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Ablative

Therapy

of Liver

Ablation of Hepatic Lesions

-FloridaBlue-

-Aetna-

Achalasia & Gastroesoph-ageal Reflux Disease (GERD) Treatments

Appendectomy

Bariatric Surgery Children & Adolescents

Breast Biopsy Procedures - Minimally Invasive

Breast Ductal Lavage & Fiberoptic Ductoscopy

Breast & Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, & Prophylactic Oophorectomy

Cholecystectomy

Colectomy

Colon Capsule Endoscopy

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Continent Ileostomy & Urostomy

Core Needle Biopsy of the Breast

Destruction of Internal Hemorrhoid(s) by

Infrared Coagulation (IRC )

Diagnostic Colonoscopy

Diagnostic Esophagogastro-duodenoscopy (EGD) or Esophagoscopy (age 59 years or younger)-

United

-Humana--

Epigastric, Incisional, or Ventral Herniorrhaphy

Esophageal & Airway pH Monitoring

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) & Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) & Laryngo-pharyngeal Endoscopic Esthesiometer (LPEER)

Gastric Electrical Stimulation

Gastrointestinal Manometry

Gastrointestinal Motility Disorders, Diagnosis & Treatment

Gastrointestinal (GI) Motility Monitoring

Gastropho-tography

(NCD 100.12)

High-resolution Anoscopy

Incision and Drainage of Abscess of Skin, Subcutaneous & Accessory Structures

Inguinal or Femoral Herniorrhaphy

Intraperitoneal Hyperthermic Chemotherapy for Abdominopelvic Cancers

Laparoscopic Hiatal Hernia Repair

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Laparoscopic Sleeve Gastrectomy for Severe Obesity

Lipoma Excision

Lipoma Removal

Liver & Other Neoplasms - Treatment Approaches

Minimally Invasive Hemorrhoid Procedures

Paraesophageal Hernia Repair

Peristeen Anal Irrigation System

Peroral Endoscopic Myotomy (POEM)

Minimally Invasive Anti-Reflux Procedures & Peroral Endoscopic Myotomy (POEM) Procedures

Select Minimally Invasive GERD Procedures (L35080)

Small Bowel Resection

Solesta Treatment for Fecal Incontinence

Surgical Management of Morbid Obesity

Transcatheter Arterial Chemoembolization as a Treatment for Primary or Metastatic Liver Malignancies

Transoral Incisionless Fundoplication (TIF)

Transrectal Ultrasound (TRUS)

Transendoscopic Therapy for Gastroesoph-ageal Reflux Disease, Dysphagia & Gastroparesis

Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic

Upper Gastrointestinal Endoscopy in Adults

Virtual Gastrointestinal Endoscopy

Capsule Endoscopy

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-Aetna-

Capsule Endoscopy

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Wireless Capsule Endoscopy