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DE-A-1/Anesthesia Provided in Conjunction with Non-covered Services
DE-A-10/Pain Control
DE-A-11/Modifying Units for Anesthesia Services
DE-A-12/Anesthesia Services Prior to Postponement of Surgery
DE-A-14/Continuous Local Delivery of Analgesia to Operative Sites Using an Elastomeric Infusion Pump (e.g., Pain Buster)
DE-A-17/Administration of Conscious Sedation with Other Specified Procedures, Same Provider
DE-A-4/Anesthesia Care/Standby Anesthesia
DE-A-7/Monitored Anesthesia Care (MAC)
DE-A-8/Payment for Anesthesia Services
DE-A-9/Services Performed in Conjunction with Administration of Anesthesia
DE-B-1/Coverage for Hearing Aids
DE-B-10/Blood Tests Performed by Pharmacists
DE-B-11/Out of Network Specialists
DE-B-12/Developmental Screening of Infants and Toddlers
DE-B-13/Chiropractic Therapy
DE-B-14/Psychiatry Consultation to Primary Care Providers
DE-B-2/Preventive Services
DE-B-3/Payment Guidelines for Advanced Practice Nurse (APN)
DE-B-4/Medical Foods
DE-B-5/Infant Hearing Screeing
DE-B-6/Screening for Colorectal Cancer
DE-B-7/Child Abuse Coverage
DE-B-8/Prescription Medication
DE-B-9/Emergency Care
DE-C-6/Mandatory Second Surgical Opinion-- groups do not have this program
DE-D-1/Periodontal and Adjunctive Surgery
DE-D-6/Dental Services
DE-E-1/Durable Medical Equipment (DME)
DE-E-12/Beds - Accessories and Related Items
DE-E-14/Self-Contained Pacemaker Monitors (Cardio Beeper)
DE-E-15/Diabetic Services and Supplies
DE-E-16/Cranial Electrical Stimulators
DE-E-17/Portable External Infusion Pump
DE-E-19/Oxygen
DE-E-2/Home Dialysis Equipment and Supplies
DE-E-20/Continuous Positive Airway Pressure (CPAP) Device
DE-E-21/(TENS) Transcutaneous Transducer Garments (TTG)
DE-E-25/Pulse Oximetry Device
DE-E-3/Home Apnea Monitors
DE-E-30/Repair, Maintenance, and Replacement of Durable Medical Equipment (DME)
DE-E-31/Negative Pressure Wound Therapy Pumps
DE-E-32/Nebulizers
DE-E-33/H-wave Electrical Stimulation
DE-E-34/Respiratory Assist Devices
DE-E-35/Ultrasound Osteogenic Stimulator
DE-E-36/Speech Generating Devices
DE-E-37/Breast Pumps
DE-E-38/Continuous Rental of Life Sustaining Durable Medical Equipment (DME)
DE-E-39/Home Uterine Activity Monitor
DE-E-40/Neuromuscular Electrical Stimulation (NMES) Device Used by Spinal Cord Injured Patients for Walking
DE-E-41/Transtympanic Micropressure Applications as a Treatment of Menieres Disease
DE-E-42/Continuous Glucose Monitors
DE-E-44/Fluency-Enhancing Devices for the Treatment of Stuttering
DE-E-45/Interferential Stimulator
DE-E-46/Electrical Stimulation Devices for the Treatment of Arthritis
DE-E-47/Negative pressure wound therapy system
DE-E-49/Seat Lift Mechanisms
DE-E-58/Automatic External Defibrillators
DE-E-6/Wheelchairs and Options/Accessories
DE-E-61/Noncontact Radiant Heat Bandage for the Treatment of Wounds
DE-E-68/High Frequency Chest Wall Oscillation Devices
DE-E-7/Pneumatic Compression Devices
DE-E-8/Patient Lifts
DE-G-1/Newborn Care & Associated Services
DE-G-10/Medical Care with Surgery
DE-G-16/Chemotherapy Services
DE-G-17/Pulmonary Rehabilitation
DE-G-19/Professional Component for Pathology Tests
DE-G-2/Obstetrical vs. Surgical Services
DE-G-20/Actinic Keratosis
DE-G-23/Investigational Exemption Devices (IDEs) and Humanitarian Use Devices (HUDs)
DE-G-24/Obesity
DE-G-25/Intra-Articular Hyaluronan Injections (e.g., Supartz, Hyalgan, Synvisc, Euflexxa, and Orthovisc) for Osteoarthritis of the Knee
DE-G-26/Electroconvulsive Therapy
DE-G-27/Coverage for Cancer Clinical Trials
DE-G-41/Wireless Capsule Endoscopy
DE-G-7/Electrocardiogram and X-ray Interpretation
DE-G-8/Bone Marrow Aspiration or Biopsy
DE-G-9/Treatment of Male Sexual Dysfunction
DE-I-107/Collagenase clostridium histolyticum (Xiaflex)
DE-I-11/Botulinum Toxin (Chemodenervation)
DE-I-12/Growth Hormone, Human Recombinant Somatrem/Somatropin
DE-I-122/Treatment of Hereditary Angioedema
DE-I-124/Azacitidine (Vidaza)
DE-I-126/Prolastin C, Aralast NP, Zemaira, Glassia (alpha1-proteinase inhibitors infusions)
DE-I-127/Blinatumomab (Blincyto)
DE-I-13/Interferon Alpha
DE-I-130/Eculizumab (Soliris)
DE-I-131/Alpha-1 Proteinase Inhibitor (Glassia)
DE-I-133/Ixabepilone (IXEMPRA)
DE-I-136/Brentuximab Vedotin (Adcetris)
DE-I-137/GAZYVA (obinutuzumab)
DE-I-138/VIMIZIM (elosulfase alfa)
DE-I-14/Intravenous Immune Globulin
DE-I-140/galsulfase (Naglazyme)
DE-I-141/Compounded Medications
DE-I-142/PCSK9 Inhibitors
DE-I-143/Inhalation Solutions for the Treatment of Cystic Fibrosis
DE-I-144/Drisapersen
DE-I-145/Testosterone Androgens
DE-I-146/Mepolizumab (NUCALA)
DE-I-147/Talimogene Laherparepvec (Imlygic)
DE-I-148/Cyramza (Ramucirumab)
DE-I-149/Chelation Therapy for Off-Label Uses
DE-I-150/DarzalexTM (daratumumab)
DE-I-16/Leuprolide/Leuprolide Acetate (Lupron, Lupron Depot, Lutrepulse, Viadur)
DE-I-18/Treatment of Pulmonary Hypertension
DE-I-19/Intravenous Antibiotic Therapy for Lyme Disease
DE-I-20/Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
DE-I-21/Trastuzumab (Herceptin)
DE-I-22/Lyme Disease Vaccine
DE-I-24/Belatacept (Nulojix)
DE-I-25/Desensitization Treatment for Renal Transplant
DE-I-26/Cellular Immunotherapy for Prostate Cancer
DE-I-27/Certolizumab (Cimia)
DE-I-28/Infliximab, cA2 (Remicade)
DE-I-29/Pegloticase (KrystexxaTM)
DE-I-3/Allergy Immunotherapy
DE-I-30/Denosumab (Prolia, Xgeva
DE-I-31/Tocilizumab (Actemra)
DE-I-32/Intravenous Anesthetics for the Treatment of Chronic Neuropathic Pain
DE-I-33/Belimumab (Benlysta)
DE-I-34/Ipilimumab (YervoyTM)
DE-I-35/Golimumab (Simponi)
DE-I-37/Ustekinumab (Stelara)
DE-I-38/Rituximab (Rituxan) for the Treatment of Rheumatoid Arthritis
DE-I-4/Hemophilia Clotting Factors
DE-I-42/Zoledronic Acid(Zometa)
DE-I-49/Alefacept (Amevive)
DE-I-51/Anthrax Immunization and Treatment
DE-I-53/Omalizumab (Xolair)
DE-I-54/Laronidase (Aldurazyme)
DE-I-55/Agalsidase beta (Fabrazyme)
DE-I-56/17 Alpha-hydroxyprogesterone Caproate (17P) Injections
DE-I-58/Alglucosidase alfa (Myozyme)
DE-I-6/Approved Drugs and Biologicals
DE-I-65/Paclitaxel, albumin-bound (Abraxane)
DE-I-7/Erythropoietin (EPO, Epoetin, Epoetin Alfa, Darbepoetin Alfa [Aranesp])
DE-I-76/Ziconotide (Prialt)
DE-I-78/Fluocinolone Acetonide Intravitreal Implant (Retisert)
DE-I-79/Plerixafor (Mozobil)
DE-I-8/Immunizations
DE-I-83/Velcade (bortezomib)
DE-I-85/Natalizumab (Tysabri)
DE-I-9/Ceredase/Cerezyme Injections
DE-I-90/Abatacept (Orencia)
DE-I-91/Intraperitoneal Chemotherapy for Ovarian Cancer
DE-I-92/Naltrexone Extended Release Injection (Vivitrol)
DE-I-93/Idursulfase (Elaprase)
DE-I-94/Intraviltreal InjectionsOld Name is Ranibizumab (Lucentis)
DE-I-99/Drug Wastage
DE-L-016/Mammostrat Breast Cancer Recurrence Assay
DE-L-1/Pap Smears
DE-L-10/Selected Tests for Rheumatic Diseases
DE-L-106/Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
DE-L-107/Genetic Testing for Carrier Status
DE-L-108/Genetic Testing for Non-Medical Purposes
DE-L-109/Genetic Testing for Prenatal Screening and Diagnostic Testing
DE-L-110/Genetic Testing for the Screening, Diagnosis, and Monitoring of Cancer
DE-L-111/Genetic Testing to Diagnose Non-Cancer Conditions
DE-L-112/Genetic Testing to Predict Disease Risk
DE-L-113/Investigational and Experimental Molecular/Genomic Testing
DE-L-114/Pharmacogenomic Testing for Drug Toxicity and Response
DE-L-115/Preimplantation Genetic Screening and Diagnosis
DE-L-116/Brugada Syndrome Known Familial Mutation Analysis
DE-L-117/Brugada Syndrome Multigene Panels
DE-L-118/Brugada Syndrome Sequencing
DE-L-119/ConfirmMDx for Prostate Cancer
DE-L-120/Hypertrophic Cardiomyopathy Testing
DE-L-121/CADASIL
DE-L-122/PCA3
DE-L-123/Liquid Biopsy Testing Solid Tumors
DE-L-124/Tumor Marker Testing-Solid Tumors
DE-L-125/Long QT Syndrome
DE-L-126/Fragile X Syndrome Testing
DE-L-127/Fragile X Associated Tremor/Ataxia Syndrome Testing
DE-L-128/Gaucher Disease Testing
DE-L-129/Li-Fraumeni Syndrome Testing
DE-L-13/HLA-B 5701 Genotyping for Abacavir Hypersensitivity
DE-L-130/Chromosomal Microarray Testing for Developmental Disorders
DE-L-131/Chromosomal Microarray Testing for Prenatal Diagnosis
DE-L-132/Marfan Syndrome Genetic Testing
DE-L-133/Thoracic Aortic Aneurysms and Dissections (TADD) Panel Testing
DE-L-134/BRCA Ashkenazi Jewish Founder Mutation Testing
DE-L-135/BRCA1/2 Deletion/Duplication Analysis
DE-L-136/BRCA Sequencing
DE-L-137/Canavan Disease Testing
DE-L-138/Factor II/Prothrombin Testing for Thrombophilia
DE-L-139/Factor V Leiden Testing for Thrombophilia
DE-L-14/HLA-B 1502 Variant Analysis for Carbamazepine Response
DE-L-140/Sexually Transmitted Infections: Molecular
DE-L-141/BRAF Mutation Analysis for Colorectal Cancer
DE-L-142/Hereditary Hemochromatosis Testing
DE-L-143/Niemann Pick Disease Types A & B Testing
DE-L-144/Tay-Sachs Disease Testing
DE-L-145/PTEN Hamartoma Tumor Syndromes Testing
DE-L-147/Niemann Pick, Type C Testing
DE-L-148/CYP2D6 Variant Analysis for Tamoxifen Response
DE-L-15/Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
DE-L-150/Lynch Syndrome Tumor Screening Second Tier
DE-L-151/Charcot-Marie-Tooth Neuropathy Testing Panel
DE-L-152/Prader-Willi Syndrome Testing
DE-L-153/Celiac Disease Testing
DE-L-154/Immunohistochemistry (IHC)
DE-L-155/Afirma Gene Expression Classifier Thyroid Cancer
DE-L-156/DPYD Variant Analysis for 5-FU Toxicity
DE-L-157/BRCA Sequencing for Olaparib Response
DE-L-158/ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
DE-L-159/Alpha-1-Antitrypsin Deficiency Testing
DE-L-16/Mammostrat Breast Cancer Recurrence Assay
DE-L-160/Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
DE-L-161/Angelman Syndrome Testing
DE-L-162/Dentatorubral-Pallidoluysian Atrophy Testing
DE-L-163/CYP2C9 and VKORC1 Testing for Warfarin Response
DE-L-164/EGFR Testing for Non-Small Cell Lung Cancer TKI Response
DE-L-165/Rett Syndrome Testing
DE-L-166/Spinal Muscular Atrophy Testing
DE-L-167/UGT1A1 Mutation Analysis for Irinotecan Response
DE-L-168/Von Hippel-Lindau Disease Testing
DE-L-169/Ataxia-Telangiectasia
DE-L-170/BCR-ABL Testing for Chronic Myeloid Leukemia
DE-L-171/BRAF Testing for Melanoma Kinase Inhibitor Response
DE-L-172/Familial Adenomatous Polyposis Testing
DE-L-173/Familial Hypercholesterolemia Genetic Testing
DE-L-174/Duchenne & Becker Muscular Dystrophy Testing
DE-L-175/Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
DE-L-176/MTHFR Variant Analysis for Hyperhomocysteinemia
DE-L-177/MUTYH Associated Polyposis Testing
DE-L-178/Peutz-Jeghers Syndrome Testing
DE-L-179/Leber Hereditary Optic Neuropathy (LHON) Genetic Testing
DE-L-180/4Kscore for Prostate Cancer Risk Assessment
DE-L-181/Prolaris for Prostate Cancer Prognosis
DE-L-182/Chromosome Analysis for Blood, Bone Marrow, and Solid Tumor Cancers
DE-L-183/Expanded Carrier Screening Panels
DE-L-184/Hereditary Cancer Syndrome Multigene Panels
DE-L-185/APOE Variant Analysis for Alzheimer Disease
DE-L-186/Bloom Syndrome Testing
DE-L-187/Flow Cytometry
DE-L188/Huntington Disease Testing
DE-L-189/MGMT Testing for Malignant Glioma Alkylating Agent Response
DE-L-189/Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) Genetic Testing
DE-L-2/Collection of Specimens
DE-L-25/Mammaprint 70-Gene Breast Cancer Recurrence Assay
DE-L-27/Organ or Disease Oriented Panels
DE-L-28/Tumor Markers
DE-L-29/Evocative/Suppression Testing Panels
DE-L-3/In Vitro Allergy Testing
DE-L-30/Fetal Fibronectin Enzyme Immunoassay
DE-L-33/Genetic Testing for Hereditary Breast and/or Ovarian Cancer
DE-L-34/Genetic Testing
DE-L-35/HIV Genotyping and Phenotyping
DE-L-36/Gene Expression Testing for Unknown Primary Cancers
DE-L-39/Anser ADA and Anser IFX
DE-L-4/Intralipidermal Nerve Fiber Density Testing
DE-L-40/Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening
DE-L-41/Prosigna Breast Cancer Prognostic Gene Signature Assay
DE-L-42/Rapid Platelet Function Assay - ASA
DE-L-49/Pharmacogenomic and Metabolite Markers for Patients with Inflammatory Bowel Disease treated with Azathioprine
DE-L-51/Assays of Genetic Expression In Tumor Tissue as a Technique to Determine Prognosis In Patients With Breast Cancer
DE-L-58/In Vitro Chemoresistance and Chemosensitivity Assays
DE-L-63/Vitamin D Assay Testing
DE-L-8/Surgical (Anatomic) Pathology
DE-L-81/Laboratory Tests for Heart Transplant Rejection
DE-L-82/Cytochrome p450 Genotyping
DE-L-84/Laboratory Testing for Novel Influenza A (H1N1)
DE-L-85/Genetic Testing for Warfarin Dose
DE-L-87/Vysis ALK Break Apart FISH Probe Kit
DE-L-91/Multi-gene Expression Assay for Predicting Recurrence in Colon Cancer
DE-L-97/Prenatal Aneuploidy FISH Testing
DE-L-98/Prenatal Chromosome Analysis
DE-L-99/Prenatal Maternal Serum Screening
DE-M-1/Computer Analysis or Generation of Automated Data
DE-M-11/Diagnostic Services - Professional and Technical Components
DE-M-13/Neurophysiological Studies
DE-M-14/Non-Invasive Vascular Diagnostic Studies
DE-M-15/Non-Invasive Peripheral Arterial Studies
DE-M-17/MultiFunction CardioGram
DE-M-18/Diagnostic Endocardial Electrical Stimulation (EES) Vs. Ablation Procedures
DE-M-20/Magnetoencephalography and Magnetic Source Imaging
DE-M-23/Esophageal Studies
DE-M-25/Rhythm Strip
DE-M-28/Electromyography (EMG)
DE-M-3/Endocrine Studies
DE-M-30/Gait Analysis
DE-M-31/Cardiac Event Detection Monitoring
DE-M-34/Electroencephalograms (EEGs)
DE-M-4/Thermography
DE-M-5/Tensilon Test
DE-M-50/Implantable Cardiac Loop Recorder
DE-M-51/Nerve Conduction Velocity (NCV) Studies
DE-M-52/External Counterpulsation (ECP)
DE-M-60/Home-Based, Real-Time Cardiac Surveillance (Monitoring)
DE-M-61/Autonomic Nervous System Function Testing
DE-M-62/Polysomnography for Non-Respiratory Sleep Disorders
DE-M-69/The Dr. Dean Ornish Program for Reversing Heart Disease
DE-M-7/Electronystagmography (ENG) and Videonystagmography (VNG) Services
DE-M-70/Ambulatory Blood Pressure Monitoring (ABPM)
DE-M-72/Digital Imaging Systems for the Detection and Evaluation of Diabetic Retinopathy
DE-M-74/Home Prothrombin Time INR Monitoring for Anticoagulation Management
DE-O-10/Dynamic Splinting Devices
DE-O-11/Wigs
DE-O-12/Foot Orthotics for Conditions Other Than Diabetes
DE-O-13/Cranial Orthosis for Plagiocephaly
DE-O-15/Microprocessor-Controlled Prosthetic Knees
DE-O-16/Parenteral Nutrition
