Medical Policies

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Showing 51– 100 of 361 Results
Title Last Updated Category
Periodontal Scaling and Root Planing Open a PDF 13.01.04 2026-07-21 Dental
Dental Inlays and Onlays Open a PDF 13.01.03 2026-07-21 Dental
Dental Crowns and Veneers Open a PDF 13.01.02 2026-07-21 Dental
Dental Implants Open a PDF 13.01.01 2026-07-21 Dental
Skilled Nursing Facility Care / Level of Care Criteria Open a PDF 11.01.21 2026-07-21 Miscellaneous
Chiropractic Care Open a PDF 10.01.02 2026-07-21 Chiropractic
Heart & Heart/Lung Transplant Open a PDF 7.02.06 2026-07-21 Transplants
Balloon Dilation of the Eustachian Tube Open a PDF 7.01.101 2026-07-21 Ear, Nose & Throat (Otorhinolaryngology)
Pain Management Techniques for Knee Pain Open a PDF 7.01.100 2026-07-21 Bone & Joints (Orthopedic)
Laboratory Testing for Transplantation Rejection Open a PDF 2.02.55 2026-07-21 Lab Tests (pathology)
Genetic Testing for Cystic Fibrosis Open a PDF 2.02.17 2026-07-21 Genetic Disease (Inherited Disease)
Urinary Tumor Markers for Bladder and Urothelial Cancers Open a PDF 2.02.12 2026-07-21 Lab Tests (pathology)
Allergy Testing Open a PDF 2.01.10 2026-07-21 Ear, Nose & Throat (Otorhinolaryngology)
Hyperbaric Oxygen Therapy (HBOT) Open a PDF 2.01.07 2026-07-21 Miscellaneous
Cardiac Event Monitors Open a PDF 2.01.03 2026-07-21 Heart & Blood Vessels (Cardiovascular)
Positive Airway Pressure Devices CPAP BiPAP APAP and Noninvasive Positive Pressure Ventilators (NIV) Open a PDF 1.01.06 2026-07-15 Sleep Medicine
Lumbar Decompression (Effective 2026-10-15) Open a PDF 7.01.113 2026-07-15 Bone & Joints (Orthopedic)
Intradiscal Procedures (Effective 2026-10-15) Open a PDF 7.01.112 2026-07-15 Bone & Joints (Orthopedic)
Prolotherapy (Effective 2026-10-15) Open a PDF 8.01.10 2026-07-15 Bone & Joints (Orthopedic)
Prolotherapy Open a PDF 8.01.10 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Fusion (Effective 2026-10-15) Open a PDF 7.01.117 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Fusion Open a PDF 7.01.117 2026-07-15 Bone & Joints (Orthopedic)
Facet Joint Injections/ Medial Branch Blocks (Effective 2026-10-15) Open a PDF 7.01.116 2026-07-15 Bone & Joints (Orthopedic)
Facet Joint Injections/ Medial Branch Blocks Open a PDF 7.01.116 2026-07-15 Bone & Joints (Orthopedic)
Epidural Steroid Injections (Effective 2026-10-15) Open a PDF 7.01.115 2026-07-15 Bone & Joints (Orthopedic)
Epidural Steroid Injections Open a PDF 7.01.115 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Decompression Open a PDF 7.01.113 2026-07-15 Bone & Joints (Orthopedic)
Intradiscal Procedures Open a PDF 7.01.112 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Microdiscectomy (Effective 2026-10-15) Open a PDF 7.01.98 2026-07-15 Bone & Joints (Orthopedic)
Lumbar Microdiscectomy Open a PDF 7.01.98 2026-07-15 Bone & Joints (Orthopedic)
Hip Arthroplasty (Effective 2026-10-15) Open a PDF 7.01.96 2026-07-15 Bone & Joints (Orthopedic)
Hip Arthroplasty Open a PDF 7.01.96 2026-07-15 Bone & Joints (Orthopedic)
Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing) (Effective 2026-10-15) Open a PDF 7.01.95 2026-07-15 Bone & Joints (Orthopedic)
Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing) Open a PDF 7.01.95 2026-07-15 Bone & Joints (Orthopedic)
Sacroiliac Joint Fusion or Stabilization (Effective 2026-10-15) Open a PDF 7.01.93 2026-07-15 Bone & Joints (Orthopedic)
Sacroiliac Joint Fusion or Stabilization Open a PDF 7.01.93 2026-07-15 Bone & Joints (Orthopedic)
Artificial Cervical Intervertebral Disc (Effective 2026-10-15) Open a PDF 7.01.80 2026-07-15 Bone & Joints (Orthopedic)
Artificial Cervical Intervertebral Disc Open a PDF 7.01.80 2026-07-15 Bone & Joints (Orthopedic)
Metal-on-Metal Total Hip Resurfacing (Effective 2026-10-15) Open a PDF 7.01.74 2026-07-15 Bone & Joints (Orthopedic)
Metal-on-Metal Total Hip Resurfacing Open a PDF 7.01.74 2026-07-15 Bone & Joints (Orthopedic)
Lysis of Epidural Adhesions (Effective 2026-10-15) Open a PDF 7.01.73 2026-07-15 Bone & Joints (Orthopedic)
Lysis of Epidural Adhesions Open a PDF 7.01.73 2026-07-15 Bone & Joints (Orthopedic)
Artificial Lumbar Intervertebral Disc (Effective 2026-10-15) Open a PDF 7.01.63 2026-07-15 Bone & Joints (Orthopedic)
Artificial Lumbar Intervertebral Disc Open a PDF 7.01.63 2026-07-15 Bone & Joints (Orthopedic)
Osteochondral Grafting of the Knee (Effective 2026-10-15) Open a PDF 7.01.59 2026-07-15 Bone & Joints (Orthopedic)
Osteochondral Grafting of the Knee Open a PDF 7.01.59 2026-07-15 Bone & Joints (Orthopedic)
Spinal Cord Stimulation / Dorsal Column Stimulation (Effective 2026-10-15) Open a PDF 7.01.51 2026-07-15 Bone & Joints (Orthopedic)
Spinal Cord Stimulation / Dorsal Column Stimulation Open a PDF 7.01.51 2026-07-15 Bone & Joints (Orthopedic)
Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation (Effective 2026-10-15) Open a PDF 7.01.42 2026-07-15 Bone & Joints (Orthopedic)
Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation Open a PDF 7.01.42 2026-07-15 Bone & Joints (Orthopedic)
Showing 51– 100 of 361 Results

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