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Keratopros-thesis

Ketamine for the Treatment of Depression

Ketogenic Diet as a Treatment of Refractory Epilepsy

Kidney Transplantation

Knee Braces, Orthopaedic Casts, Splints

KRAS, NRAS,

& BRAF Mutation Analysis in Metastatic Colorectal Cancer

Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Laboratory/Pathology Services

Laparoscopic, Percutaneous & Transcervical Techniques for the Myolysis of Uterine Fibroids

Laser-Assisted Tonsillectomy

Laser Treatment of Active Acne

Laser Treatment of Onychomycosis

Leadless Cardiac Pacemaker

Light Therapy for Dermatologic Conditions

Lipid Apheresis

Liquid Biopsy

Liver Transplant & Combined Liver-Kidney Transplant

Local or Whole Body Hyperthermia

Low-Level Laser Therapy

Lung & Lobar Lung Transplant

Lung Volume Reduction Surgery for Severe Emphysema

Lyme Disease Testing

Lynch Syndrome Testing

Lysis of Epidural Adhesions

 Magnetic Esophageal Sphincter Augmentation to Treat Gastroesoph-ageal Reflux Disease

Maternity/Obstetrical Care Benefits

Measurement of Thromboxane Metabolites for Aspirin Resistance

Medical Policy Development and Review

Medical Records Documentation Standards

Medication Administration Site of Care

Melanoma Vaccines

Meniscal Allografts

& Other Meniscal Implants

Mepolizumab (Nucala®)

Methadone Treatment for Opiate Addiction

Minimally Invasive Hip

& Knee Arthroplasty

Molecular Panel Testing of Cancers for Diagnosis, Prognosis, & Identification of Targeted Therapy

Molecular Testing in the Management of Pulmonary Nodules

Multianalyte Assays with Algorithmic Analyses for Predicting Risk of Type 2 Diabetes

Multigene Expression Assay for Predicting Recurrence in Colon Cancer

Multispectral Digital Skin Lesion Analysis

Natalizumab (Tysabri®)

Negative Pressure Wound Therapy in the Outpatient Setting

Nerve Graft with Radical Prostatectomy

Neural Therapy

Neurofeedback

Nivolumab (Opdivo)

Non-contact Ultrasound Treatment of Wounds

Non-Pharmacologic Treatment of Rosacea

Noncontact Radiant Heat Bandage for the Treatment of Wounds

Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease

Nusinersen for Spinal Muscular Atrophy

Occipital Nerve Stimulation

Occlusion of Uterine Arteries Using Transcatheter Embolization

Occupational Therapy

Ocrelizumab (Ocrevus™)

Ocriplasmin for Symptomatic Vitreomacular Adhesion

Octreotide Acetate (Sandostatin)

Ocular Photoscreening in the Primary Care Physician's Office as a Screening Tool to Detect Amblyogenic Factors

Olaratumab (Lartruvo)

Omalizumab (Xolair®)

Oncologic Applications of Interleukin-2 (Aldesleukin) When Used as Monotherapy

Oncologic uses of Interferon Therapy

Open & Thoracoscopic Approaches to Treat Atrial Fibrillation & Atrial Flutter (Maze and Related Procedures)

Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma

Opioid Antagonists Under Heavy Sedation or General Anesthesia as a Technique of Opioid Detoxification

Optical Coherence Tomography for Imaging of Coronary Arteries

Optical Coherence Tomography of the Anterior Eye Segment

Oral Screening, Lesion Identification Systems & Genetic Screening

Orthodontic Treatment

Orthognathic Surgery

Orthopedic Applications of Platelet-Rich Plasma

Orthopedic Applications of Stem Cell Therapy (Including Allografts & Bone Substitutes Used With Autologous Bone Marrow)

Orthoptic Training for the Treatment of Vision or Learning Disabilities

Oscillatory Devices for the Treatment of Cystic Fibrosis & Other Respiratory Conditions

Outpatient Pulmonary Rehabilitation

Ovarian & Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome

Oxygen Therapy

Pain Management Services (Chronic Pain & Rehabilitation Therapies)

Pancreatic Cancer Risk Testing Using Molecular Classifier in Pancreatic Cyst Fluid

Pancreatic Enzyme Testing for Acute Pancreatitis

Paraspinal Surface Electromyography to Evaluate & Monitor Back Pain

Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Partial Coherence Interferometry as a Technique to Measure the Axial Length of the Eye