DE-O-19/Ostomy Supplies
DE-O-2/Prosthetic Shoe
DE-O-24/Ankle-Foot/Knee-Ankle-Foot Orthosis
DE-O-28/Knee Orthosis
DE-O-31/Myoelectric Prosthesis for the Upper Limb and i-Limb Hand Prosthesis
DE-O-4/Intraocular Lens (Pseudophakos)
DE-O-5/Powered Robotic Lower Body Exoskeleton Devices
DE-O-6/Enteral Nutrition
DE-O-8/Braces and Supports
DE-O-9/Screening List for Prosthetic Devices
DE-P-1/Coverage Requirements for Routine Foot Care and Debridement of Mycotic/Hypertrophic Nails
DE-Q-1/Ambulance Services (Medical Transportation)
DE-Q-4/Private Duty Nursing
DE-Q-5/Air Ambulance Services
DE-R-10/Intravascular Brachytherapy for Prevention and Management of Restenosis
DE-R-11/Intensity Modulated Radiation Therapy (IMRT)
DE-R-14/Stereotactic Body Radiation Therapy (SBRT)
DE-R-15/Selective Internal Radiation Therapy (SIRT)
DE-R-18/Proton Beam Radiation Therapy
DE-R-21/Stereotactic Radiosurgery and Stereotactic Radiotherapy
DE-R-22/Positron Emission Mammography (PEM)
DE-R-23/Radiation Therapy Following Breast Conserving Surgery
DE-R-4/Radiation Therapy
DE-R-5/Myocardial Perfusion SPECT Imagingconsider DE new pre-cert processACC Focus
DE-R-58/Radioimmunotherapy for the Evaluation and Treatment of Certain Non-Hodgkins Lymphoma
DE-R-6/Single Photon Emission Computed Tomography (SPECT)
DE-R-60/Image-Guided Target Localization and Image-Guided Radiation Therapy for Treatment Delivery
DE-R-8/Non-Malignant Applications of Positron Emission Tomography (PET)
DE-R-9/Oncologic Applications of PET Scanning
DE-S-100/Multiple Surgical Procedures
DE-S-106/Treatment of Urinary Incontinence/Periurethral Bulking Agents
DE-S-109/Transcatheter Arterial Chemoembolization
DE-S-11/Pheresis Therapy
DE-S-112/Co-Surgery
DE-S-113/Pallidotomy and Other Treatments of Parkinsons Disease
DE-S-116/Corneal Transplantation
DE-S-118/Small Bowel/Liver Transplantation
DE-S-119/Multivisceral Transplantation
DE-S-12/Team Surgery
DE-S-121/Liver Transplantation
DE-S-122/Heart Transplantation
DE-S-123/Lung and Lobar Lung Transplantation
DE-S-124/Kidney Transplantation
DE-S-125/Heart/Lung Transplantation
DE-S-126/Pancreas/Kidney Transplantation
DE-S-127/Solitary Pancreas Transplantation
DE-S-128/Photodynamic Therapy (PDT)
DE-S-129/Mastectomy and Reconstructive Surgery
DE-S-13/Rigid Immobilization
DE-S-131/Sacral Nerve Modulation/Stimulation (SNS) for Pelvic Floor Dysfunction
DE-S-133/Endovascular Aneurysm Repair
DE-S-137/Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
DE-S-140/Ocular Photodynamic Therapy
DE-S-141/Radiofrequency Thermal Ablation of Liver Tumors (RFA)
DE-S-143/Donor Leukocyte Infusion for Hematologic Malignancies that Relapse after Allogeneic Stem Cell Transplant
DE-S-144/Islet Cell Transplantation
DE-S-145/Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (GERD)
DE-S-146/Percutaneous Vertebroplasty
DE-S-147/Epithelial Cell Cytology in Breast Cancer Risk Assessment and High-Risk Patient Management (Ductal Lavage and Suction Collection Systems)
DE-S-148/Kyphoplasty
DE-S-15/Second Surgical Assistant for Cardiovascular Surgery
DE-S-150/Radiofrequency Facet Nerve Denervation
DE-S-151/Transmyocardial (Laser) Revascularization (TMR)
DE-S-152/Transcatheter Closure Devices for Congenital Heart Defects (Amplatzer, CardioSeal)
DE-S-153/Biventricular Pacemakers for Treatment of CHF
DE-S-155/Gastric Electrical Stimulation, Gastric Pacing
DE-S-156/Stretta Procedure
DE-S-157/Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
DE-S-158/Cryosurgical Ablation and Radiofrequency Ablation of Renal Tumors
DE-S-159/Nucleoplasty and Biacuplasty
DE-S-16/Assistant Surgery Eligibility Criteria
DE-S-160/Preventable Serious Adverse Events
DE-S-163/Prophylactic Mastectomy
DE-S-166/Breast Duct Endoscopy
DE-S-169/Intradiscal Electrothermal Annuloplasty (IDEA) or Intradiscal Electrothermal Therapy (IDET)
DE-S-172/Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
DE-S-174/Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
DE-S-176/Arthroscopic Treatment of Femoroacetabular Impingement
DE-S-178/Treatment of Hyperhidrosis
DE-S-179/Myolysis of Uterine Fibroids
DE-S-180/Autologous Platelet-Derived Growth Factors as a Primary Treatment for Wound Healing and Other Miscellaneous Conditions
DE-S-181/Coronary Revascularization
DE-S-183/Partial and Total Hip Resurfacing Arthroplasty
DE-S-184/Gender Reassignment Surgery
DE-S-185/Transplantation for Chondral Defects
DE-S-186/MRI-Guided High Intensity Ultrasound Ablation of Uterine Fibroids
DE-S-187/Artificial Intervertebral Disc Replacement
DE-S-188/Alcohol Induced Septal Ablation (AISA)
DE-S-189/Transforaminal Epidural Injection
DE-S-190/Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
DE-S-191/Interspinous Distraction Devices for Treatment of Spinal Stenosis
DE-S-192/Ultrafiltration in Decompensated Heart Failure (Aquapheresis Therapy)
DE-S-193/Prolotherapy
DE-S-194/Subtalar Arthroereisis
DE-S-196/Saturation Biopsy for Diagnosis and Staging of Prostate Cancer
DE-S-197/Manipulation under Anesthesia
DE-S-198/Acellular Dermal Grafts for Reconstruction
DE-S-2/Abortions
DE-S-20/Arterial Puncture Hemostasis (e.g., Angio-Seal)
DE-S-200/Percutaneous Intracranial Balloon Angioplasty With or Without Stenting
DE-S-201/Nasal/Sinus Endoscopy (Balloon Sinuplasty)
DE-S-202/Total Ankle Replacement
DE-S-203/Melody Transcatheter Pulmonary Valve Therapy
DE-S-204/Radiofrequency Ablation of the Esophagus
DE-S-206/Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
DE-S-207/Hematopoietic Stem-Cell Transplantation for Multiple Myeloma
DE-S-208/Hematopoietic Stem-Cell transplantation for Non-Hodgkin Lymphoma
DE-S-209/Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
DE-S-210/Allogenic Hematopoietic Stem-Cell Transplantation for Genetic Diseases and Acquired Anemia
DE-S-211/Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer
DE-S-212/Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults
DE-S-213/Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases
DE-S-214/Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia
DE-S-215/Hematopoietic Stem-Cell Transplantation for Breast Cancer
DE-S-216/Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma
DE-S-217/Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma
DE-S-218/Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia
DE-S-219/Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma
DE-S-220/Allogeneic and Autologous Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia in Adults and Children
DE-S-221/Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors of Childhood
DE-S-222/Hematopoietic Stem-Cell Transplantation in the Treatment of Germ-Cell Tumors
DE-S-223/Hematopoietic Stem Cell Transplantation for Primary Amyloidosis
DE-S-224/Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia
DE-S-225/Orthopedic Applications of Stem-Cell Therapy
DE-S-226/Placental/Umbical Cord Blood as a Source of Stem Cells
DE-S-229/Lumbar Laminectomy and Decompression
DE-S-230/Lumbar Spinal Fusion Surgery
DE-S-231/Biometric Bone Void Filler
DE-S-232/Transcatheter Aortic Valve Replacement (TAVR)
DE-S-239/Minimally Invasive Microdiscectomy
DE-S-242/Patient Temporarily Unsuitable for Organ Transplant, OPTN and UNOS Status 7
DE-S-25/Operative Cholangiography Prior to Exploration of the Common Bile Duct
DE-S-28/Cosmetic Surgery vs. Reconstructive Surgery
DE-S-29/Preparation and Insertion of an Obturator
DE-S-30/Insertion and Removal of Tympanic Ventilation Tubes
DE-S-31/Arthrocentesis or Needling of Bursa
DE-S-32/Implantable Hormone Replacement Pellets
DE-S-33/Bio-Engineered Skin and Soft Tissue Substitutes
DE-S-36/Removal of Multiple Skin Lesions
DE-S-37/Invasive Intracranial Pressure Monitoring
DE-S-4/Endoscopic Procedures and Related Services
DE-S-40/Implantable Infusion Pump
DE-S-41/Corneal Surgery to Correct Refractive Errors and Phototherapeutic Keratectomy
DE-S-45/Repair of Lacerations
DE-S-46/Mohs Chemosurgery
DE-S-49/Eye Procedures Done in Stages or Sessions
DE-S-50/Surgical Techniques (e.g., Laser, Microsurgery, Robotic Surgery)
DE-S-51/Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
DE-S-52/Postoperative Services Following Definitive Surgery
DE-S-54/Implantation of Subcutaneous Intravascular Catheter
DE-S-55/Surgical Treatment of Varicose Veins
DE-S-59/Implantable Automatic Cardioverter-Defibrillator
DE-S-60/Artificial Hearts and Ventricular Assist Devices
DE-S-66/Minimally Invasive Coronary Artery Bypass Graft Surgery (MIDCAB)
DE-S-67/Cochlear Implantation
DE-S-68/Routine Neonatal Circumcision/Slitting of Prepuce
DE-S-69/Surgical Treatment of Lymphedema
DE-S-70/Bronchial Thermoplasty
DE-S-71/Photodynamic Therapy (PDT) Using Levulan Kerastick
DE-S-73/Bone Marrow, Peripheral Blood, and Umbilical Cord Stem Cell Transplantation
DE-S-74/Suction Assisted Lipectomy (SAL)
DE-S-75/Extracorporeal Photopheresis
DE-S-79/Hemodialysis/Peritoneal Dialysis
DE-S-82/Intra-Arterial/Intravenous Therapeutic Procedures
DE-S-83/Percutaneous Lumbar Discectomy
DE-S-84/Insertion of Tissue Expanders
DE-S-87/Fractures/Dislocations
DE-S-88/Ilizarov Bone Lengthening
DE-S-89/Bone Growth Stimulation
DE-S-9/Hearing Aids
DE-S-90/Failed or Incomplete Colonoscopy
DE-S-92/Treatment of Acne
DE-S-97/Treatment of the Prostate
DE-S-99/Meniscal Allograft Transplantation
DE-U-2/Antepartum and Postpartum Care
DE-U-3/Obstetrical Delivery & Associated Services
DE-U-5/Assisted Fertilization
DE-U-7/Fetal Surgery for Prenatally Diagnosed Malformations
DE-U-8/Treatment of Twin-Twin Transfusion Syndrome with Amnioreduction and/or Fetoscopic Laser Therapy
DE-V-1/Cardiac Rehabilitation Programs
DE-V-11/Ventilatory Assistance (Respirator Care)
DE-V-15/Psychiatric Care Defined
DE-V-16/Speech Therapy
DE-V-2/Concurrent Care
DE-V-20/Prolonged Detention or Critical Care
DE-V-21/Physician Certification and Recertification of Home Health Services
DE-V-23/Temporomandibular Joint (TMJ) Dysfunction
DE-V-28/Inpatient Preoperative Care
DE-V-3/Provider Billing of Observation Room
DE-V-31/Medical Care and Associated Services
DE-V-35/Annual Gynecological Examinations Annual Gynecological Examinations
DE-V-37/Autism Spectrum Disorder
DE-V-38/Hyperkinetic Syndromes and Other Developmental Disorders
DE-V-39/Mental Illness Coverage
DE-V-40/Rectal Examinations
DE-V-44/Medical Nutrition Management Services (MNT)
DE-V-48/Preventive Medicine and Office/Outpatient Evaluation and Management (E/M) Services
DE-V-59/Contraceptive Management
DE-V-60/Special Services
DE-X-11/Multiple Diagnostic X-ray Studies Performed on the Same Day
DE-X-17/Obstetrical Ultrasound
DE-X-2/Magnetic Resonance Imaging (MRI)
DE-X-20/Positional MRI
DE-X-21/Mammography
DE-X-24/Bone Mineral Density Studies
DE-X-26/Ultrasound Studies for the Diagnosis and Treatment of Infertility
DE-X-27/Stereotactic Localization
DE-X-28/Magnetic Resonance Angiography (MRA)
DE-X-4/Diagnostic Radiographs of the Teeth
DE-X-44/Magnetic Resonance Imaging (MRI) of the Breast
DE-X-5/Portable Radiography and ECG Services
DE-X-50/Magnetic Resonance Spectroscopy (MRS
DE-X-51/Fetal Nuchal Translucency
DE-X-52/CT Colonography/Virtual Colonoscopy
DE-X-54/Computed Tomographic Angiography (CTA) for Coronary Artery Evaluation
DE-X-56/Vertebral Fracture Assessment Using Dual X-ray Absorptiometry (DXA)
DE-X-57/Advanced Imaging
DE-X-69/Multiple Procedure Payment Reduction for the Technical Component of Certain Diagnostic Imaging
DE-X-8/Stress Films and Weight Bearing X-rays
DE-Y-1/Physical Medicine
DE-Y-11/Manual Lymphedema Drainage Therapy
DE-Y-12/Urinary Incontinence Therapy
DE-Y-16/Chronic Wound Management
DE-Y-19/Vertebral Axial Decompression (VAX-D)
DE-Y-2/Occupational Therapy
DE-Y-20/Biofeedback
DE-Y-21/Cognitive Rehabilitation
DE-Y-5/Vision Therapy (Orthoptics and Pleoptics)
DE-Y-6/Isokinetic Evaluation and Therapy
DE-Y-9/Manipulation Services
DE-Z-1/Ultraviolet Light Therapies
DE-Z-10/Services of Physicians Assistants
DE-Z-11/Definition of Medical Necessity
DE-Z-13/Emergency Medical Care
DE-Z-14/Acupuncture
DE-Z-24/Miscellaneous Services
DE-Z-26/Allergy Skin Testing
DE-Z-27/Eligible Providers and Supervision Guidelines
DE-Z-29/Hypnosis
DE-Z-3/Hyperbaric Oxygen (HBO) Therapy
DE-Z-30/Membership Dues, Service Policy and Insurance Premiums
DE-Z-32/Standby Services
DE-Z-35/Repeat Surgical Procedures
DE-Z-38/Hospital Admission Provision (Benefits After Contract Termination)
DE-Z-39/Provider Overhead Expenses
DE-Z-4/Transcranial Magnetic Stimulation
DE-Z-46/Blood and Bone Marrow Storage
DE-Z-5/Photography
DE-Z-50/Determination of Refractive State
DE-Z-61/Paravertebral Facet Joint Nerve Blocks
DE-Z-63/Procedure Codes Not Applicable to Highmark Commercial Products
DE-Z-64/Diagnosis and Treatment of Obstructive Sleep Apnea in Children
DE-Z-65/Telestroke
DE-Z-67/Experimental/Investigational Services
DE-Z-7/Electrical Nerve Stimulation
DE-Z-75/Posterior Tibial Nerve Stimulation
DE-Z-76/Neural Therapy
DE-Z-8/Sleep Disorder Services
DE-Z-9/Immediate Relatives or Household Members
HMK -L-192/Genetic Testing by Multigene Panels
HMK-A-1/Anesthesia Provided in Conjunction with Non-covere
HMK-A-10/Pain Control
HMK-A-11/Modifying Units for Anesthesia Services
HMK-A-12/Anesthesia Services Prior to Postponement of Surge
HMK-A-14/Continuous Local Delivery of Anesthesia to Operati
HMK-A-17/Administration of Conscious Sedation with Other Sp
HMK-A-18/Ultra-Rapid Detoxification (UROD)
HMK-A-4/Anesthesia Care Standby Anesthesia
HMK-A-7/Monitored Anesthesia Care
HMK-A-8/Payment for Anesthesia Services
HMK-A-9/Services Performed in Conjunction with the Adminis
HMK-C-6/Mandatory Second Surgical Opinion
HMK-D-1/Periodontal and Adjunctive Surgery
HMK-D-6/Dental Services
HMK-E-1/Durable Medical Equipment (DME)
HMK-E-12/Beds - Accessories and Related Items
HMK-E-15/Diabetic Services and Supplies
HMK-E-16/Cranial Electrical Stimulators
HMK-E-17/Portable External Infusion Pump
HMK-E-19/Oxygen
HMK-E-2/Home Dialysis Equipment and Supplies
HMK-E-20/Continuous Positive Airway Pressure (CPAP) Device
HMK-E-21/Transcutaneous Transducer Garments (TTG)
HMK-E-25/Pulse Oximetry Device
HMK-E-3/Home Apnea Monitors
HMK-E-30/Repair/ Maintenance and Replacement of Durable Me
HMK-E-31/Negative Pressure Wound Therapy Pumps/Vacuum Assisted Closure of Chronic Wounds
