Durable Medical Equipment
Imaging
Select Sub-section
NM
Bone and/or Joint Imaging
Surgery & Injections
Collagenase Clostridium Histolyticum (Xiaflex ®) for Dupuytren's Contracture
Complex Regional Pain Syndrome
(RSD)
Debridement Services of Bone, Muscle, Fascia, & Subcutaneous Tissue
Debridement Services of Extensive Eczematous or Infected Skin
Destruction by Neurolytic Agent; Interdigital Nerve of the Foot—Morton’s Neuroma
Destruction of Paravertebral Facet Joint Nerve(s)
Excision of Malignant Skin Lesions- Trunk, Arms, or Legs
Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions
Implantable Infusion Pump for the Treatment of Chronic Intractable Pain Opioid Drugs
Implantable Infusion Pump for the Treatment of Chronic Intractable Spasticity
Incision and Drainage of Abscess of Skin, Subcutaneous and Accessory Structures
Injection of Morton's neuroma
Injection of
Trigger Points
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes & Morton's Neuroma
Lumbar Spinal Fusion for Instability & Degenerative Disc Conditions
Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions-Authorization Required
Lumbar Spinal Fusion for Pseudoarthrosis-Authorization Required
Lumbar Spinal Fusion for Spinal Stenosis-Authorization Required
Shoulder
Manipulation Under Anesthesia (MUA)
Metacarpo-phalangeal (MCP)
& Proximal Interphalangeal (PIP) Joint Implants
Surgical Correction of Pectus Excavatum & Poland's Syndrome
Pedicle Screws for Spinal Fixation & Intervertebral Body Fusion Devices
Percutaneous Vertebral Augmentation (Vertebral Augmentation) (Formerly Kyphoplasty)
Peripheral Nerve
& Peripheral Nerve Field Stimulation
Shoulder Arthroscopy-Claviculectomy/Decompresion-Partial Acromioplasty
Shoulder Arthroscopy-Rotator Cuff
Repair
Thoracic Laminectomy (and/or Thoracic Diskectomy & Fusion)
Thoracic Laminectomy Other Than for Herniated Disc
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