Partial Left Ventriculectomy

Paternal or Fetal Antigen Immunotherapy for Recurrent Fetal Loss

Patient-Specific Instrumentation (eg, Cutting Guides) for Joint Arthroplasty

Pegloticase (Krystexxa)

Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence

Pembrolizumab (Keytruda)

Percutaneous Electrical Nerve Stimulation (PENS) & Percutaneous Neuromodulation Therapy (PNT)

Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, & Biacuplasty

Percutaneous Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

Percutaneous Treatment of Fracture Non-Unions or Bone Defects with Autologous Bone Marrow with or without Demineralized Bone Matrix (DBM)

Peripheral Subcutaneous Field Stimulation

Periureteral Bulking Agents for the Treatment of Vesicoureteral Reflux (VUR)

Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia

Pertuzumab for Treatment of Malignancies

Pharmacogen-etic Testing

Pharmacologic Treatment of Hereditary Transthyretin-Mediated Amyloidosis (Onpattro™/Tegsedi™)

Photocoagu-lation of Macular Drusen

 Photodynamic Therapy for Choroidal Neovascularization

Phototherapeutic Keratectomy

Physical Therapy

Placental & Umbilical Cord Blood as a Source of Stem Cells

Plasma Exchange (Plasmapheresis)

Plasma HIV-1 RNA Quantification for HIV-1 Infection

Plugs for Fistula Repair

Pneumatic Compression Pumps for Treatment of Lymphedema

Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities

Prenatal Screening

Prenatal Screening for Fetal Aneuploidy

Preventive Services for Non-Grandfathered (PPACA) Plans: Behavioral Counseling for Prevention

Preventive Services for Non-Grandfathered (PPACA) Plans: USPSTF recommended services

Preventive Services for Non Grandfathered (PPACA) Plans: Immunizations

Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia

Progesterone Therapy as a Technique to Reduce Preterm Delivery in High-Risk Pregnancies

Prolotherapy

Proteoge-nomic Testing for Patients With Cancer

Quantitative Electroencepha-lography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder

Quantitative Sensory Testing

Quantose Impaired Glucose Tolerance (IGT) Test

Radiation Oncology Services

 RADICAVA (edaravone injection)

Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors

Radiofrequency Ablation of Primary or Metastatic Liver Tumors

Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension

Radioimmuno-therapy in the Treatment of Non-Hodgkin Lymphoma

Radium Ra 223 (Xofigo®) Injection

Ramucirumab (Cyramza®)

Recombinant

& Autologous Platelet-Derived Growth Factors for Wound Healing & Other Non‒Orthopedic Conditions

Reduction Mammaplasty for Breast-Related Symptoms

Registered Nurses Practicing in Extended Roles

Repository Corticotropin Injection

Reproductive Techniques

Responsive Neurostimu-lation for the Treatment of Refractory Focal Epilepsy

Retinal Prosthesis

Retinal Telescreening for Diabetic Retinopathy

Risk-Reducing Mastectomy

Rituximab

Robotic Assisted Surgery - Reimbursement Policy

Sacral Nerve Neuromod-ulation/Stimulation

Salivary Hormone Testing

Saturation Biopsy for Diagnosis & Staging of Prostate Cancer

Semi-Implantable Middle Ear Hearing Aid for Moderate to Severe Sensorineural Hearing Loss

Sensory Integration Therapy & Auditory Integration Therapy

Sensory Stimulation for Coma Patients

Serum Holo-Transcobalamin as a Marker of Vitamin B12 (i.e., Cobalamin) Status

Serum Testing for Evidence of Mild Traumatic Brain Injury

Serum Tumor Markers for Malignancies

Signal-Averaged Electrocardi-ography

Siltuximab (Sylvant)

SIMPONI ARIA (golimumab injection for intravenous use)

Skin Contact Monochromatic Infrared Energy as a Technique to Treat Cutaneous Ulcers, Diabetic Neuropathy & Miscellaneous Musculoskeletal Conditions

Small Bowel/Liver & Multivisceral Transplant

Speculoscopy

Speech Generating Devices

Sphenopalatine Ganglion Block for Headache

ST2 Assay for Chronic Heart Failure

Stem-cell Therapy for Peripheral Arterial Disease

Stereotactic Electroenceph-alography

Stereotactic Radiofrequency Pallidotomy for the Treatment of Parkinson’s Disease

Stereotactic Radiosurgery & Stereotactic Body Radiation Therapy

Steroid-Eluting Sinus Stents

Stimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury

Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy

Subtalar Arthroereisis & Subtalar Joint Implant

Sufentanil Sublingual Tablet (Dsuvia)