HMK-E-32/Nebulizers
HMK-E-33/H-wave Electrical Stimulation
HMK-E-34/Respiratory Assist Devices
HMK-E-35/Ultrasound Osteogenic Stimulator
HMK-E-36/Speech Generating Devices
HMK-E-37/Breast Pumps
HMK-E-38/Continuous Rental of Life Sustaining Durable Medic
HMK-E-39/Home Uterine Activity Monitor
HMK-E-40/Neuromuscular Electrical Stimulation (NMES) Device
HMK-E-41/Transtympanic Micropressure Applications as a Trea
HMK-E-42/Continuous Glucose Monitors
HMK-E-44/Fluency-Enhancing Devices for the Treatment of Stu
HMK-E-45/Interferential Stimulator
HMK-E-46/Electrical Stimulation Devices for the Treatment o
HMK-E-47/Non-Powered Negative Pressure Wound Therapy System
HMK-E-49/Seat Lift Mechanisms
HMK-E-5/Tumor Treatment Fields
HMK-E-52/Home Cervical Traction Therapy
HMK-E-58/Automatic External Defibrillators
HMK-E-6/Wheelchairs and Options/Accessories
HMK-E-61/Noncontact Radiant Heat Bandage for the Treatment
HMK-E-68/High Frequency Chest Wall Oscillation Devices
HMK-E-7/Pneumatic Compression Devices
HMK-E-8/Patient Lifts
HMK-E-9/Gradient Compression Garments
HMK-G-1/Newborn Care & Associated Services
HMK-G-10/Medical Care with Surgery
HMK-G-16/Chemotherapy Services
HMK-G-17/Pulmonary Rehabilitation
HMK-G-19/Professional Component for Pathology Tests
HMK-G-2/Obstetrical vs. Surgical Services
HMK-G-20/Actinic Keratosis
HMK-G-23/Investigational Exemption Devices (IDEs) and Humanitarian Use Devices (HUDs)
HMK-G-24/Obesity
HMK-G-25/Intra-Articular Hyaluron Injections (e.g. Supartz
HMK-G-26/Electroconvulsive Therapy
HMK-G-27/Coverage for Cancer Clinical Trials
HMK-G-41/Wireless Capsule Endoscopy
HMK-G-42/Varicella Zoster Immune Globulin
HMK-G-7/Electrocardiogram and X-ray Interpretation
HMK-G-8/Bone Marrow Aspiration or Biopsy
HMK-G-9/Treatment of Male Sexual Dysfunction
HMK-I-100/Cetuximab (Erbitux)
HMK-I-107/Collagenase clostridium histolyticum (Xiaflex)
HMK-I-109/Irinotecan (Camptosar)
HMK-I-11/Botulinum Toxin (Chemodenervation)
HMK-I-112/Ziv-aflibercept (Zaltrap)
HMK-I-113/Ado-trastuzumab emtansine (Kadcyla)
HMK-I-114/Levoleucovorin
HMK-I-116/Ofatumumab (Arzerra)
HMK-I-117/Panitumumab (Vectibix)
HMK-I-118/Alemtuzumab (Lemtrada)
HMK-I-119/Eribulin Mesylate (Halaven)
HMK-I-12/Growth Hormone/ Human Recombinant Somatrem/Somatro
HMK-I-120/Oncologic Indications for PD-1 Blocking Antibodies
HMK-I-121/Repository Corticotropin (H.P. Acthar)
HMK-I-122/Treatment of Hereditary Angioedema
HMK-I-123/Fulvestrant (Faslodex)
HMK-I-124/Azacitidine (Vidaza)
HMK-I-126/Prolastin C, Aralast NP, Zemaira, Glassia (alpha1-proteinase inhibitors infusions)
HMK-I-127/Blinatumomab (Blincyto)
HMK-I-128/Decitabine (Dacogen)
HMK-I-129/Vedolizumab (Entyvio)
HMK-I-13/Interferon Alpha
HMK-I-130/Eculizumab (Soliris)
HMK-I-131/Alpha-1 Proteinase Inhibitor (Glassia)
HMK-I-133/Ixabepilone (IXEMPRA)
HMK-I-136/Brentuximab Vedotin (Adcetris)
HMK-I-137/GAZYVA (obinutuzumab)
HMK-I-138/VIMIZIM (elosulfase alfa)
HMK-I-14/Intravenous Immune Globulin
HMK-I-140/galsulfase (Naglazyme)
HMK-I-141/Compounded Medications
HMK-I-142/PCSK9 Inhibitors
HMK-I-143/Inhalation Solutions for the Treatment of Cystic Fibrosis
HMK-I-144/Drisapersen
HMK-I-145/Testosterone Androgens
HMK-I-146/Mepolizumab (NUCALA)
HMK-I-147/Talimogene Laherparepvec (Imlygic)
HMK-I-148/Cyramza (Ramucirumab)
HMK-I-149/Chelation Therapy for Off-Label Uses
HMK-I-150/DarzalexTM (daratumumab)
HMK-I-152/Exondys 51 (Eteplirsen)
HMK-I-157/Nusinersen (SpinrazaTM)
HMK-I-159/Oncologic Indications for Histone Deacetylase (HDAC) Inhibitors
HMK-I-16/Leuprolide/Leuprolide Acetate (Lupron/ Lupron Depo
HMK-I-160/Buprenorphine Implant for Treatment of Opioid Dependence
HMK-I-161/Irinotecan Liposomal (Onivyde)
HMK-I-18/Treatment of Pulmonary Hypertension
HMK-I-19/Intravenous Antibiotic Therapy for Lyme Disease
HMK-I-20/Immune Prophylaxis for Respiratory Syncytial Virus
HMK-I-21/Trastuzumab (Herceptin)
HMK-I-22/Lyme Disease Vaccine
HMK-I-24/Belatacept (Nulojix)
HMK-I-25/Desensitization Treatment for Renal Transplant
HMK-I-26/Cellular Immunotherapy for Prostate Cancer
HMK-I-27/Certolizumab (Cimia)
HMK-I-28/Infliximab cA2 (Remicade)
HMK-I-29/Pegloticase (Krystexxa)
HMK-I-3/Allergy Immunotherapy
HMK-I-30/Denosumab (Prolia/ Xgeva)
HMK-I-31/Tocilizumab (Actemra)
HMK-I-32/Intravenous Anesthetics for the Treatment of Chron
HMK-I-33/Belimumab (Benlysta)
HMK-I-34/Ipilimumab (Yervoy)
HMK-I-35/Golimumab (Simponi)
HMK-I-36/Palonosetron Hydrochloride (Aloxi)
HMK-I-37/Ustekinumab (Stelara)
HMK-I-38/Rituximab (Rituxan) for the Treatment of Rheumato
HMK-I-4/Hemophilia Clotting Factors
HMK-I-40/Pertuzumab for Treatment of Malignancies
HMK-I-41/Carfilzomib
HMK-I-42/Zoledronic Acid (Zometa)
HMK-I-49/Alefacept (Amevive)
HMK-I-51/Anthrax Immunization and Treatment
HMK-I-53/Omalizumab (Xolair)
HMK-I-54/Laronidase (Aldurazyme)
HMK-I-55/Agalsidase beta (Fabrazyme)
HMK-I-56/17 Alpha-hydroxyprogesterone Caproate (17P) Inject
HMK-I-58/Alglucosidase alfa (Myozyme)
HMK-I-59/Gemcitabine HCL (Gemzar)
HMK-I-6/Approved Drugs and Biologicals
HMK-I-65/Paclitaxel, albumin-bound (Abraxane)
HMK-I-7/Erythropoietin (EPO/ Epoetin/ Epoetin Alfa/ Darbep)
HMK-I-73/Docetaxel (Taxotere)
HMK-I-74/Pemetrexed (Alimta)
HMK-I-75/Paclitaxel (Taxol)
HMK-I-76/Ziconotide (Prialt)
HMK-I-78/Fluocinolone Acetonide Intravitreal Implant (Retis
HMK-I-79/Plerixafor (Mozobil)
HMK-I-8/Immunizations
HMK-I-83/Velcade (bortezomib)
HMK-I-85/Natalizumab (Tysabri)
HMK-I-86/Bevacizumab (Avastin)
HMK-I-87/Oxaliplatin (Eloxatin)
HMK-I-88/Pegfilgrastim (Neulasta) Subcutaneous (SC) Injection
HMK-I-89/Carboplatin (Paraplatin)
HMK-I-9/Ceredase/Cerezyme Injections
HMK-I-90/Abatacept (Orencia)
HMK-I-91/Intraperitoneal Chemotherapy for Ovarian Cancer
HMK-I-92/Naltrexone Extended Release Injection (Vivitrol)
HMK-I-93/Idursulfase (Elaprase)
HMK-I-94/Intravitreal Injections
HMK-I-97/Radium Ra 223 Dichloride for Treatment of Prostate Cancer
HMK-I-98/Bendamustine (Treanda)
HMK-I-99/Drug Wastage
HMK-L-1/Pap Smears
HMK-L-10/Selected Tests for Rheumatic Diseases
HMK-L-100/Genetic Testing for Duchenne and Becker Muscular
HMK-L-102/Urine Drug Testing
HMK-L-104/Mutation Analysis
HMK-L-105/Next-Generation Gene Sequencing (NGS) for Oncology
HMK-L-106/Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
HMK-L-107/Genetic Testing for Carrier Status
HMK-L-108/Genetic Testing for Non-Medical Purposes
HMK-L-109/Genetic Testing for Prenatal Screening and Diagnostic Testing
HMK-L-110/Genetic Testing for the Screening, Diagnosis, and Monitoring of Cancer
HMK-L-111/Genetic Testing to Diagnose Non-Cancer Conditions
HMK-L-112/Genetic Testing to Predict Disease Risk
HMK-L-113/Investigational and Experimental Molecular/Genomic Testing
HMK-L-114/Pharmacogenomic Testing for Drug Toxicity and Response
HMK-L-115/Preimplantation Genetic Screening and Diagnosis
HMK-L-116/Brugada Syndrome Known Familial Mutation Analysis
HMK-L-116/Brugada Syndrome Known Familial Mutation Analysis
HMK-L-117/Brugada Syndrome Multigene Panels
HMK-L-118/Brugada Syndrome Sequencing
HMK-L-119/ConfirmMDx for Prostate Cancer
HMK-L-120/Hypertrophic Cardiomyopathy Testing
HMK-L-121/CADASIL
HMK-L-122/PCA3
HMK-L-123/Liquid Biopsy Testing Solid Tumors
HMK-L-124/Tumor Marker Testing-Solid Tumors
HMK-L-125/Long QT Syndrome
HMK-L-126/Fragile X Syndrome Testing
HMK-L-127/Fragile X Associated Tremor/Ataxia Syndrome Testing
HMK-L-128/Gaucher Disease Testing
HMK-L-129/Li-Fraumeni Syndrome Testing
HMK-L-13/HLA-B 5701 Genotyping for Abacavir Hypersensitivity
HMK-L-130/Chromosomal Microarray Testing for Developmental Disorders
HMK-L-131/Chromosomal Microarray Testing for Prenatal Diagnosis
HMK-L-132/Marfan Syndrome Genetic Testing
HMK-L-133/Thoracic Aortic Aneurysms and Dissections (TADD) Panel Testing
HMK-L-134/BRCA Ashkenazi Jewish Founder Mutation Testing
HMK-L-135/BRCA1/2 Deletion/Duplication Analysis
HMK-L-136/BRCA Sequencing
HMK-L-137/Canavan Disease Testing
HMK-L-138/Factor II/Prothrombin Testing for Thrombophilia
HMK-L-139/Factor V Leiden Testing for Thrombophilia
HMK-L-14/HLA-B 1502 Variant Analysis for Carbamazepine Response
HMK-L-140/Sexually Transmitted Infections: Molecular
HMK-L-141/BRAF Mutation Analysis for Colorectal Cancer
HMK-L-142/Hereditary Hemochromatosis Testing
HMK-L-143/Niemann Pick Disease Types A & B Testing
HMK-L-144/Tay-Sachs Disease Testing
HMK-L-145/PTEN Hamartoma Tumor Syndromes Testing
HMK-L-147/Niemann Pick, Type C Testing
HMK-L-148/CYP2D6 Variant Analysis for Tamoxifen Response
HMK-L-149/Lynch Syndrome Tumor Screening First Tier
HMK-L-15/Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
HMK-L-150/Lynch Syndrome Tumor Screening Second Tier
HMK-L-151/Charcot-Marie-Tooth Neuropathy Testing Panel
HMK-L-152/Prader-Willi Syndrome Testing
HMK-L-153/Celiac Disease Testing
HMK-L-154/Immunohistochemistry (IHC)
HMK-L-155/Afirma Gene Expression Classifier Thyroid Cancer
HMK-L-156/DPYD Variant Analysis for 5-FU Toxicity
HMK-L-157/BRCA Sequencing for Olaparib Response
HMK-L-158/ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
HMK-L-159/Alpha-1-Antitrypsin Deficiency Testing
HMK-L-16/Mammostrat Breast Cancer Recurrence Assay
HMK-L-160/Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
HMK-L-161/Angelman Syndrome Testing
HMK-L-162/Dentatorubral-Pallidoluysian Atrophy Testing
HMK-L-163/CYP2C9 and VKORC1 Testing for Warfarin Response
HMK-L-164/EGFR Testing for Non-Small Cell Lung Cancer TKI Response
HMK-L-165/Rett Syndrome Testing
HMK-L-166/Spinal Muscular Atrophy Testing
HMK-L-167/UGT1A1 Mutation Analysis for Irinotecan Response
HMK-L-168/Von Hippel-Lindau Disease Testing
HMK-L-169/Ataxia-Telangiectasia
HMK-L-170/BCR-ABL Testing for Chronic Myeloid Leukemia
HMK-L-171/BRAF Testing for Melanoma Kinase Inhibitor Response
HMK-L-172/Familial Adenomatous Polyposis Testing
HMK-L-173/Familial Hypercholesterolemia Genetic Testing
HMK-L-174/Duchenne & Becker Muscular Dystrophy Testing
HMK-L-175/Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
HMK-L-176/MTHFR Variant Analysis for Hyperhomocysteinemia
HMK-L-177/MUTYH Associated Polyposis Testing
HMK-L-178/Peutz-Jeghers Syndrome Testing
HMK-L-179/Leber Hereditary Optic Neuropathy (LHON) Genetic Testing
HMK-L-180/4Kscore for Prostate Cancer Risk Assessment
HMK-L-181/Prolaris for Prostate Cancer Prognosis
HMK-L-182/Chromosome Analysis for Blood, Bone Marrow, and Solid Tumor Cancers
HMK-L-183/Expanded Carrier Screening Panels
HMK-L-184/Hereditary Cancer Syndrome Multigene Panels
HMK-L-185/APOE Variant Analysis for Alzheimer Disease
HMK-L-186/Bloom Syndrome Testing
HMK-L-187/Flow Cytometry
HMK-L-188/Huntington Disease Testing
HMK-L-189/Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) Genetic Testing
HMK-L-190/MGMT Testing for Malignant Glioma Alkylating Agent Response
HMK-L-191/Intracellular Micronutrient Testing
HMK-L-193/OralCDx Brush Biopsy
HMK-L-194/EndoCDx
HMK-L-195/Hereditary (Germline) Testing After Tumor (Somatic) Testing
HMK-L-196/Neurogenic Muscle Weakness, Ataxia, and Retinitis Pigmentosa (NARP)
HMK-L-197/Mitochondrial DNA Deletion Syndromes
HMK-L-198/Mitochondrial Neurogastrointestinal Encephalopathy (MNGIE)
HMK-L-199/Myoclonic Epilepsy with Ragged Red Fibers (MERRF)
HMK-L-2/Collection of Specimens
HMK-L-200/GPS Cancer (NantHealth)
HMK-L-201/BCR-ABL Negative Myeloproliferative Neoplasm Testing
HMK-L-202/Gene Expression Profiling Tests for Prostate Cancer
HMK-L-203/BRCA Analysis
HMK-L-204/Myeloma Prognostic Risk Signature (MyPRS)
HMK-L-205/Cxbladder
HMK-L-206/Whole Exome Sequencing
HMK-L-207/EndoPredict for Breast Cancer Prognosis
HMK-L-208/Sept9 Methylation Analysis for Colorectal Cancer
HMK-L-25/Mammaprint 70-Gene Breast Cancer Recurrence Assay
HMK-L-27/Organ or Disease Oriented Panels
HMK-L-28/Tumor Markers
HMK-L-29/Evocative/Suppression Testing Panels
HMK-L-3/In Vitro Allergy Testing
HMK-L-30/Fetal Fibronectin Enzyme Immunoassay
HMK-L-32/Laboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease
HMK-L-33/Genetic Testing for Hereditary Breast and
HMK-L-34/Genetic Testing/or Ovari
HMK-L-35/HIV Genotyping and Phenotyping
HMK-L-36/Gene Expression Testing for Unknown Primary Cancers (UPC)
HMK-L-37/Multi-panel Gene Expression Test(s)
HMK-L-38/VeriStrat Assay
HMK-L-39/Anser ADA and Anser IFX
HMK-L-4/Intraepidermal Nerve Fiber Density Testing
HMK-L-40/Analysis of Human DNA in Stool Samples as a Techni
HMK-L-41/Prosigna Breast Cancer Prognostic Gene Signature Assay
HMK-L-42/Rapid Platelet Function Assay - ASA
HMK-L-49/Pharmacogenomic and Metabolite Markers for Patient
HMK-L-51/Assays of Genetic Expression In Tumor Tissue as a
HMK-L-58/In Vitro Chemoresistance and Chemosensitivity Assa
HMK-L-63/Vitamin D Assay Testing
HMK-L-8/Surgical (Anatomic) Pathology
HMK-L-81/Laboratory Tests for Heart Transplant Rejection
HMK-L-82/Cytochrome p450 Genotyping
HMK-L-84/Laboratory Testing for Novel Influenza A (H1N1)
HMK-L-85/Genetic Testing for Warfarin Dose
HMK-L-86/Genetic Testing for Cystic Fibrosis
HMK-L-87/Vysis ALK Break Apart FISH Probe Kit
HMK-L-88/Excision repair cross-complementing factor 1 (ERCC
HMK-L-9/Corus CAD
HMK-L-91/Multi-gene Expression Assay for Predicting Recurre
HMK-L-92/Maternal Plasma DNA Test for Fetal Aneuploidy
HMK-L-96/Biomarkers in Risk Assessment and Management of Cardiovascular Disease
HMK-L-97/Prenatal Aneuploidy FISH Testing
HMK-L-98/Prenatal Chromosome Analysis
HMK-L-99/Prenatal Maternal Serum Screening
HMK-M-1/Computer Analysis or Generation of Automated Data
HMK-M-11/Diagnostic Services - Professional and Technical C
HMK-M-13/Neurophysiological Studies
HMK-M-14/Non-Invasive Vascular Diagnostic Studies
HMK-M-15/Non-invasive Peripheral Arterial Studies
HMK-M-17/MultiFunction CardioGram
HMK-M-18/Diagnostic Endocardial Electrical Stimulation (EES
HMK-M-20/Magnetoencephalography and Magnetic Source Imaging
HMK-M-23/Esophageal Studies
HMK-M-25/Rhythm Strip
HMK-M-28/Electromyography (EMG)
HMK-M-3/Endocrine Studies
HMK-M-30/Gait Analysis
HMK-M-31/Cardiac Event Detection Monitoring
HMK-M-34/Electroencephalograms (EEGs)
HMK-M-4/Thermography
HMK-M-5/Tensilon Test
HMK-M-50/Implantable Cardiac Loop Recorder
HMK-M-51/Nerve Conduction Velocity (NCV) Studies
HMK-M-52/External Counterpulsation (ECP)
