01.07 2019-09-19 Heart & Blood Vessels (Cardiovascular)
Varicosities/Varicose Veins, Treatment Alternatives to Vein Stripping and Ligation (e.g., Ambulatory, Stab or Transilluminated Powered Phlebectomy, ClariVein®, Endoluminal Radiofrequency Ablation, Endovenous Laser Ablation, Mechanochemical Endovenous Ablation, MOCA, Sclerotherapy, Varithena™, Venaseal™,VNUS) Open a PDF 7.01.47 2019-10-16 Cosmetic / Reconstructive Surgery
Vagus Nerve Stimulation Open a PDF 7.01.05 2019-08-22 Nervous Systems (Neurology)
Uterine Artery Occlusion in the Treatment of Uterine Fibroids: Uterine Artery/Fibroid Embolization (UAE/UFE), Uterine Artery Coagulation Open a PDF 4.01.04 2019-03-22 Women's Health (Obstetrics & Gynecology)
Urine Drug Testing, immunoassay, presumptive testing, confirmatory testing Open a PDF 2.02.50 2019-02-06 Lab Tests (pathology)
Urinary Tumor Markers for Bladder Cancer: AccuDx, BTA Stat™, Fibrin/Fibrinogen Degradation Products (FDP), ImmunoCyt, Nuclear Matrix Protein (NMP-22), Urinary Bladder Cancer Antigen (UBC Rapid Test) Open a PDF 2.02.12 2019-08-22 Lab Tests (pathology)
Tumor-Treatment Field Therapy for Glioblastoma: Electrical Field Therapy, NovoTTF-100™ Open a PDF 6.01.45 2019-04-29 Cancer Treatment (Oncology)
Treatment of Tinnitus: Habituation Therapy, Jastreboff Method, Masking, Retraining Therapy Open a PDF 8.01.07 2019-03-22 Ear, Nose & Throat (Otorhinolaryngology)
Treatment of Hirsutism/Hypertrichosis (Hair Removal) (e.g., Electrolysis, Epilation) Open a PDF 2.01.38 2019-01-17 Cosmetic / Reconstructive Surgery
Treatment of Gambling Disorder and Other Repetitive Behaviors Open a PDF 3.01.19 2019-04-29 Behavioral Health (Psychology)
Transurethral Microwave Thermotherapy (e.g., Prostatron, Targis, Urowave System, CoreTherm, Prolieve, TMx-2000, TUMT) Open a PDF 7.01.28 2019-01-17 Urinary System (Genitourinary)
Transpupillary Thermotherapy (TTT) Open a PDF 9.01.05 2019-09-19 Eyes (Ophthalmology)
Transmyocardial Revascularization (TMR), Percutaneous Transmyocardial Revascularization (PTMR) Open a PDF 7.01.12 2019-03-22 Heart & Blood Vessels (Cardiovascular)
Transendoscopic Therapies for Gastroesophageal Reflux Disease (GERD): ELF, EndoCinch, Endoluminal Fundoplication, Endoluminal Gastroplication, Enteryx, EsophyX, Gatekeeper, Plexiglas Microspheres, NDO Plicator System, Radiofrequency Esophageal Treatment, Stretta) Open a PDF 7.01.45 2019-06-14 Digestive System (Gastroenterology)
Transcranial Magnetic Stimulation: Deep TMS device, MagVita TMS, NeuroStar TMS device, rTMS, TMS Open a PDF 3.01.09 2019-01-17 Behavioral Health (Psychology)
Transcranial Doppler Ultrasound Open a PDF 6.01.18 2019-01-17 Radiology (x-rays) & Imaging
Transcatheter Closure Devices for Cardiac Defects: Amplatzer Septal Occluder, Angel Wing Device, Atrial Septal Detect Occluding System (ASDOS), CardioSEAL, HELEX, Sideris Buttoned Device Open a PDF 7.01.34 2019-09-19 Heart & Blood Vessels (Cardiovascular)
Total Parenteral Nutrition (TPN), Intradialytic Parenteral Nutrition (IDPN), Intraperitoneal Nutrition (IPN), or Hyperalimentation Open a PDF 11.01.04 2019-04-29 Food (Nutrition)
Total Hip Resurfacing, Metal-on-Metal Open a PDF 7.01.74 2019-07-18 Bone & Joints (Orthopedic)
Temporomandibular Joint (TMJ) Disease Open a PDF 11.01.17 2019-01-17 Bone & Joints (Orthopedic)
Showing 1– 25 of 291 Results

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