Historical Medical Policies and Clinical UM Guidelines
Historical Medical Policies
Medical policies contained within this page are historical and not the most current versions. Current medical policy content may be accessed from the Medical Policies and Clinical UM Guidelines page. Implementation dates of the most current versions vary per state notification requirements.
- GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling
- MED.00099 Electromagnetic Navigational Bronchoscopy
- OR-PR.00004 Partial-Hand Myoelectric Prosthesis
- SURG.00010 Treatments for Urinary Incontinence
- SURG.00026 Deep Brain, Cortical, and Cerebellar Stimulation
- SURG.00037 Treatment of Varicose Veins (Lower Extremities)
- SURG.00097 Vertebral Body Stapling and Tethering for the Treatment of Scoliosis in Children and Adolescents
Historical Clinical UM Guidelines
Clinical UM guidelines contained within this page are historical and not the most current versions. Current clinical UM guideline content may be accessed from the Medical Policies and Clinical UM Guidelines page. Implementation dates of the most current versions vary per state notification requirements.
- CG-DME-06 Pneumatic Compression Devices for Lymphedema
- CG-MED-53 Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing
- CG-MED-81 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications
- CG-OR-PR-05 Myoelectric Upper Extremity Prosthetic Devices
- CG-SURG-78 Locoregional and Surgical Techniques for Treating Primary and Metastatic Liver Malignancies
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