HMK-M-54/Ambulatory and Outpatient Cardiac Hemodynamic Monitoring of Heart Failure
HMK-M-60/Home-Based/ Real-Time Cardiac Surveillance (Monito
HMK-M-61/Autonomic Nervous System Function Testing
HMK-M-62/Polysomnography for Non-Respiratory Sleep Disorders
HMK-M-69/The Dr. Dean Ornish Program for Reversing Heart Di
HMK-M-7/Electronystagmography (ENG) and Videonystagmograph
HMK-M-70/Ambulatory Blood Pressure Monitoring (ABPM)
HMK-M-72/Digital Imaging Systems for the Detection and Eval
HMK-M-74/Home Prothrombin Time INR Monitoring for Anticoagu
HMK-M-76/High Resolution Anoscopy
HMK-M-77/Upper Gastrointestinal Endoscopy
HMK-O-10/Dynamic Splinting Devices
HMK-O-11/Wigs
HMK-O-12/Foot Orthotics for Conditions Other Than Diabetes
HMK-O-13/Cranial Orthosis for Plagiocephaly
HMK-O-15/Microprocessor-Controlled Prosthetic Knees
HMK-O-16/Parenteral Nutrition
HMK-O-19/Ostomy Supplies
HMK-O-2/Prosthetic Shoe
HMK-O-24/Ankle-Foot/Knee-Ankle-Foot Orthosis
HMK-O-27/Urological Supplies
HMK-O-28/Knee Orthosis
HMK-O-31/Myoelectric Prosthesis for the Upper Limb and i-Li
HMK-O-4/Intraocular Lens (Pseudophakos)
HMK-O-5/Powered Robotic Lower Body Exoskeleton Devices
HMK-O-6/Enteral Nutrition
HMK-O-8/Braces and Supports
HMK-O-9/Screening List for Prosthetic Devices
HMK-P-1/Coverage Requirements for Routine Foot Care and De
HMK-Q-1/Ambulance Services (Medical Transportation)
HMK-Q-4/Private Duty Nursing
HMK-Q-5/Air Ambulance Services
HMK-R-10/Intravascular Brachytherapy for Prevention and Man
HMK-R-11/Intensity Modulated Radiation Therapy (IMRT)
HMK-R-14/Stereotactic Body Radiation Therapy (SBRT)
HMK-R-15/Selective Internal Radiation Therapy (SIRT)
HMK-R-16/PET/CT Fusion Imaging
HMK-R-18/Proton Beam Radiation Therapy
HMK-R-21/Stereotactic Radiosurgery and Stereotactic Radioth
HMK-R-22/Positron Emission Mammography (PEM)
HMK-R-23/Radiation Therapy Following Breast Conserving Surgery
HMK-R-4/Radiation Therapy
HMK-R-5/Myocardial Perfusion SPECT Imaging
HMK-R-57/Radioimmunotherapy: Ibritumomab Tiuxetan (Zevalin)
HMK-R-58/Radioimmunotherapy for the Evaluation and Treatmen
HMK-R-59/Radioimmunotherapy: Tositumomab/Iodine I-131 Tosit
HMK-R-6/Single Photon Emission Computed Tomography (SPECT)
HMK-R-60/Image-Guided Target Localization and Image-Guided
HMK-R-8/Non-Malignant Applications of PET and PET-CT
HMK-R-9/PET and PET/CT Scanning for Oncologic Indications
HMK-S-100/Multiple Surgical Procedures
HMK-S-106/Treatment of Urinary Incontinence/Periurethral Bul
HMK-S-109/Transcatheter Arterial Chemoembolization
HMK-S-11/Pheresis Therapy
HMK-S-112/Co-Surgery
HMK-S-113/Pallidotomy and Other Treatments of Parkinsons Di
HMK-S-116/Corneal Transplantation
HMK-S-118/Small Bowel/Liver Transplantation
HMK-S-119/Multivisceral Transplantation
HMK-S-12/Team Surgery
HMK-S-121/Liver Transplantation
HMK-S-122/Heart Transplantation
HMK-S-123/Lung and Lobar Lung Transplantation
HMK-S-124/Kidney Transplantation
HMK-S-125/Heart/Lung Transplantation
HMK-S-126/Pancreas/Kidney Transplantation
HMK-S-127/Solitary Pancreas Transplantation
HMK-S-128/Photodynamic Therapy (PDT)
HMK-S-129/Mastectomy and Reconstructive Surgery
HMK-S-13/Rigid Immobilization
HMK-S-131/Sacral Nerve Modulation/Stimulation (SNS) for Pelv
HMK-S-133/Endovascular Aneurysm Repair
HMK-S-137/Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
HMK-S-140/Ocular Photodynamic Therapy
HMK-S-141/Radiofrequency Thermal Ablation of Liver Tumors (R
HMK-S-143/Donor Leukocyte Infusion for Hematologic Malignanc
HMK-S-144/Islet Cell Transplantation
HMK-S-145/Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (GERD)
HMK-S-146/Percutaneous Vertebroplasty
HMK-S-147/Epithelial Cell Cytology in Breast Cancer Risk Assesment
HMK-S-148/Kyphoplasty
HMK-S-15/Second Surgical Assistant for Cardiovascular Surge
HMK-S-150/Radiofrequency Facet Nerve Denervation
HMK-S-151/Transmyocardial (Laser) Revascularization (TMR)
HMK-S-152/Transcatheter Closure Devices for Congenital Heart
HMK-S-153/Biventricular Pacemakers for the Treatment of Congenital Heart
HMK-S-155/Gastric Electrical Stimulation/ Gastric Pacing
HMK-S-156/Stretta Procedure
HMK-S-157/Extracorporeal Shock Wave Therapy (ESWT) for Muscu
HMK-S-158/Cryosurgical Ablation and Radiofrequency Ablation
HMK-S-159/Nucleoplasty and Biacuplasty
HMK-S-16/Assistant Surgery Eligibility Criteria
HMK-S-160/Preventable Serious Adverse Events
HMK-S-163/Prophylactic Mastectomy
HMK-S-166/Breast Duct Endoscopy
HMK-S-169/Intradiscal Electrothermal Annuloplasty (IDEA) or
HMK-S-172/Ovarian and Internal Iliac Vein Embolization as Tr
HMK-S-174/Surgical Interruption of Pelvic Nerve Pathways for
HMK-S-176/Arthroscopic Treatment of Femoroacetabular Impinge
HMK-S-178/Treatment of Hyperhidrosis
HMK-S-179/Myolysis of Uterine Fibroids
HMK-S-180/Autologous Platelet-Derived Growth Factors as a Pr
HMK-S-181/Coronary Revascularization
HMK-S-183/Partial and Total Hip Resurfacing Arthroplasty
HMK-S-184/Gender Reassignment Surgery
HMK-S-185/Transplantation for Chondral Defects
HMK-S-186/MRI-Guided High Intensity Ultrasound Ablation of U
HMK-S-187/Artificial Intervertebral Disc Replacement
HMK-S-188/Alcohol Induced Septal Ablation (AISA)
HMK-S-189/Transforaminal Epidural Injection
HMK-S-190/Computer-assisted Musculoskeletal Surgical Navigat
HMK-S-191/Interspinous Distraction Devices for Treatment of
HMK-S-192/Ultrafiltration in Decompensated Heart Failure (Aq
HMK-S-193/Prolotherapy
HMK-S-194/Subtalar Arthroereisis
HMK-S-195/Artificial Intervertebral Disc: Thoracic Spine
HMK-S-196/Saturation Biopsy for Diagnosis and Staging of Pro
HMK-S-197/Manipulation under Anesthesia
HMK-S-198/Acellular Dermal Grafts for Reconstruction
HMK-S-2/Abortions
HMK-S-20/Arterial Puncture Hemostasis (e.g. Angio-Seal)
HMK-S-200/Percutaneous Intracranial Balloon Angioplasty With
HMK-S-201/Nasal/Sinus Endoscopy (Balloon Sinuplasty)
HMK-S-202/Total Ankle Replacement
HMK-S-203/Melody Transcatheter Pulmonary Valve Therapy
HMK-S-204/Radiofrequency Ablation of the Esophagus
HMK-S-206/Hematopoietic Stem-Cell Transplantation for Chroni
HMK-S-207/Hematopoietic Stem-Cell Transplantation for Multip
HMK-S-208/Hematopoietic Stem-Cell Transplantation for Non-Ho
HMK-S-209/Allogeneic Stem-Cell Transplantation for Myelodysp
HMK-S-210/Allogeneic Hematopoietic Stem-Cell Transplantation
HMK-S-211/Hematopoietic Stem-Cell Transplantation for Epithe
HMK-S-212/Hematopoietic Stem-Cell Transplantation for Miscel
HMK-S-213/Hematopoietic Stem-Cell Transplantation for Autoim
HMK-S-214/Hematopoietic Stem-Cell Transplantation for Acute
HMK-S-215/Hematopoietic Stem-Cell Transplantation for Breast
HMK-S-216/Hematopoietic Stem-Cell Transplantation for CNS Em
HMK-S-217/Hematopoietic Stem-Cell Transplantation for Hodgki
HMK-S-218/Hematopoietic Stem-Cell Transplantation for Chroni
HMK-S-219/Autologous Hematopoietic Stem-Cell Transplantation
HMK-S-220/Allogeneic and Autologous Hematopoietic Stem-Cell
HMK-S-221/Hematopoietic Stem-Cell Transplantation for Solid
HMK-S-222/Hematopoietic Stem-Cell Transplantation in the Tre
HMK-S-223/Hematopoietic Stem Cell Transplantation for Primar
HMK-S-224/Hematopoietic Stem-Cell Transplantation for Walden
HMK-S-225/Orthopedic Applications of Stem-Cell Therapy
HMK-S-226/Placental/Umbilical Cord Blood as a Source of Stem
HMK-S-229/Lumbar Laminectomy and Decompression
HMK-S-230/Lumbar Spine Fusion Surgery
HMK-S-231/Biometric Bone Void Filler
HMK-S-232/Transcatheter Aortic Valve Replacement (TAVR)
HMK-S-233/Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (GERD)
HMK-S-234/Hysterectomy
HMK-S-234/Hysterectomy
HMK-S-235/Bone Morphogenetic Protein
HMK-S-236/Aqueous Shunts and Stents for Glaucoma
HMK-S-237/Discography
HMK-S-238/Transcatheter Mitral Valve Repair (TMVR)
HMK-S-239/Minimally Invasive Microdiscectomy
HMK-S-240/Trigger Point Injections
HMK-S-240/Trigger Point Injections
HMK-S-241/Fecal Microbiota Transplantation
HMK-S-242/Patient Temporarily Unsuitable for Organ Transplant, OPTN and UNOS Status 7
HMK-S-244/Fibrin Sealants
HMK-S-25/Operative Cholangiography Prior to Exploration of
HMK-S-28/Cosmetic Surgery vs. Reconstructive Surgery
HMK-S-29/Preparation and Insertion of an Obturator
HMK-S-30/Insertion and Removal of Tympanic Ventilation Tube
HMK-S-31/Arthrocentesis or Needling of Bursa
HMK-S-32/Implantable Hormone Replacement Pellets
HMK-S-33/Bio-Engineered Skin and Soft Tissue Substitutes
HMK-S-36/Removal of Multiple Skin Lesions
HMK-S-37/Invasive Intracranial Pressure Monitoring
HMK-S-4/Endoscopic Procedures and Related Services
HMK-S-40/Implantable Infusion Pump
HMK-S-41/Corneal Surgery to Correct Refractive Errors and P
HMK-S-45/Repair of Lacerations
HMK-S-46/Mohs Chemosurgery
HMK-S-49/Eye Procedures Done in Stages or Sessions
HMK-S-50/Surgical Techniques (e.g.Laser, Microsurgery
HMK-S-51/Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
HMK-S-52/Postoperative Services Following Definitive Surger
HMK-S-54/Implantation of Subcutaneous Intravascular Cathete
HMK-S-55/Surgical Treatment of Varicose Veins
HMK-S-59/Implantable Automatic Cardioverter-Defibrillator
HMK-S-60/Artificial Hearts and Ventricular Assist Devices
HMK-S-63/Optic Nerve Decompression Surgery
HMK-S-66/Minimally Invasive Direct Coronary Artery Bypass G
HMK-S-67/Cochlear Implantation
HMK-S-68/Routine Neonatal Circumcision/Slitting of Prepuce
HMK-S-69/Surgical Treatment of Lymphedema
HMK-S-70/Bronchial Thermoplasty
HMK-S-71/Photodynamic Therapy (PDT) Using Levulan Kerastick
HMK-S-73/Bone Marrow Donor Search Charges
HMK-S-74/Suction Assisted Lipectomy (SAL)
HMK-S-75/Extracorporeal Photopheresis
HMK-S-79/Hemodialysis/Peritoneal Dialysis
HMK-S-82/Intra-Arterial/Intravenous Therapeutic Procedure
HMK-S-83/Percutaneous Lumbar Discectomy
HMK-S-84/Insertion of Tissue Expanders
HMK-S-87/Fractures/Dislocations
HMK-S-88/Ilizarov Bone Lengthening
HMK-S-89/Bone Growth Stimulation
HMK-S-9/Hearing Aids
HMK-S-90/Failed or Incomplete Colonoscopy
HMK-S-92/Treatment of Acne
HMK-S-96/Laparoscopic Surgery
HMK-S-97/Treatment of the Prostate
HMK-S-99/Meniscal Allograft Transplantation
HMK-U-2/Antepartum and Postpartum Care
HMK-U-3/Obstetrical Delivery & Associated Services
HMK-U-5/Assisted Fertilization
HMK-U-7/Fetal Surgery for Prenatally Diagnosed Malformatio
HMK-U-8/Treatment of Twin-Twin Transfusion Syndrome with A
HMK-U-9/Lactation Counseling
HMK-V-1/Cardiac Rehabilitation Programs
HMK-V-11/Ventilatory Assistance (Respirator Care)
HMK-V-15/Psychiatric Care Defined
HMK-V-16/Speech Therapy
HMK-V-2/Concurrent Care
HMK-V-20/Prolonged Detention or Critical Care
HMK-V-21/Physician Certification and Recertification of Hom
HMK-V-23/Temporomandibular Joint (TMJ) Dysfunction
HMK-V-28/Inpatient Preoperative Care
HMK-V-3/Billing of Observation Services
HMK-V-31/Medical Care and Associated Services
HMK-V-35/Annual Gynecological Examinations Annual Gynecolog
HMK-V-37/Autism/ Hyperkinetic Syndromes and Other Developme
HMK-V-39/Mental Illness Coverage
HMK-V-40/Rectal Examinations
HMK-V-44/Medical Nutrition Management Services (MNT)
HMK-V-48/Preventive Medicine and Office/Outpatient Evaluati
HMK-V-59/Contraceptive Management
HMK-V-60/Special Services
HMK-X-11/Multiple Diagnostic X-ray Studies Performed on the
HMK-X-17/Obstetrical Ultrasound
HMK-X-2/Magnetic Resonance Imaging (MRI)
HMK-X-20/Positional MRI
HMK-X-21/Mammography Digital Breast Tomosynthesis
HMK-X-23/Fluoroscopy Without Film for Positioning or Intrao
HMK-X-24/Bone Mineral Density Studies
HMK-X-26/Ultrasound Studies for the Diagnosis and Treatment
HMK-X-27/Stereotactic Localization
HMK-X-28/Magnetic Resonance Angiography (MRA)
HMK-X-4/Diagnostic Radiographs of the Teeth
HMK-X-44/Magnetic Resonance Imaging (MRI) of the Breast
HMK-X-5/Portable Radiography and ECG Services
HMK-X-50/Magnetic Resonance Spectroscopy (MRS
HMK-X-51/Fetal Nuchal Translucency
HMK-X-52/CT Colonography/Virtual Colonoscopy
HMK-X-54/Computed Tomographic Angiography (CTA) for Coronar
HMK-X-56/Vertebral Fracture Assessment Using Dual X-ray Abs
HMK-X-57/Advanced Imaging
HMK-X-58/CT for lung cancer screening
HMK-X-69/Multiple Procedure Payment Reduction for the Techn
HMK-X-70/MPPR for the Professional Component of Certain Diagnostic Imaging Procedures
HMK-X-71/Functional MRI-fMRI
HMK-X-8/Stress Films and Weight Bearing X-rays
HMK-Y-1/Physical Medicine
HMK-Y-11/Manual Lymphedema Drainage Therapy
HMK-Y-12/Urinary Incontinence Therapy
HMK-Y-16/Chronic Wound Management
HMK-Y-19/Vertebral Axial Decompression (VAX-D)
HMK-Y-2/Occupational Therapy
HMK-Y-20/Biofeedback
HMK-Y-21/Cognitive Rehabilitation
HMK-Y-22/Opioid Dependence Therapy (Suboxone)
HMK-Y-5/Vision Therapy (Orthoptics and Pleoptics)
HMK-Y-6/Isokinetic Evaluation and Therapy
HMK-Y-9/Manipulation Services
HMK-Z-1/Ultraviolet Light Therapies
HMK-Z-10/Services of Physicians Assistants
HMK-Z-11/Definition of Medical Necessity
HMK-Z-13/Emergency Medical Care
HMK-Z-14/Acupuncture
HMK-Z-24/Miscellaneous Services
HMK-Z-26/Allergy Skin Testing
HMK-Z-27/Eligible Providers and Supervision Guidelines
HMK-Z-29/Hypnosis
HMK-Z-3/Hyperbaric Oxygen (HBO) Therapy
HMK-Z-30/Membership Dues/Service Policy and Insurance Prem
HMK-Z-32/Standby Services
HMK-Z-35/Repeat Surgical Procedures
HMK-Z-38/Hospital Admission Provision (Benefits After Contr
HMK-Z-39/Provider Overhead Expenses
HMK-Z-4/Transcranial Magnetic Stimulation
HMK-Z-46/Blood and Bone Marrow Storage
HMK-Z-5/Photography
HMK-Z-50/Determination of Refractive State
HMK-Z-52/Pain Management of Peripheral Nerves by Injection
HMK-Z-61/Paravertebral Facet Joint Nerve Blocks
HMK-Z-62/Sacroiliac Joint Injections
HMK-Z-63/Procedure Codes Not Applicable to Highmark Commerc
HMK-Z-64/Diagnosis and Treatment of Obstructive Sleep Apnea
HMK-Z-65/Telestroke
HMK-Z-67/Experimental/Investigational Services
HMK-Z-7/Electrical Nerve Stimulation
HMK-Z-70/Teledermatology
HMK-Z-75/Posterior Tibial Nerve Stimulation
HMK-Z-76/Neural Therapy
HMK-Z-8/Sleep Disorder Services
HMK-Z-9/Immediate Relatives or Household Members
L-142/Hereditary Hemochromatosis Testing
WV-B-38/Opioid Dependency Program
WV-B-41/Clinical Trials for Life Threatening Conditions
WV-B-49/Dynamic Splinting Devices
WV-B-55/Oxygen
WV-E-15/Diabetic Services and Supplies
WV-G-16/Chemotherapy Services
WV-G-23/Investigational Exemption Devices (IDEs) and Humanitarian Use Devices (HUDs)