Suit Therapy

Suprachoroidal Delivery of Pharmacologc Agents

Surgery for Groin Pain in Athletes

Surgery for Lymphedema

Surgical & Ablative Treatments for Chronic Headaches

Surgical Guidelines (Secondary, Multiple Procedures, Co-Surgeons, Assistant Surgeons, Stand- By Physicians, Microsurgery/Microdissection)

Surgical Interruption of Pelvic Nerve Pathways for Primary & Secondary Dysmenorrhea

Surgical Treatment of Bilateral Gynecomastia

Surgical Treatment of Snoring & Obstructive Sleep Apnea Syndrome

Surgical Ventricular Restoration

Sympathetic Therapy for the Treatment of Pain

T-Wave Alternans

Tagraxofusp-erzs (Elzonris)

TECENTRIQ™ (atezolizumab)

Telehealth

Telemedicine

Temporary Prostatic Stent

Temporo-mandibular Joint Dysfunction

Testing for Diagnosis of Active or Latent Tuberculosis

Testing for Mosquito- or Tick-Related Infections

Testing of Homocysteine Metabolism-Related Conditions

Testosterone Replacement Therapies

Testosterone Testing

Therapeutic Drug Monitoring for 5-Fluorouracil

Testing for Diagnosis of Active or Latent Tuberculosis

Thermal Capsulorrhaphy as a Treatment of Joint Instability

Thermography

Thoracic-Lumbo-Sacral Orthosis with Pneumatics

Three-Dimensional Printed Orthopedic Implants

Threshold Electrical Stimulation as a Treatment of Motor Disorders

Thyroid Disease Testing

Tocilizumab (Actemra®)

Topographic Brain Mapping

Total Artificial Hearts & Implantable Ventricular Assist Devices

Total Parenteral Nutrition & Enteral Nutrition in the Home

Toxicology

Transanal Endoscopic Microsurgery (TEMS)

Transanal Radiofrequency Treatment of Fecal Incontinence

Transcatheter Aortic-Valve Implantation for Aortic Stenosis

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

Transcatheter Closure of Patent Ductus Arteriosus

Transcatheter Mitral Valve Repair

Transcatheter Pulmonary Valve Implantation

Transcranial Doppler Ultrasound

Transcutaneous Electrical Nerve Stimulation (TENS)

Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease

Transfusion Therapy for Hemolytic Disease of the Fetus & the Newborn

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transmyocardial Revascularization

Transplant Rejection Testing

Transpupillary Thermotherapy for Treatment of Choroidal Neovascular Conditions

Transtympanic Micropressure Applications as a Treatment of Meniere’s Disease

Transvaginal & Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence

Trastuzumab/Trastuzumab-dkst (Herceptin/Ogivri)

Treatment of Hepatitis C with Interferon and/or Ribavirin

Treatment of Hyperhidrosis

Treatment of Tinnitus

Treatment of Twin-Twin Transfusion Syndrome with Amnioreduction and/or Fetoscopic Laser Therapy

Tumor Treatment Fields Therapy for Glioblastoma

Ultrafiltration in Decompensated Heart Failure

Ultraviolet Light Therapy in the Home Setting (UVB)

Unicompartmental & Bicompartmental Knee Arthroplasties

Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee

Urinary Tumor Markers for Bladder Cancer

Urine Culture Testing for Bacteria

Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer

Uses of Monoclonal Antibodies

ustekinumab (Stelara™)

Vacuum Therapy as a Treatment for Female Sexual Dysfunction

Vagus Nerve Blocking Therapy for Treatment of Obesity

Vagus Nerve Stimulation

Vasectomy Using a Polymeric Clip

Vectra DA Blood Test for Rheumatoid Arthritis

Vedolizumab (Entyvio™)

Venous Thrombosis Risk Testing

Vertebral Axial Decompression

Vertebral Fracture Assessment with Densitometry

Vertical Expandable Prosthetic Titanium Rib

Vestibular Function Testing

Videofluoroscopic Evaluation of Velopharyngeal Dysfunction

Viscocanalostomy & Canaloplasty

Visual & Auditory Evoked Potentials

Vitamin B12 & Methylmalonic Acid Testing

Wearable Cardioverter-Defibrillators

Wireless Capsule Endoscopy to Diagnose Disorders of the Small Bowel, Esophagus, & Colon

Wireless Pressure Sensors in Endovascular Aneurysm Repair

Women's Preventive Services

Work Hardening Programs

Zolgensma® (Onasemnogene Abeparvovec-Xioi)

Zometa (zoledronic acid)