WV-G-24/Obesity
WV-I-121/Repository Corticotropin intramuscular injection (H.P. Acthar Gel)
WV-I-122/Treatment of Hereditary Angioedema
WV-I-124/Azacitidine (Vidaza)
WV-I-126/Prolastin C, Aralast NP, Zemaira, Glassia (alpha1-proteinase inhibitors infusions)
WV-I-126/Aralast, Prolastin, Zemaira
WV-I-127/Blinatumomab (Blincyto)
WV-I-130/Eculizumab (Soliris)
WV-I-131/Alpha-1 Proteinase Inhibitor (Glassia)
WV-I-133/Ixabepilone (IXEMPRA)
WV-I-136/Brentuximab Vedotin (Adcetris)
WV-I-137/GAZYVA (obinutuzumab)
WV-I-138/VIMIZIM (elosulfase alfa)
WV-I-14/Immune Globulin Therapy
WV-I-140/galsulfase (Naglazyme)
WV-I-141/Compounded Medications
WV-I-142/PCSK9 Inhibitors
WV-I-143/Inhalation Solutions for the Treatment of Cystic Fibrosis
WV-I-144/Drisapersen
WV-I-145/Testosterone Androgens
WV-I-146/Mepolizumab (NUCALA)
WV-I-147/Talimogene Laherparepvec (Imlygic)
WV-I-148/Cyramza (Ramucirumab)
WV-I-149/Chelation Therapy for Off-Label Uses
WV-I-150/DarzalexTM (daratumumab)
WV-I-65/Paclitaxel, albumin-bound (Abraxane)
WV-I-8/Immunizations
WV-I-83/Velcade (bortezomib)
WV-L-1/Pap Smears
WV-L-10/Selected Tests for Rheumatic Diseases
WV-L-106/Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
WV-L-108/Genetic Testing for Non-Medical Purposes
WV-L-109/Genetic Testing for Prenatal Screening and Diagnostic Testing
WV-L-110/Genetic Testing for the Screening, Diagnosis, and Monitoring of Cancer
WV-L-111/Genetic Testing to Diagnose Non-Cancer Conditions
WV-L-112/Genetic Testing to Predict Disease Risk
WV-L-113/Investigational and Experimental Molecular/Genomic Testing
WV-L-114/Pharmacogenomic Testing for Drug Toxicity and Response
WV-L-115/Preimplantation Genetic Screening and Diagnosis
WV-L-116/Brugada Syndrome Known Familial Mutation Analysis
WV-L-117/Brugada Syndrome Multigene Panels
WV-L-118/Brugada Syndrome Sequencing
WV-L-119/ConfirmMDx for Prostate Cancer
WV-L-120/Hypertrophic Cardiomyopathy Testing
WV-L-121/CADASIL
WV-L-122/PCA3
WV-L-123/Liquid Biopsy Testing Solid Tumors
WV-L-124/Tumor Marker Testing-Solid Tumors
WV-L-125/Long QT Syndrome
WV-L-126/Fragile X Syndrome Testing
WV-L-127/Fragile X Associated Tremor/Ataxia Syndrome Testing
WV-L-128/Gaucher Disease Testing
WV-L-129/Li-Fraumeni Syndrome Testing
WV-L-13/HLA-B 5701 Genotyping for Abacavir Hypersensitivity
WV-L-130/Chromosomal Microarray Testing for Developmental Disorders
WV-L-131/Chromosomal Microarray Testing for Prenatal Diagnosis
WV-L-132/Marfan Syndrome Genetic Testing
WV-L-133/Thoracic Aortic Aneurysms and Dissections (TADD) Panel Testing
WV-L-134/BRCA Ashkenazi Jewish Founder Mutation Testing
WV-L-135/BRCA1/2 Deletion/Duplication Analysis
WV-L-136/BRCA Sequencing
WV-L-137/Canavan Disease Testing
WV-L-138/Factor II/Prothrombin Testing for Thrombophilia
WV-L-139/Factor V Leiden Testing for Thrombophilia
WV-L-14/HLA-B 1502 Variant Analysis for Carbamazepine Response
WV-L-140/Sexually Transmitted Infections: Molecular
WV-L-141/BRAF Mutation Analysis for Colorectal Cancer
WV-L-142/Hereditary Hemochromatosis Testing
WV-L-143/Niemann Pick Disease Types A & B Testing
WV-L-144/Tay-Sachs Disease Testing
WV-L-145/PTEN Hamartoma Tumor Syndromes Testing
WV-L-147/Niemann Pick, Type C Testing
WV-L-148/CYP2D6 Variant Analysis for Tamoxifen Response
WV-L-149/Lynch Syndrome Tumor Screening First Tier
WV-L-15/Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
WV-L-150/Lynch Syndrome Tumor Screening Second Tier
WV-L-151/Charcot-Marie-Tooth Neuropathy Testing Panel
WV-L-152/Prader-Willi Syndrome Testing
WV-L-153/Celiac Disease Testing
WV-L-154/Immunohistochemistry (IHC)
WV-L-155/Afirma Gene Expression Classifier Thyroid Cancer
WV-L-156/DPYD Variant Analysis for 5-FU Toxicity
WV-L-157/BRCA Sequencing for Olaparib Response
WV-L-158/ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
WV-L-159/Alpha-1-Antitrypsin Deficiency Testing
WV-L-16/Mammostrat Breast Cancer Recurrence Assay
WV-L-160/Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
WV-L-161/Angelman Syndrome Testing
WV-L-162/Dentatorubral-Pallidoluysian Atrophy Testing
WV-L-163/CYP2C9 and VKORC1 Testing for Warfarin Response
WV-L-164/EGFR Testing for Non-Small Cell Lung Cancer TKI Response
WV-L-165/Rett Syndrome Testing
WV-L-166/Spinal Muscular Atrophy Testing
WV-L-167/UGT1A1 Mutation Analysis for Irinotecan Response
WV-L-168/Von Hippel-Lindau Disease Testing
WV-L-169/Ataxia-Telangiectasia
WV-L-171/BRAF Testing for Melanoma Kinase Inhibitor Response
WV-L-172/Familial Adenomatous Polyposis Testing
WV-L-173/Familial Hypercholesterolemia Genetic Testing
WV-L-174/Duchenne & Becker Muscular Dystrophy Testing
WV-L-175/Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
WV-L-176/MTHFR Variant Analysis for Hyperhomocysteinemia
WV-L-177/MUTYH Associated Polyposis Testing
WV-L-178/Peutz-Jeghers Syndrome Testing
WV-L-179/Leber Hereditary Optic Neuropathy (LHON) Genetic Testing
WV-L-180/4Kscore for Prostate Cancer Risk Assessment
WV-L-181/Prolaris for Prostate Cancer Prognosis
WV-L-182/Chromosome Analysis for Blood, Bone Marrow, and Solid Tumor Cancers
WV-L-183/Expanded Carrier Screening Panels
WV-L-184/Hereditary Cancer Syndrome Multigene Panels
WV-L-185/APOE Variant Analysis for Alzheimer Disease
WV-L-186/Bloom Syndrome Testing
WV-L-187/Flow Cytometry
WV-L-188/Huntington Disease Testing
WV-L-189/Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) Genetic Testing
WV-L-190/MGMT Testing for Malignant Glioma Alkylating Agent Response
WV-L-25/Mammaprint 70-Gene Breast Cancer Recurrence Assay
WV-L-34/Genetic Testing
WV-L-39/Anser ADA and Anser IFX
WV-L-41/Prosigna Breast Cancer Prognostic Gene Signature Assay
WV-L-63/Vitamin D Assay Testing
WV-L-97/Prenatal Aneuploidy FISH Testing
WV-L-98/Prenatal Chromosome Analysis
WV-L-99/Prenatal Maternal Serum Screening
WV-M-20/Magnetoencephalography and Magnetic Source Imaging
WV-M-62/Polysomnography for Non-Respiratory Sleep Disorders
WV-O-19/Ostomy Supplies
WV-O-5/Powered Robotic Lower Body Exoskeleton Devices
WV-O-6/Enteral Nutrition
WV-Q-4/Private Duty Nursing
WV-R-23/Radiation Therapy Following Breast Conserving Surgery
WV-S-129/Mastectomy and Reconstructive Surgery
WV-S-137/Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
WV-S-143/Donor Leukocyte Infusion for Hematologic Malignancies that Relapse after Allogeneic Stem Cell Transplant
WV-S-160/Preventable Serious Adverse Events
WV-S-239/Minimally Invasive Microdiscectomy
WV-S-242/Patient Temporarily Unsuitable for Organ Transplant, OPTN and UNOS Status 7
WV-S-31/Arthrocentesis or Needling of Bursa
WV-S-33/Bio-Engineered Skin and Soft Tissue Substitutes
WV-S-51/Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
WV-S-69/Surgical Treatment of Lymphedema
WV-V-16/Speech Therapy
WV-V-21/Physician Certification and Recertification of Home Health Services
WV-V-23/Temporomandibular Joint (TMJ)Dysfunction
WV-V-3/Provider Billing of Observation Services
WV-V-37/Autism Spectrum Disorders
WV-V-39/Mental Illness Coverage
WV-V-44/Medical Nutrition Management Services (MNT)
WV-Y-1/Physical Medicine
WV-Y-2/Occupational Therapy
WV-Y-20/Biofeedback
WV-Y-9/Manipulation Services
WV-Z-24/Miscellaneous Services
WV-Z-27/Eligible Providers and Supervision Guidelines
WV-Z-3/Hyperbaric Oxygen (HBO)
WV-Z-7/Electrical Nerve Stimulation
MA Policy Number
Please Select
NoPolicy/all
HMK-S-208/Cochlear Implantation
MA N-174/Outpatient Physicial Medicine and Rehabilitation Services, PT and OT
MA N-248/Percutaneous Left Atrial Appendage Closure NCD - 20.34
MA-A-2/Administration of Anesthesia by the Surgeon
MA-A-4/Monitored Anesthesia Care (MAC)
MA-A-9/Services Performed in Conjunction with the Adminis
MA-E-1/Screening List for Durable Medical Equipment (DME)
MA-E-15/Home Blood Glucose Monitors
MA-E-17/Portable (External) Infusion Pump
MA-E-18/Heating Pads and Heat Lamps
MA-E-19/Home Use of Oxygen and Oxygen Equipment
MA-E-2/Bowel Management Devices
MA-E-20/Positive Airway Pressure for the Treatment of OSA
MA-E-21/Oral Appliances for Obstructive Sleep Apnea
MA-E-23/Transcutaneous Electrical Nerve Stimulators (TENS)
MA-E-31/Negative Pressure Wound Therapy (NPWT) Pumps
MA-E-32/Nebulizers
MA-E-34/Respiratory Assist Devices
MA-E-35/Ultrasonic Osteogenic Stimulator
MA-E-36/Speech Generating Devices
MA-E-4/Home Dialysis Supplies and Equipment
MA-E-43/Infrared Heating Pad Systems
MA-E-49/Seat Lift Mechanisms
MA-E-52/Manual Wheelchair Bases
MA-E-55/Wheelchair Seating
MA-E-56/Wheelchair Options/Accessories
MA-E-58/Automatic External Defibrillators
MA-E-60/Power Mobility Devices
MA-E-63/Hospital Beds and Accessories
MA-E-64/Pressure Reducing Support Surfaces Group 1
MA-E-65/Pressure Reducing Support Surfaces Group 2
MA-E-66/Pressure Reducing Support Surfaces Group 3
MA-E-67/Cold Therapy
MA-E-68/High Frequency Chest Wall Oscillation Devices
MA-E-69/Canes and Crutches
MA-E-7/Pneumatic Compression Devices
MA-E-70/Cervical Traction Devices
MA-E-71/Commodes
MA-E-72/Intrapulmonary Percussive Ventilation System
MA-E-73/Mechanical In-exsufflation Devices
MA-E-74/Suction Pumps
MA-E-75/Surgical Dressings
MA-E-76/Walkers
MA-E-77/Tumor Treatment Field Therapy (TTFT)
MA-E-78/Transcutaneous Electrical Joint Stimulation Devices (TEJSD)
MA-E-8/Patient Lifts
MA-G-17/Pulmonary Rehabilitation Program Services
MA-G-25/Hyaluronan Acid Therapies for Osteoarthritis of the Knee
MA-G-41/Wireless Capsule Endoscopy
MA-G-42/Removal of Impacted Cerumen
MA-G-50/Oral Antiemetic Drugs (Replacement for Intravenous
MA-G-51/Oral Anticancer Drugs
MA-I-10/Thrombolytic Agents
MA-I-103/Intravenous Immune Globulin
MA-I-104/Billing and Coding Information Regarding Uses, Inc
MA-I-105/Approved Drugs and Biologicals; Includes Cancer Ch
MA-I-106/Provenge (sipuleucel-T)
MA-I-107/Injectable Collagenase Clostridium Histolyticum fo
MA-I-108/Qutenza (capsaicin) 8% Patch
MA-I-109/Pneumococcal Vaccine
MA-I-112/ziv-aflibercept (Zaltrap
MA-I-113/Ado-trastuzumab emtansine (Kadcyla)
MA-I-114/Levoleucovorin
MA-I-115/Pertuzumab for Treatment of Malignancies
MA-I-116/Ofatumumab (Arzerra)
MA-I-117/Panitumumab (Vectibix)
MA-I-118/Alemtuzumab (Lemtrada)
MA-I-119/Eribulin Mesylate (Halaven)
MA-I-12/Luteinizing Hormone-Releasing Hormone
MA-I-120/Oncologic Indications for PD-1 Blocking Antibodies
MA-I-120/Oncologic Indications for PD-1 Blocking Antibodies
MA-I-121/Repository Corticotropin (H.P. Acthar)
MA-I-122/Treatment of Hereditary Angioedema
MA-I-123/Fulvestrant (Faslodex)
MA-I-124/Azacitidine (Vidaza)
MA-I-126/Prolastin C, Aralast NP, Zemaira, Glassia (alpha1-proteinase inhibitors infusions)
MA-I-126/Aralast, Prolastin, Zemaira
MA-I-127/Blinatumomab (Blincyto)
MA-I-128/Decitabine (Dacogen)
MA-I-129/Vedolizumab (Entyvio)
MA-I-130/Eculizumab (Soliris)
MA-I-131/Alpha-1 Proteinase Inhibitor (Glassia)
MA-I-132/Agalsidase beta (Fabrazyme)
MA-I-133/Ixabepilone (IXEMPRA)
MA-I-134/Alglucosidase alfa (Lumizyme, Myozyme)
MA-I-135/Laronidase (Aldurazyme)
MA-I-136/Brentuximab Vedotin (Adcetris)
MA-I-137/GAZYVA (obinutuzumab)
MA-I-138/VIMIZIM (elosulfase alfa)
MA-I-139/Ustekinumab (Stelara)
MA-I-140/galsulfase (Naglazyme)
MA-I-142/Proprotein Convertase Subtilisin Kexin 9 (PCSK9) Inhibitors
MA-I-145/Testosterone Androgens
MA-I-146/Mepolizumab (NUCALA)
MA-I-147/Talimogene Laherparepvec (Imlygic)
MA-I-148/Cyramza (Ramucirumab)
MA-I-150/DarzalexTM (daratumumab)
MA-I-156/Prolonged Drug and Biological Infusions Started Incident To a Physicians Service Using an External Pump
MA-I-157/Nusinersen (SpinrazaTM)
MA-I-159/Oncologic Indications for Histone Deacetylase (HDAC) Inhibitors
MA-I-161/Irinotecan Liposomal (Onivyde)
MA-I-20/Denosumab (Prolia, Xgeva)
MA-I-24/Irinotecan (Camptosar)
MA-I-25/Docetaxel (Taxotere)
MA-I-28/Infliximab (Remicade)
MA-I-28/Infliximab (Remicade)
MA-I-3/Allergen Immunotherapy
MA-I-30/Carboplatin (Paraplatin)
MA-I-32/Gemcitabine (Gemzar)
MA-I-38/Rituximab (Rituxan)
MA-I-4/Hemophilia Factor Products
MA-I-48/Oxaliplatin (Eloxatin) Chemotherapy Usage
MA-I-51/Self Administered Drug Exclusion
MA-I-52/Palonosetron Hydrochloride (Aloxi)
MA-I-54/Paclitaxel (Taxol)
MA-I-55/Bendamustine (Treanda)
MA-I-56/Granulocyte Colony-Stimulating Factors (Pegfilgrastim and Filgrastim)
MA-I-57/MA I-57 Carfilzomib (Kyprolis)
MA-I-59/Ipilimumab (Yervoy)
MA-I-65/Paclitaxel, albumin-bound (Abraxane)
MA-I-67/Botulinum Toxin Type A and B
MA-I-68/Treatment of Gauchers Disease
MA-I-69/Cetuximab (Erbitux)
MA-I-7/Epoetin alfa
MA-I-74/Pemetrexed (Alimta)
MA-I-75/Bevacizumab (Avastin)
MA-I-79/Plerixafor (Mozobil)
MA-I-8/Immunizations
MA-I-83/VELCADE (bortezomib)
MA-I-84/Trastuzumab (Herceptin) Chemotherapy Usage
MA-I-84/Trastuzumab (Herceptin)
MA-I-85/Natalizumab (Tysabri)
MA-I-93/Idursulfase (Elaprase)
MA-I-94/Intravitreal Injections
MA-I-98/Immunosuppressive Drugs in Transplant Patients
MA-L-1/Screening Pap Smears and Pelvic Examinations
MA-L-104/GeneSight Assay for Refractory Depression
MA-L-105/Pharmacokinetic Testing for Chemotherapy Dosing
MA-L-153/Frequency of Laboratory Tests
MA-L-154/Glycated Hemoglobin/Glycated Protein
MA-L-160/BRCA1 and BRCA2 Genetic Testing
MA-L-45/Lipids Testing
MA-L-50/Blood Glucose Testing
MA-L-58/Oncologic In Vitro Chemoresponse Assays
MA-L-62/Parathormone (Parathyroid Hormone)
MA-L-63/Vitamin D Assay Testing
MA-L-64/C-Reactive Protein Testing
MA-L-68/Flow Cytometry
MA-L-8/Circulating Tumor Cell (CTC) Assay
MA-L-81/Qualitative Drug Testing
MA-L-83/RedPath - PathFinder TG
MA-L-84/Blood Glucose Monitoring in a Skilled Nursing Faci
MA-L-85/B-Type Peptide (BNP) Assays
MA-L-86/Cytogenetic Analysis
MA-L-87/Rast Type Tests
MA-L-88/Vitamin B12 Assays
MA-L-89/OVA-1 Assay
MA-L-9/Corus CAD Test
MA-L-91/Assay for Vitamins and Metabolic Function
MA-L-92/MolDX: Afirma Assay by Veracyte
MA-L-95/Oncotype DX Colon Cancer Assay
MA-L-96/Biomarkers for Oncology
MA-L-99/Biomarkers Overview
MA-M-1/Neuromuscular Junction Testing
MA-M-123/Neurophysiology Evoked Potentials (NEPs)
MA-M-124/Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure
MA-M-127/Single Chamber and Dual Chamber Permanent Cardiac Pacemakers Cardiac Pacemakers
MA-M-127/Single Chamber and Dual Chamber Permanent Cardiac Pacemakers Cardiac Pacemakers
MA-M-129/Electrocardiographic Services
MA-M-31/Cardiovascular Stress Testing
MA-M-36/Fluorescein Angiography
MA-M-37/Fundus Photography
MA-M-39/Non-invasive Peripheral Arterial Studies
MA-M-4/Molecular Diagnostics: Genitourinary Infectious Disease Testing and Other Applications for Amplified Probe Testing
MA-M-40/Noninvasive Peripheral Venous Studies
MA-M-43/Noninvasive Cerebrovascular Arterial Studies
MA-M-44/Ophthalmoscopy, Extended
MA-M-45/Electrocardiography
MA-M-47/Visual Fields
MA-M-48/Sacral Nerve Stimulation
MA-M-55/Intraoperative Neurophysiological Testing
MA-M-57/3D Interpretation and Reporting of Imaging Studies
MA-M-58/Dynamic Electrocardiography
MA-M-60/Home-Based, Real-Time Cardiac Surveillance System
MA-M-62/Scanning Computerized Ophthalmic Diagnostic Imagin
MA-M-67/Cardiac Rhythm Device Evaluation
MA-M-71/Diagnostic Laryngoscopy
MA-M-75/Electromyography (EMG) and Nerve Conduction Studie
MA-M-76/Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
MA-M-77/Autonomic Function Tests
MA-M-78/Pulmonary Function Testing
MA-M-79/Independent Diagnostic Testing Facility
MA-M-80/Continuous Glucose Monitoring (CGM)
MA-M-82/Vestibular and Audiologic Function Studies
MA-N-1/Cardiac Rehabilitation Programs
MA-N-1/Cardiac Rehabilitation Programs
MA-N-10/Ambulatory Blood Pressure Monitoring (ABPM)
MA-N-100/Multiple Surgical Procedures
MA-N-102/Aprepitant for Chemotherapy-Induced Emesis
MA-N-103/Intravenous Immune Globuling (IVIG) for the Treatment of Autoimmune Mucocutaneous Blistering Diseases - NCD 250.3
MA-N-104/Anti-Cancer Chemotherapy for Colorectal Cancer
MA-N-105/Screening for the Human Immunodeficiency Virus (HI
MA-N-106/Intravenous Iron Therapy
MA-N-107/Levocarnitine for Use in the Treatment of Carnitin
MA-N-108/Anti-Inhibitor Coagulant Complex (AICC)
MA-N-109/Vagus Nerve Stimulation
MA-N-110/Endothelial Cell Photography
MA-N-111/Diagnostic Pap Smears
MA-N-112/Co-Surgery
MA-N-113/Nurse Practitioner Services
MA-N-114/Clinical Social Worker
MA-N-115/Clinical Nurse Specialist Services
MA-N-116/Services of Physicians Assistants
MA-N-117/Services of Nurse Midwives
MA-N-118/Anesthesia Services Provided by a Qualified Anesth
MA-N-119/Clinical Psychologist Services
MA-N-12/Digital Subtraction Angiography
MA-N-120/Team Surgery
MA-N-121/Cardiac Output Monitoring by Thoracic Electrical B
MA-N-122/Implantable Infusion Pump
MA-N-123/Transmyocardial Revascularization
MA-N-124/Intraoperative Ventricular Mapping
MA-N-125/External Counterpulsation (ECP)
MA-N-126/Biofeedback Therapy
MA-N-127/Electrocardiographic Services
MA-N-128/Ambulatory EEG Monitoring
MA-N-129/Transplantations
MA-N-13/Arthroscopic Lavage and Arthroscopic Debridement f
MA-N-130/Payment for Anesthesia Services
MA-N-131/Treatment of Obesity and Bariatric Surgery for Tre
MA-N-132/Cavernous Nerves by Electrical Stimulation with Pe
MA-N-133/Cryosurgery of the Prostate
MA-N-134/Pheresis Therapy (Apheresis)
MA-N-135/Plethysmography
MA-N-136/Porcine Skin and Gradient Pressure Dressings - NCD
MA-N-137/Electroencephalographic Monitoring During Surgical
MA-N-138/Microsurgery
MA-N-139/Stem Cell Transplantation
MA-N-14/Electrical Stimulation (ES) and Electromagnetic Th
MA-N-140/Collection and Handling of Specimens
MA-N-142/Gravlee Jet Washer-NCD 230.5
MA-N-143/Breast Reconstruction Following Mastectomy
MA-N-144/Multiple Endoscopic Procedures
MA-N-145/Cosmetic Surgery vs. Reconstructive Surgery
MA-N-146/Histocompatibility Testing- NCD 190.1
MA-N-147/Cytogenic Studies
MA-N-148/Induced Lesions of Nerve Tracts NCD 160.1
MA-N-149/Transcatheter Treatment of Non-Coronary Vascular S
MA-N-15/Diabetes Self-Management Training (DSMT)
MA-N-150/Initial Preventive Physical Examination (IPPE) Ben
MA-N-152/Artificial Hearts and Related Devices
MA-N-153/Deep Brain Stimulation for Essential Tremor and Pa
MA-N-154/Carotid Sinus Nerve Stimulation
MA-N-155/Home Health Nurses Visits to Patients Requiring H
MA-N-156/Therapy for Pulmonary Conditions
MA-N-157/Treatment of Psoriasis
MA-N-158/Intensive Behavioral Therapy for Cardiovascular Di
MA-N-159/Percutaneous Image-Guided Breast Biopsy
MA-N-16/Lung Volume Reduction Surgery (Reduction Pneumopla
MA-N-160/Chemical Aversion Therapy for Treatment of Alcoholism
MA-N-161/Clinical Pathology Consultation Services
MA-N-162/Laboratory Tests for Chronic Renal Disease (CRD) P
MA-N-163/Repeat Surgical Procedures
MA-N-164/Subsequent Hospital Visits and Hospital Discharge
MA-N-166/Portable X-ray and ECG Services
MA-N-168/Sterilization
MA-N-169/Prolonged Services
MA-N-170/Physician Certification and Recertification of Hom
MA-N-171/Heartsbreath Test for Heart Transplant Rejection
MA-N-172/Thermal Intradiscal Procedures (TIPs)
MA-N-174/Outpatient Physicial Medicine and Rehabilitation Services, PT and OT
MA-N-175/Lumbar Artificial Disc Replacement (LADR)
MA-N-177/Services Provided for the Diagnosis and Treatment
MA-N-178/Diagnostic Endocardial Electrical Stimulation and
MA-N-18/Vertebral Artery Surgery and Extracranial-Intracra
MA-N-180/Deluxe or Special Features for Durable Medical Equ
MA-N-181/Medical Direction of Anesthesia Services
MA-N-182/Inpatient Hospital Pain Rehabilitation Programs
MA-N-183/Screening List for Prosthetics and Orthotics
MA-N-184/Repairs, Maintenance, and Replacement of Durable M
MA-N-185/Professional and Technical Components for Applicab
MA-N-186/Pronouncement of Death
MA-N-187/Hearing Aids and Auditory Implants
MA-N-189/Closed-Loop Blood Glucose Control Device (CBGCD) -
MA-N-19/Vertebral Axial Decompression (VAX-D)
MA-N-190/Hospital and Skilled Nursing Facility Admission Di
MA-N-191/Blood Transfusions - NCD 110.7
MA-N-192/Screening for Depression in Adults - NCD 210.9
MA-N-193/Pharmacogenomic Testing for Warfarin Response
MA-N-194/Pulmonary Rehabilitation
MA-N-195/Collagen Meniscus Implant
MA-N-196/Body Mass Measurement
MA-N-197/Coverage of Kidney Disease Patient Education Servi
MA-N-198/Dimethyl Sulfoxide (DMSO) - NCD 230.12
MA-N-199/Outpatient Hospital Pain Rehabilitation Programs (
MA-N-2/Treatment of facial Lipodystrophy Syndrome (LDS)
MA-N-20/Smoking and Tobacco-Use Cessation Counseling
MA-N-200/Phaco-Emulsification Procedure - Cataract Extracti
MA-N-201/Challenge Ingestion Food Testing NCD 110.12
MA-N-202/Ultrafiltration, Ultrafiltration Monitor, Hemoperfusion, and Hemofiltration - NCD 110.15, NCD 230.14
MA-N-203/Screening for Sexually Transmitted Infections (STI
MA-N-204/Transcatheter Aortic Valve Replacement (TAVR) NCD 20.32
MA-N-206/Acupuncture
MA-N-207/Blood Platelets Transfusion
MA-N-209/Carotid Body Resection / Carotid Body Denerveration
MA-N-21/Critical Care (See References Section)
MA-N-210/Uroflowmetric Evaluations
MA-N-213/Injection Sclerotherapy for Esophageal Bleeding
MA-N-214/Implantation of Gastroesophageal Reflux Device - NCD. 100.9
MA-N-217/Ultrasonic Surgery
MA-N-218/Vitrectomy
MA-N-219/Treatment of Decubitus Ulcers
MA-N-222/Hemodialysis for Treatment of Schizophrenia
MA-N-224/Treatment of Kidney Stones
MA-N-226/Prostate Cancer Screening Tests NCD 210.1
MA-N-226/Prostate Cancer Screening Tests NCD 210.1
MA-N-227/Sweat Test
MA-N-229/Autologous Blood-Derived Products for Chronic Non-Healing Wounds
MA-N-230/Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
MA-N-231/Transcutaneous Electrical Stimulation (TENS) for Chronic Low Back Pain (CLBP) - NCD 160.27
MA-N-232/MPPR for the Professional Component of Certain Diagnostic Imaging Procedures
MA-N-233/Screening for Hepatitis C Virus (HCV) in Adults
MA-N-234/Transcatheter Mitral Valve Repair (TMVR)
MA-N-235/Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions
MA-N-236/Blood Glucose Testing and Diabetes Screening
MA-N-237/Screening Pap Smears and Pelvic Examination
MA-N-238/Screening for Lung Cancer with Computed Tomography (LDCT)
MA-N-239/Colorectal Cancer Screening Tests -NCD 210.3
MA-N-24/Miscellaneous Services (National)
MA-N-240/Percutaneous Image-guided Lumbar Decompression for Lumbar Spinal Stenosis NCD 150.13
MA-N-241/Outpatient Hospital Services for Treatment of Alcoholism
MA-N-241/Outpatient Hospital Services for Treatment of Alcoholism
MA-N-242/Computer Enhanced Perimetry-NCD 80.9
MA-N-242/Computer Enhanced Perimetry-NCD 80.9
MA-N-243/Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic-NCD-130.3
MA-N-244/Consultation Services Rendered by a Podiatrist in a Skilled Nursing Facility
MA-N-245/Serologic Testing for Acquired Immunodeficiency Syndrome (AIDS)
MA-N-246/Intraocular Photography NCD 80.6
MA-N-247/Water Purification and Softening Systems Used in Conjunction with Home Dialysis NCD 230.7
MA-N-248/Percutaneous Left Atrial Appendage Closure (LAAC) NCD 20.34
MA-N-25/Displacement Cardiokymography (CKG)
MA-N-26/Scalp Hypothermia during Chemotherapy to Prevent H
MA-N-27/Clinical Trials
MA-N-28/Assistant at Surgery Services
MA-N-29/Services Performed in Conjunction with the Adminis
MA-N-3/Hyperbaric Oxygen (HBO) Therapy
MA-N-30/Investigational Device Exemption (IDE) Clinical Tr
MA-N-31/Ocular Photodynamic Therapy
MA-N-32/Serum Iron Studies
MA-N-35/Gamma Glutamyl Transferase
MA-N-36/Screening and Behavioral Counseling Interventions
MA-N-37/Stereotaxic Depth Electrode Implantation - NCD 160
MA-N-38/Partial Thromboplastin Time
MA-N-39/Immediate Relatives or Household Members
MA-N-4/Medical Nutrition Therapy - NCD 180.1
MA-N-40/Neuromuscular Electrical Stimulators (NMES)
MA-N-41/Intensive Behavioral Therapy for Obesity
MA-N-42/Magnetic Resonance Imaging (MRI)
MA-N-43/Magnetic Resonance Spectroscopy (MRS)
MA-N-44/Glycated Hemoglobin/Glycated Protein
MA-N-45/Lipids - NCD 190.23
MA-N-46/Thyroid Testing
MA-N-47/Diagnostic Breath Analysis
MA-N-48/Carcinoembryonic Antigen
MA-N-49/Single Photon Emission Computed Tomography (SPECT)
MA-N-5/Manual Manipulation
MA-N-51/Electrocardiogram and X-ray Interpretation
MA-N-52/Prostatic Specific Antigen (PSA) and Prostate Canc
MA-N-53/Digoxin Therapeutic Drug Assay
MA-N-54/Urine Culture, Bacterial
MA-N-55/Implanted Peripheral Nerve Stimulator
MA-N-56/Blood Counts
MA-N-57/Prothrombin Time
MA-N-58/Magnetic Resonance Angiography (MRA)
MA-N-59/Implantable Automatic Cardioverter-Defibrillator
MA-N-6/Nesiritide for Treatment of Heart Failure Patients
MA-N-60/Telemedicine/Telehealth Services
MA-N-61/Noncontact Normothermic Wound Therapy (NNWT)
MA-N-62/INDEPENDENCE iBOT 4000 Mobility System
MA-N-63/Intraocular Lens (Pseudophakos)
MA-N-64/Mammography
MA-N-65/Glaucoma Screening
MA-N-66/T-Wave Alternans
MA-N-67/Wrong Surgery
MA-N-68/Cochlear Implantation
MA-N-69/Multiple Procedure Payment Reduction for the Techn
MA-N-7/Home Prothrombin Time INR Monitoring for Anticoagu
MA-N-70/Alpha-Fetoprotein
MA-N-71/Fecal Occult Blood
MA-N-72/Collagen Crosslinks, Any Method
MA-N-73/Human Chorionic Gonadotropin
MA-N-74/Hepatitis Panel
MA-N-75/Human Immunodeficiency Virus Testing (Diagnosis)
MA-N-76/Human Immunodeficiency Virus Testing (Prognosis In
MA-N-77/Tumor Antigen by Immunoassay
MA-N-78/Tumor Antigen by Immunoassay
MA-N-79/Tumor Antigen by Immunoassay
MA-N-8/Extracorporeal Photopheresis
MA-N-80/Hydrophilic Soft Contact Lenses
MA-N-81/Lymphocyte Mitogen Response Assays
MA-N-83/Diagnostic Ultrasound Procedures
MA-N-84/Air Ambulance Services
MA-N-85/Dorsal Column (Spinal Cord) Neurostimulation
MA-N-86/Percutaneous Electrical Nerve Stimulation (PENS)
MA-N-87/Transcutaneous Electrical Nerve Stimulation (TENS)
MA-N-89/Physician Laboratory and Pathology Services
MA-N-90/Cardiac Pacemakers
MA-N-91/Therapeutic Embolization - NCD 20.28
MA-N-92/Electron Microscope - NCD 190.4
MA-N-94/CT Scans
MA-N-95/Sacral Nerve Stimulation
MA-N-96/Abortion
MA-N-97/Outpatient Intravenous Insulin Treatment (Therapy)
MA-N-98/Annual Wellness Visit (AWV), Including Personalize
MA-N-99/Global Surgery
MA-O-12/Foot Orthotics for conditions Other Than Diabetes
MA-O-16/Parenteral Nutrition
MA-O-17/Therapeutic shoes for Persons with Diabetes
MA-O-18/External Breast Prostheses
MA-O-19/Ostomy Supplies
MA-O-20/Tracheostomy Care Supplies
MA-O-21/Facial Prostheses
MA-O-22/Spinal Orthoses: TLSO and LSO
MA-O-23/Eye Prosthesis
MA-O-24/Ankle-Foot/Knee-Ankle-Foot Orthosis
MA-O-25/Lower Limb Prostheses
MA-O-26/Refractive Lenses
MA-O-27/Urological Supplies
MA-O-27/Urological Supplies
MA-O-28/Knee Orthoses
MA-O-29/Oral Maxillofacial Prosthesis
MA-O-3/Enteral Nutrition
MA-O-30/Vacuum Erection Devices
MA-O-9/Screening List for Prosthetic Devices
MA-P-1/Coverage Requirements for Routine Foot Care and De
MA-P-2/Ankle-Foot/Knee-Ankle-Foot Orthosis
MA-Q-4/Private Duty Nursing
MA-R-13/Radiation Therapy Services
MA-R-14/Stereotactic Body Radiation Therapy (SBRT)
MA-R-15/PET and PET/CT Scans Used for Non-Oncologic Condit
MA-R-16/PET and PET and PET/CT Scans Used for Oncologic Co
MA-R-18/Proton Beam Therapy
MA-R-21/Stereotactic Radiosurgery
MA-R-5/Cardiovascular Nuclear Medicine
MA-R-60/Multiple Imaging in Oncology
MA-R-61/Intensity Modulated Radiation Therapy (IMRT)
MA-S-105/Non-Coronary Vascular Stents
MA-S-126/Mohs Micrographic Surgery (MMS)
MA-S-134/Blepharoplasty/Blepharoptosis
MA-S-139/Human Skin Equivalents (HS)
MA-S-14/Cataract Surgery
MA-S-145/Transoral Incisionless Fundoplication (TIF)
MA-S-147/Vertebroplasty, Vertebral Augmentation (Kyphoplasty), Percutaneous
MA-S-168/Wound Care Debridement
MA-S-170/Infrared Photocoagulation (IRC) of Hemorrhoids
MA-S-178/Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
MA-S-178/Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
MA-S-184/Complex Cataract Extraction
MA-S-192/Isolated Ultrafiltration for Management of Gluid O
MA-S-195/Removal of Benign or Premalignant Skin Lesions
MA-S-196/Removal of Benign or Premalignant Skin Lesions
MA-S-199/Co-Management of Surgical Procedures
MA-S-20/Hemodialysis Vascular Access Evaluation and Maintenance
MA-S-200/Thermotherapies [Minimally Invasive Surgical Techn
MA-S-201/Radiofrequency Treatment for Urinary Incontinence
MA-S-203/Bariatric Surgical Management of Morbid Obesity
MA-S-205/Prostate Mapping Biopsy
MA-S-206/Bariatric Surgical Management of Morbid Obesity
MA-S-207/Glaucoma Treatment with Aqueous Drainage Device
MA-S-212/Artificial Hearts and Related Devices
MA-S-213/Billing and Coding for Rezum Procedure
MA-S-218/Endovascular Repair of Aortic Aneurysms
MA-S-221/Cosmetic Surgery vs. Reconstructive Surgery
MA-S-32/Implantable Hormone Replacement Pellets
MA-S-39/Lower Extremity Major Joint Replacement (Hip and Knee)
MA-S-40/Implantable Infusion Pump
MA-S-55/Treatment of Varicose Veins of the Lower Extremiti
MA-S-72/Surgical Treatment of Nails
MA-T-2/Covered Ambulance Services
MA-T-3/Air Ambulance Services
MA-V-1/Cardiac Rehabilitation Programs
MA-V-16/Speech-Language Pathology (SLP Services: Communica
MA-V-34/Observation Care
MA-V-41/Psychiatric Therapeutic Procedures
MA-V-42/Coverage of Services and Procedures in Nursing Fac
MA-V-43/Evaluation and Management Services in a Nursing Fa
MA-V-44/Medical Nutrition Therapy (MNT)
MA-V-7/Psychiatric Codes
MAWV-I-150/DarzalexTM (daratumumab)
MA-X-10/Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
MA-X-12/Diagnostic Abdominal Aortography and Renal Angiography
MA-X-24/Bone Mass Measurements
MA-X-28/Magnetic Resonance Angiography (MRA)
MA-X-31/Radiologic Examination of the Chest
MA-X-4/Multiple Imaging in Oncology
MA-X-44/Magnetic Resonance Imaging (MRI) of the Breast
MA-X-45/Computed Tomographic Angiography (CTA) of the Ches
MA-X-47/Ophthalmic Biometry for Intraocular Lens (IOL) Pow
MA-X-52/Non-vascular Extremity Ultrasound
MA-X-61/Transesophageal Echocardiography (TEE)
MA-X-68/Transthoracic Echocardiography (TTE)
MA-X-69/Multiple Procedure Payment Reduction for the Technical Component of Certain Diagnostic Imaging Procedures
MA-X-7/Ophthalmic Echography and Biometry
MA-X-71/Barium Swallow Studies, Modified
MA-Y-1/Physical Therapy and Rehabilitation Services
MA-Y-14/Speech-Language Pathology (SLP) Services: Dysphagi
MA-Y-17/End-Diastolic Pneumatic Compression Therapy
MA-Y-18/Magnetic Pelvic Floor Stimulation (MPFS)
MA-Y-3/Therapy for Pulmonary Conditions
MA-Y-5/Hydration Therapy
MA-Y-6/Isolated Ultrafiltration for Management of Fluid Overload in Cardiac Disease
MA-Z-11/Definition of Medical Necessity
MA-Z-14/Services that are not reasonable and necessary
MA-Z-26/Allergy Testing
MA-Z-3/Hyperbaric Oxygen (HBO) Therapy
MA-Z-30/Frequency of Dialysis
MA-Z-4/Transcranial Magnetic Stimulation for Severe Depression
MA-Z-50/Spinal Cord Stimulation (Dorsal Column Stimulation)
MA-Z-56/Trigger Point Injections
MA-Z-57/Lacrimal Punctum Plugs
MA-Z-6/Chiropractic Services
MA-Z-61/Transforaminal Epidural, Paravertebral Facet Joint Nerve Block and Sacroliliac Joint Injection
MA-Z-62/Pain Management of Peripheral Nerves by Injection
MA-Z-67/Posterior Tibial Nerve Stimulation
MA-Z-68/Telemedicine/Telehealth Services
MA-Z-8/Sleep Disorder Testing
MA-Z-81/Oximetry Services
MA-Z-82/Spinal Cord Stimulation (Dorsal Column Stimulation)
MA-Z-91/Strapping
MA-Z-92/Microvascular Therapy
MA-Z-93/Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device)
WV-I-158/Neulasta (pegfilgrastim) Onpro Kit (On-body Injector)
WVMA-A-2/Administration of Anesthesia by the Surgeon or Assistant Surgeon
WVMA-A-3/Anesthesia Services Provided by a Qualified Anesthetist
WVMA-A-9/Services Performed in Conjunction with the Administration of Anesthesia
WVMA-E-1/Screening List for Durable Medical Equipment (DME)
WVMA-E-15/Home Blood Glucose Monitors
WVMA-E-17/Portable (External) Infusion Pump
WVMA-E-18/Heating Pads and Heat Lamps
WVMA-E-19/Home Use of Oxygen and Oxygen Equipment
WvMA-E-2/Bowel Management Devices
WVMA-E-20/Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
WVMA-E-21/Oral Appliances for Obstructive Sleep Apnea
WVMA-E-23/Transcutaneous Electrical Nerve Stimulators (TENS)
WVMA-E-31/Negative Pressure Wound Therapy (NPWT) Pumps
WVMA-E-32/Nebulizers
WVMA-E-34/Respiratory Assist Devices
WVMA-E-35/Ultrasonic Osteogenic Stimulator
WVMA-E-36/Speech Generating Devices
WVMA-E-4/Home Dialysis Supplies and Equipment
WVMA-E-43/Infrared Heating Pad Systems
WVMA-E-49/Seat Lift Mechanisms
WVMA-E-52/Manual Wheelchair Bases
WVMA-E-55/Wheelchair Seating
WVMA-E-56/Wheelchair Options/Accessories
WVMA-E-58/Automatic External Defibrillators
WVMA-E-60/Power Mobility Devices
WVMA-E-63/Hospital Beds and Accessories
WVMA-E-64/Pressure Reducing Support Surfaces - Group 1
WVMA-E-65/Pressure Reducing Support Surfaces - Group 2
WVMA-E-66/Pressure Reducing Support Surfaces - Group 3
WVMA-E-67/Cold Therapy
WVMA-E-68/High Frequency Chest Wall Oscillation Devices
WVMA-E-69/Canes and Crutches
WVMA-E-7/Pneumatic Compression Devices
WVMA-E-70/Cervical Traction Devices
WVMA-E-71/Commodes
WVMA-E-72/Intrapulmonary Percussive Ventilation System
WVMA-E-73/Mechanical In-exsufflation Devices
WVMA-E-74/Suction Pumps
WVMA-E-75/Surgical Dressings
WVMA-E-76/Walkers
WVMA-E-77/Tumor Treatment Field Therapy (TTFT)
WVMA-E-8/Patient Lifts
WVMA-E-81/Spiracur SNaP Wound Care System
WVMA-G-41/Wireless Capsule Endoscopy
WVMA-G-5/Neuromodulation for Fecal Incontinence
WVMA-G-50/Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
WVMA-G-51/Oral Anticancer Drugs
WVMA-G-52/Hyaluronate Polymers
WVMA-G-53/Wireless Gastrointestinal Motility Monitoring Systems
WVMA-I-100/Avastin Coverage for Intraocular Use
WVMA-I-103/Intravenous Immune Globulin
WVMA-I-106/Sipuleucel-T (Provenge)
WVMA-I-110/Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions
WVMA-I-111/KRAS Testing Required before Epidermal Growth Factor Receptor Antibody Use in Colorectal Cancer
WVMA-I-117/Panitumumab(Vectibix)
WVMA-I-118/Alemtuzumab (Lemtrada)
WVMA-I-119/Eribulin Mesylate (Halaven)
WVMA-I-120/Oncologic Indications for PD-1 Blocking Antibodies
WVMA-I-122/Treatment of Hereditary Angioedema
WVMA-I-123/Fulvestrant (Faslodex)
WVMA-I-124/Azacitidine (Vidaza)
WVMA-I-126/Aralast, Prolastin, Zemaira
WVMA-I-126/Prolastin C, Aralast NP, Zemaira, Glassia (alpha1-proteinase inhibitors infusions)
WVMA-I-127/Blinatumomab (Blincyto)
WVMA-I-128/Decitabine (Dacogen)
WVMA-I-129/Vedolizumab (Entyvio)
WVMA-I-130/Eculizumab (Soliris)
WVMA-I-131/Alpha-1 Proteinase Inhibitor (Glassia)
WVMA-I-132/Agalsidase beta (Fabrazyme)
WVMA-I-133/Ixabepilone (IXEMPRA)
WVMA-I-134/Alglucosidase alfa (Lumizyme, Myozyme)
WVMA-I-135/Laronidase (Aldurazyme)
WVMA-I-136/Brentuximab Vedotin (Adcetris)
WVMA-I-137/GAZYVA (obinutuzumab)
WVMA-I-138/VIMIZIM (elosulfase alfa)
WVMA-I-139/Ustekinumab (Stelara)
WVMA-I-140/galsulfase (Naglazyme)
WVMA-I-142/Proprotein Convertase Subtilisin Kexin 9 (PCSK9) Inhibitors
WVMA-I-144/Drisapersen
WVMA-I-145/Testosterone Androgens
WVMA-I-146/Mepolizumab (NUCALA)
WVMA-I-147/Talimogene Laherparepvec (Imlygic)
WVMA-I-148/Cyramza (Ramucirumab)
WVMA-I-152/Radium Ra 223 dichloride (Xofigo)
WVMA-I-153/FDA Approved Ramucirumab (Cyramza)
WVMA-I-154/FDA Approves Iluvien for Diabetic Macular Edema
WVMA-I-155/Preventive Coverage for Certain Vaccines
WVMA-I-17/White Cell Colony Stimulating Factors
WVMA-I-27/Octreotide Acetate for Injectable Suspension (Sandostatin LAR Depot)
WVMA-I-28/Remicade
WVMA-I-3/Allergen Immunotherapy
WVMA-I-38/Rituximab (Rituxan)
WVMA-I-51/Self-Administered Drug Exclusion
WVMA-I-54/Paclitaxel (Taxol
WVMA-I-57/Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications
WVMA-I-65/Paclitaxel, albumin-bound (Abraxane)
WVMA-I-67/Chemodenervation
WVMA-I-68/Treatment of Gauchers Disease
WVMA-I-69/Cetuximab (Erbitux)
WVMA-I-75/Bevicizumab (Avastin)
WVMA-I-79/Plerixafor (Mozobil)
WVMA-I-79/Chemotherapy and Biologicals
WVMA-I-83/VELCADE (bortezomib)
WVMA-I-93/Idursulfase (Elaprase)
WVMA-I-94/Intravitreal Injections
WVMA-I-98/Immunosuppressive Drugs in Transplant Patients
WVMA-L-1/Screening Pap Smears and Pelvic Examinations
WVMA-L-100/CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
WVMA-L-101/NRAS Genetic Testing
WVMA-L-102/MoleDX Breast Cancer Index Genetic Assay
WVMA-L-103/MoleDX ConfirmMDx Epigenetic Molecular Assay
WVMA-L-104/MoleDX GeneSight Assay for Refractory Depression
WVMA-L-106/Prolaris Prostate Cancer Genomic Assay
WVMA-L-107/MOLDX: NSCLC, Comprehensive Genomic Profile Testing
WVMA-L-108/MolDX: Molecular RBC Phenotyping
WVMA-L-109/MolDX: Biomarkers in Cardiovascular Risk Assessment
WVMA-L-110/MolDX: Breast Cancer Assay: Prosigna
WVMA-L-111/MolDX: MGMT Promoter Methylation Analysis
WVMA-L-112/MOLDX: HLA-B15:02 GENETIC TESTING
WVMA-L-113/Special Histochemical Stains and Immunohistochemical Stains
WVMA-L-115/MolDX Genomic Health Oncotype DX Prostate Cancer
WVMA-L-116/MolDX Genetic Testing for BCR-ABL Negative Myeloprolifeative Disease
WVMA-L-117/Human Immunodeficiency Virus Testing (Prognosis Including Monitoring)
WVMA-L-118/Human Immunodeficiency Virus Testing (Diagnosis) and Serologic Testing for Acquired Immune Deficiency Syndrome
WVMA-L-119/MolDX: Serotonin Transporter genotyping (HTTLPR) Gene Testing
WVMA-L-120/MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
WVMA-L-121/MolDX: ATP7B Gene Tests Coding and Billing Guidelines
WVMA-L-122/MolDX: BluePrint Coding and Billing Guidelines
WVMA-L-123/MolDX: CHD7 Gene Analysis Coding and Billing Guidelines
WVMA-L-124/MolDX: Chromosome 1p/19q Deletion Analysis
WVMA-L-125/GlycoMark Testing for Glycemic Control
WVMA-L-126/Spiracur SNaP Wound Care System
WVMA-L-126/Spiracur SNaP Wound Care System
WVMA-L-127/4K Score Assay
WVMA-L-128/PreDx Diabetes Risk Score (DRS) (LCA A53489.)
WVMA-L-129/CDH1 Genetic Testing Coding and Billing Guidelines
WVMA-L-130/MolDX: CYP2B6 Test Coding and Billing Guidelines
WVMA-L-131/Darzalex Coding and Billing Guidelines and Indications
WVMA-L-132/MolDX: RPS19 Gene Tests Coding and Billing Guidelines
WVMA-L-133/MolDX: SEPT9 Gene Test Coding and Billing Guidelines
WVMA-L-134/MolDX: NSD1 Gene Tests Coding and Billing Guidelines
WVMA-L-135/MolDX: myPap Coding and Billing Guidelines
WVMA-L-136/MolDx: OncoCee Billing and Coding Guidelines
WVMA-L-137/MolDX: SULT4A1 Genetic Testing Coding and Billing Guidelines
WVMA-L-137/MolDX: SULT4A1 Genetic Testing Coding and Billing Guidelines
WVMA-L-138/MolDX: ENG and ACVRL1 Gene Tests Coding and Billing Guidelines
WVMA-L-139/MolDX: Immunohistochemistry (IHC) Indications for Breast Pathology
WVMA-L-140/MolDX: KIF6 Genotype Billing and Coding Guidelines
WVMA-L-141/MolDX: BRCA1 and BRCA2 Genetic Testing
WVMA-L-142/SLCO1B1 Genotype Coding and Billing Guidelines
WVMA-L-143/MolDX: PTCH1 Gene Testing Coding and Billing Guidelines
WVMA-L-144/MolDX: HBB Gene Tests Coding and Billing Guidelines
WVMA-L-145/LPA-Aspirin Genotype Coding and Billing Guidelines
WVMA-L-146/MolDX: TP53 Gene Test Coding and Billing Guidelines
WVMA-L-147/MolDX: TERC Gene Tests Coding and Billing Guidelines
WVMA-L-148/MolDX: SLCO1B1 Genotype Coding and Billing Guidelines
WVMA-L-149/MolDX- CDD: ProMark Risk Score
WVMA-L-150/MolDX: know error Billing and Coding Guidelines Update
WVMA-L-151/MolDX: L1CAM Gene Sequencing Coding and Billing Guidelines
WVMA-L-152/MolDX: HAX1 Gene Sequencing Coding and Billing Guidelines
WVMA-L-154/
WVMA-L-156/MolDX: LPA-Aspirin Genotype
WVMA-L-157/MolDX: VEGFR2 Tests Coding and Billing Guidelines
WVMA-L-158/MolDX: LPA-Intron 25 Genotype
WVMA-L-159/MolDX: 4q25-AF Risk Genotype Coding and Billing Guidelines
WVMA-L-4/Brain Natriuretic Peptide (BNP) Level
WVMA-L-45/Lipids Testing
WVMA-L-5/Flow Cytometry
WVMA-L-50/Blood Glucose Testing
WVMA-L-59/Chemosensitivity and Chemoresistance Assays
WVMA-L-66/Decipher Prostate Cancer Classifier Assay
WVMA-L-69/C-Reactive Protein
WVMA-L-7/Infectious Disease Molecular Diagnostic Testing
WVMA-L-8/Circulating Tumor Cell Markers Assays
WVMA-L-81/Controlled Substance Monitoring and Drugs of Abuse Testing
WVMA-L-82/MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin and MTHFR)
WVMA-L-9/Corus CAD Diagnostic Test
WVMA-L-90/Allergy Skin Testing
WVMA-L-91/Assays for Vitamins and Metabolic Function
WVMA-L-92/MolDX: Afirma Assay By Veracyte
WVMA-L-93/MolDX: 9p21 Genotype
WVMA-L-94/Hemoglobin A1c (HbA1c)
WVMA-L-95/Oncotype DX Colon Cancer Assay
WVMA-L-97/Molecular Diagnostic Tests (MDT)
WVMA-L-98/Genetic Testing for Lynch Syndrome
WVMA-M-1/Special Electroencephalography
WVMA-M-125/Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
WVMA-M-126/CT of the Abdomen and Pelvis
WVMA-M-128/Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
WVMA-M-130/Upper Gastrointestinal Endoscopy and Visualization
WVMA-M-130/Upper Gastrointestinal Endoscopy and Visualization
WVMA-M-131/Once in a Lifetime Abdominal Aortic Aneurysm (AAA) Screening
WVMA-M-132/Ophthalmic Angiography (Fluorescein and Indocyanine Green)
WVMA-M-28/Neuromuscular Electrodiagnostic Testing
WVMA-M-29/Cardiokymography (CKG)
WVMA-M-30/Pulmonary Stress Testing
WVMA-M-43/Non-invasive Vascular Testing (NIVT)
WVMA-M-44/Ocular Photography and Ophthalmoscopy
WVMA-M-45/Electrocardiography
WVMA-M-55/Intraoperative Neurophysiological Monitoring
WVMA-M-57/3D Interpretation and Reporting of Imaging Studies
WVMA-M-65/Corneal Pachymetry
WVMA-M-67/Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
WVMA-M-68/Bladder Tumor Markers
WVMA-M-75/Nerve Conduction Studies and Electromyography
WVMA-M-81/ Stress Echocardiography
WVMA-M-81/Stress Echocardiography
WVMA-M-82/Vestibular Function Testing
WVMA-M-84/Anoscopy
WVMA-N-1/Cardiac Rehabilitation Programs
WVMA-N-1/Cardiac Rehabilitation Programs
WVMA-N-10/Ambulatory Blood Pressure Monitoring (ABPM)
WVMA-N-100/Multiple Surgical Procedures
WVMA-N-102/Aprepitant for Chemotherapy-Induced Emesis
WVMA-N-103/Intravenous Immune Globulin (IVIG) for the Treatment of Autoimmune Mucocutaneous Blistering Diseases - NCD 250.3
WVMA-N-104/Anti-Cancer Chemotherapy for Colorectal Cancer
WVMA-N-105/Screening for the Human Immunodeficiency Virus (HIV) Infection
WVMA-N-106/Intravenous Iron Therapy
WVMA-N-108/Anti-Inhibitor Coagulant Complex (AICC)
WVMA-N-109/Vagus Nerve Stimulation
WVMA-N-110/Endothelial Cell Photography
WVMA-N-111/Diagnostic Pap Smears
WVMA-N-112/Co-Surgery
WVMA-N-113/Nurse Practitioner Services
WVMA-N-114/Clinical Social Worker
WVMA-N-115/Clinical Nurse Specialist Services
WVMA-N-116/Services of Physicians Assistants
WVMA-N-117/Services of Nurse Midwives
WVMA-N-118/Anesthesia Services Provided by a Qualified Anesthetist
WVMA-N-119/Clinical Psychologist Services
WVMA-N-12/Digital Subtraction Angiography
WVMA-N-120/Team Surgery
WVMA-N-121/Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
WVMA-N-122/Implantable Infusion Pump
WVMA-N-123/Transmyocardial Revascularization
WVMA-N-124/Intraoperative Ventricular Mapping
WVMA-N-125/External Counterpulsation (ECP)
WVMA-N-126/Biofeedback Therapy
WVMA-N-127/Electrocardiographic Services
WVMA-N-128/Ambulatory EEG Monitoring
WVMA-N-129/Transplantations
WVMA-N-13/Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee
WVMA-N-130/Payment for Anesthesia Services
WVMA-N-131/Treatment of Obesity and Bariatric Surgery for Treatment of Morbid Obesity
WVMA-N-132/Cavernous Nerves by Electrical Stimulation with Penile Plethysmography
WVMA-N-133/Cryosurgery of the Prostate
WVMA-N-134/Pheresis Therapy (Apheresis)
WVMA-N-135/Plethysmography
WVMA-N-136/Porcine Skin and Gradient Pressure Dressings - NCD 270.5
WVMA-N-137/Electroencephalographic Monitoring During Surgical Procedures Involving the Cerebral Vasculature - NCD 160.8
WVMA-N-138/Microsurgery
WVMA-N-139/Stem Cell Transplantation
WVMA-N-14/Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds
WVMA-N-140/Collection and Handling of Specimens
WVMA-N-141/Routine Foot Care and Debridement of Mycotic Nails
WVMA-N-142/Gravlee Jet Washer - NCD 230.5
WVMA-N-143/Breast Reconstruction Following Mastectomy
WVMA-N-144/Multiple Endoscopic Procedures
WVMA-N-145/Cosmetic Surgery vs. Reconstructive Surgery
WVMA-N-146/Histocompatibility Testing- NCD 190.1
WVMA-N-147/Cytogenetic Studies - NCD 190.3 - Archived 2/21/2011
WVMA-N-148/Induced Lesions of Nerve Tracts - NCD 160.1
WVMA-N-149/Transcatheter Treatment of Non-Coronary Vascular Stenosis
WVMA-N-15/Diabetes Self-Management Training (DSMT)
WVMA-N-150/Initial Preventive Physical Examination (IPPE) Benefit
WVMA-N-152/Artificial Hearts and Related Devices
WVMA-N-153/Deep Brain Stimulation for Essential Tremor and Parkinsons Disease
WVMA-N-154/Carotid Sinus Nerve Stimulation
WVMA-N-155/Home Health Nurses Visits to Patients Requiring Heparin Injection - NCD 290.2
WVMA-N-156/Therapy for Pulmonary Conditions
WVMA-N-157/Treatment of Psoriasis
WVMA-N-158/Intensive Behavioral Therapy for Cardiovascular Disease - 210.11
WVMA-N-159/Percutaneous Image-Guided Breast Biopsy
WVMA-N-16/Lung Volume Reduction Surgery (Reduction Pneumoplasty)
WVMA-N-160/Chemical Aversion Therapy for Treatment of Alcoholism - NCD 130.3
WVMA-N-161/Clinical Pathology Consultation Services
WVMA-N-162/Laboratory Tests for Chronic Renal Disease (CRD) Patients
WVMA-N-163/Repeat Surgical Procedures
WVMA-N-164/Subsequent Hospital Visits and Hospital Discharge Day Management Services
WVMA-N-165/Treatment of Actinic Keratosis - NCD 250.4
WVMA-N-166/Portable X-ray and ECG Services
WVMA-N-167/Hospital Observation Services (See Reference Section)
WVMA-N-168/Sterilization
WVMA-N-169/Prolonged Services
WVMA-N-170/Physician Certification and Recertification of Home Health Services
WVMA-N-171/Heartsbreath Test for Heart Transplant Rejection
WVMA-N-172/Thermal Intradiscal Procedures (TIPs)
WVMA-N-173/Speech-Language Pathology services
WVMA-N-174/Outpatient Physical Medicine and Rehabilitation Services, PT and OT (See Reference Section)
WVMA-N-175/Lumbar Artificial Disc Replacement (LADR)
WVMA-N-177/Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy)
WVMA-N-178/Diagnostic Endocardial Electrical Stimulation and HIS Bundle Studies
WVMA-N-179/Certain Drugs Distributed by the National Cancer Institute - NCD 110.2
WVMA-N-18/Vertebral Artery Surgery and Extracranial-Intracranial Arterial Bypass Surgery - NCD 20.1, 20.2
WVMA-N-180/Deluxe or Special Features for Durable Medical Equipment (DME)
WVMA-N-181/Medical Direction of Anesthesia Services
WVMA-N-182/Inpatient Hospital Pain Rehabilitation Programs - NCD 10.3
WVMA-N-183/Screening List for Prosthetics and Orthotics
WVMA-N-184/Repairs, Maintenance, and Replacement of Durable Medical Equipment (DME)
WVMA-N-185/Professional and Technical Components for Applicable Services
WVMA-N-186/Pronouncement of Death
WVMA-N-187/Hearing Aids and Auditory Implants
WVMA-N-189/Closed-Loop Blood Glucose Control Device (CBGCD) - NCD 40.3
WVMA-N-19/Vertebral Axial Decompression (VAX-D)
WVMA-N-190/Hospital and Skilled Nursing Facility Admission Diagnostic Procedures - NCD 70.5
WVMA-N-191/Blood Transfusions - NCD 110.7
WVMA-N-192/Screening for Depression in Adults - NCD 210.9
WVMA-N-193/Pharmacogenomic Testing for Warfarin Response
WVMA-N-194/Pulmonary Rehabilitation
WVMA-N-195/Collagen Meniscus Implant
WVMA-N-196/Bone Mass Measurements - NCD 150.3
WVMA-N-197/Coverage of Kidney Disease Patient Education Services (See Reference Section)
WVMA-N-198/Dimethyl Sulfoxide (DMSO) - NCD 230.12
WVMA-N-199/Outpatient Hospital Pain Rehabilitation Programs (10.4)
WVMA-N-2/Treatment of facial Lipodystrophy Syndrome (LDS)
WVMA-N-20/Smoking and Tobacco-Use Cessation Counseling
WVMA-N-200/Phaco-Emulsification Procedure - Cataract Extraction (80.10)
WVMA-N-201/Challenge Ingestion Food Testing - NCD 110.12
WVMA-N-202/Ultrafiltration, Ultrafiltration Monitor, Hemoperfusion, and Hemofiltration - NCD 110.15, NCD 230.14
WVMA-N-203/Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs - NCD 210.10
WVMA-N-205/Obsolete or Unreliable Diagnostic Tests - NCD 300.1
WVMA-N-206/Acupuncture - NCD 30.3.1, 30.3.2, 30.3
WVMA-N-207/Blood Platelet Transfusions
WVMA-N-208/Blood Brain Barrier Osmotic Disruption for Treatment of Brain Tumors - NCD
WVMA-N-209/Carotid Body Resection/Carotid body Denervation - NCD 20.18
WVMA-N-21/Critical Care (See References Section)
WVMA-N-210/Uroflowmetric Evaluations
WVMA-N-212/24-Hour Ambulatory Esophageal pH Monitoring - NCD 100.3
WVMA-N-214/Implantation of Gastroesophageal Reflux Device - NCD 100.9
WVMA-N-215/PET and PET/CT Scans Used for Non-Oncologic Conditions
WVMA-N-216/PET and PET/CT Scans Used for Oncologic Conditions (See References Section)
WVMA-N-217/Ultrasonic Surgery - NCD 50.8
WVMA-N-218/Vitrectomy - NCD 80.11
WVMA-N-219/Treatment of Decubitus Ulcers - NCD 270.4
WVMA-N-220/Nonselective (Random) Transfusions and Living-Related and Living-Related Donor-Specific Transfusions (DST) in Kidney Transplantation - NCD 110.16 , Informational Only
WVMA-N-221/L-Dopa - NCD 160.17( Informational Only)
WVMA-N-222/Hemodialysis for Treatment of Schizophrenia - NCD 130.8
WVMA-N-224/Treatment of Kidney Stones
WVMA-N-225/Institutional and home care patient education programs (informational only)
WVMA-N-226/Prostate Cancer Screening Tests NCD 210.1
WVMA-N-228/Telephone Transmission of Electroencephalograms (EEGs)
WVMA-N-231/Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) - NCD 160.27
WVMA-N-236/Blood Glucose Testing and Diabetes Screening
WVMA-N-237/Screening Pap Smears and Pelvic Examination
WVMA-N-238/Screening for Lung Cancer with Computed Tomography (LDCT)
WVMA-N-239/Colorectal Cancer Screening Tests -NCD 210.3
WVMA-N-24/Miscellaneous Services (National)
WVMA-N-240/Percutaneous Image-guided Lumbar Decompression for Lumbar Spinal Stenosis NCD 150.13
WVMA-N-241/Outpatient Hospital Services for Treatment of Alcoholism
WVMA-N-242/Computer Enhanced Perimetry-NCD 80.9
WVMA-N-243/Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic-NCD-130.3
WVMA-N-244/Consultation Services Rendered by a Podiatrist in a Skilled Nursing Facility
WVMA-N-247/Water Purification and Softening Systems Used in Conjunction with Home Dialysis NCD 230.7
WVMA-N-248/Percutaneous Left Atrial Appendage Closure (LAAC) NCD 20.34
WVMA-N-25/Displacement Cardiokymography (CKG)
WVMA-N-250/Artificial Hearts and Related Devices
WVMA-N-26/Scalp Hypothermia during Chemotherapy to Prevent Hair Loss - NCD 110.6
WVMA-N-27/Clinical Trials
WVMA-N-28/Assistant at Surgery Services
WVMA-N-29/Services Performed in Conjunction with the Administration of Anesthesia
WVMA-N-3/Hyperbaric Oxygen (HBO) Therapy
WVMA-N-30/Investigational Device Exemption (IDE) Clinical Trials
WVMA-N-31/Ocular Photodynamic Therapy
WVMA-N-32/Serum Iron Studies
WVMA-N-35/Gamma Glutamyl Transferase
WVMA-N-36/Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse - NCD 210.8
WVMA-N-37/Stereotaxic Depth Electrode Implantation - NCD 160.5
WVMA-N-38/Partial Thromboplastin Time
WVMA-N-39/Immediate Relatives or Household Members
WVMA-N-4/Medical Nutrition Therapy - NCD 180.1
WVMA-N-40/Neuromuscular Electrical Stimulators (NMES)
WVMA-N-41/Intensive Behavioral Therapy for Obesity
WVMA-N-43/Magnetic Resonance Spectroscopy (MRS)
WVMA-N-44/Glycated Hemoglobin/Glycated Protein
WVMA-N-46/Thyroid Testing
WVMA-N-47/Diagnostic Breath Analysis
WVMA-N-48/Carcinoembryonic Antigen
WVMA-N-49/Single Photon Emission Computed Tomography (SPECT)
WVMA-N-5/Manual Manipulation
WVMA-N-51/Electrocardiogram and X-ray Interpretation
WVMA-N-52/Prostatic Specific Antigen (PSA) and Prostate Cancer Screening
WVMA-N-53/Digoxin Therapeutic Drug Assay
WVMA-N-54/Urine Culture, Bacterial
WVMA-N-55/Implanted Peripheral Nerve Stimulator
WVMA-N-56/Blood Counts
WVMA-N-57/Prothrombin Time
WVMA-N-58/Magnetic Resonance Angiography (MRA)
WVMA-N-59/Implantable Automatic Cardioverter-Defibrillator
WVMA-N-6/Nesiritide for Treatment of Heart Failure Patients
WVMA-N-60/Telemedicine/Telehealth Services
WVMA-N-61/Noncontact Normothermic Wound Therapy (NNWT)
WVMA-N-62/INDEPENDENCE iBOT 4000 Mobility System
WVMA-N-63/Intraocular Lens (Pseudophakos)
WVMA-N-64/Mammography
WVMA-N-65/Glaucoma Screening
WVMA-N-67/Wrong Surgery
WVMA-N-68/Cochlear Implantation
WVMA-N-69/Multiple Procedure Payment Reduction for the Technical Component of Certain Diagnostic Imaging Procedures
WVMA-N-7/Home Prothrombin Time INR Monitoring for Anticoagulation Management
WVMA-N-70/Alpha-Fetoprotein
WVMA-N-71/Fecal Occult Blood
WVMA-N-72/Collagen Crosslinks, Any Method
WVMA-N-73/Human Chorionic Gonadotropin
WVMA-N-74/Hepatitis Panel
WVMA-N-75/Human Immunodeficiency Virus Testing (Diagnosis)
WVMA-N-76/Human Immunodeficiency Virus Testing (Prognosis Including Monitoring)
WVMA-N-77/Tumor Antigen by Immunoassay
WVMA-N-78/Tumor Antigen by Immunoassay
WVMA-N-79/Tumor Antigen by Immunoassay
WVMA-N-8/Extracorporeal Photopheresis - NCD 110.4
WVMA-N-80/Hydrophilic Soft Contact Lenses
WVMA-N-81/Lymphocyte Mitogen Response Assays
WVMA-N-82/Use of Vaccines or Inoculations for Treatment of Injury or Exposure (See Reference Section)
WVMA-N-83/Diagnostic Ultrasound Procedures
WVMA-N-84/Air Ambulance Services
WVMA-N-85/Dorsal Column (Spinal Cord) Neurostimulation
WVMA-N-86/Percutaneous Electrical Nerve Stimulation (PENS)
WVMA-N-87/Transcutaneous Electrical Nerve Stimulation (TENS) - NCD 160.7.1, 10.2
WVMA-N-88/Sensory Nerve Conduction Threshold Tests (sNCTs) - NCD 160.23
WVMA-N-89/Physician Laboratory and Pathology Services
WVMA-N-9/Electronic Analysis of Pacemakers (See Reference Section)
WVMA-N-90/Cardiac Pacemakers
WVMA-N-91/Therapeutic Embolization - NCD 20.28
WVMA-N-92/Electron Microscope - NCD 190.4
WVMA-N-94/CT Scans
WVMA-N-95/Sacral Nerve Stimulation
WVMA-N-96/Abortion
WVMA-N-97/Outpatient Intravenous Insulin Treatment (Therapy)
WVMA-N-98/Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)(See References Section)
WVMA-N-99/Global Surgery
WVMA-O-12/Foot Orthotics for conditions Other Than Diabetes
WVMA-O-16/Parenteral Nutrition
WVMA-O-17/Therapeutic shoes for Persons with Diabetes
WVMA-O-18/External Breast Prostheses
WVMA-O-19/Ostomy Supplies
WVMA-O-20/Tracheostomy Care Supplies
WVMA-O-21/Facial Prostheses
WVMA-O-22/Spinal Orthosis
WVMA-O-23/Eye Prosthesis
WVMA-O-23/ArgusM II Retinal Prosthesis System (LCA A53044.)
WVMA-O-24/Ankle-Foot/Knee-Ankle-Foot Orthosis
WVMA-O-25/Lower Limb Prostheses
WVMA-O-26/Refractive Lenses
WVMA-O-27/Urological Supplies
WVMA-O-28/Knee Orthoses
WVMA-O-3/Enteral Nutrition
WVMA-O-31/Implantable Miniature Telescope (IMT) for Macular Degeneration
WVMA-O-9/Screening List for Prosthetic Devices
WVMA-P-1/Coverage Requirements for Routine Foot Care and Debridement of Mycotic Nails
WVMA-P-2/Debridement of Mycotic Nails
WVMA-Q-4/Private Duty Nursing
WVMA-R-20/Intraoperative Radiation Therapy
WVMA-R-22/Bexxar (Tositumomab and Iodine 131-Tositumomab)
WVMA-R-4/Radiation Oncology
WVMA-R-5/Cardiovascular Nuclear Medicine
WVMA-S-105/Non-Coronary Vascular Stents
WVMA-S-122/Implantable Infusion Pump
WVMA-S-126/Mohs Micrographic Surgery (MMS)
WVMA-S-134/Blepharoplasty/Blepharoptosis
WVMA-S-14/Cataract Surgery
WVMA-S-148/Vertebroplasty/Vertebral Augmentation
WVMA-S-149/Percutaneous Transluminal Angioplasty
WVMA-S-168/Wound Care - Debridement
WVMA-S-170/Infrared Photocoagulation (IRC) of Hemorrhoids
WVMA-S-175/Lumbar Epidural Steroid Injections
WVMA-S-175/Lumbar Epidural Steroid Injections
WVMA-S-195/Removal of Benign and Malignant Skin Lesions
WVMA-S-198/Outpatient Co-management of Surgical Procedures
WVMA-S-200/Oral Maxillofacial Prosthesis
WVMA-S-203/Laparoscopic Sleeve Gastrectomy for Servere Obesity
WVMA-S-204/Total Joint Arthroplasty
WVMA-S-208/Cochlear Implantation
WVMA-S-209/Hemorrhoid Artery Ligation
WVMA-S-210/Billing and Coding for Rezum Procedure
WVMA-S-211/Application of Skin Substitutes
WVMA-S-214/Endometrial Hyperplasia Treatment
WVMA-S-215/Fracture of Ribs with Internal Fixation
WVMA-S-216/Gender Reassignment Services for Gender Dysphoria
WVMA-S-217/Thermal Capsulorrhaphy
WVMA-S-219/Cardiac Pacemakers
WVMA-S-220/Sacroiliac-Bone Implant System
WVMA-S-28/Cosmetic and Reconstructive Surgery
WVMA-S-31/Photodynamic Therapy with Verteporfin (Visudyne)
WVMA-S-32/Implantable Hormone Replacement Pellets
WVMA-S-55/Treatment of Varicose Veins of the Lower Extremities
WVMA-S-75/Extracorporeal Photopheresis
WVMA-S-76/Extracorporeal Shock Wave Therapy for Musculoskeletal Problems
WVMA-S-97/Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift)
WVMA-T-2/Covered Ambulance Services
WVMA-T-3/Air Ambulance Services
WVMA-V-1/Cardiac Rehabilitation
WVMA-V-44/Medical Nutrition Therapy (MNT)
WVMA-X-22/Diagnostic Mammography
WVMA-X-24/Bone Mass Measurements
WVMA-X-28/Magnetic Resonance Angiography (MRA)
WVMA-X-29/Positron Emission Tomography (PET)
WVMA-X-42/Magnetic Resonance Imaging (MRI) of a Joint
WVMA-X-52/Virtual Colonoscopy-CT Colonography
WVMA-X-54/Cardiac Computed Tomography and Angiography (CCTA)
WVMA-X-61/Transesophageal Echocardiography (TEE)
WVMA-X-67/Radiology Services: Multiple, Identical Services on Same Day
WVMA-X-68/Transthoracic Echocardiography (TTE)
WVMA-X-7/Ophthalmic Echography and Biometry
WVMA-X-70/Computerized Axial Tomography (CT), Thorax
WVMA-X-71/Barium Swallow Studies, Modified
WVMA-Y-3/Therapy for Pulmonary Conditions
WVMA-Z-11/Definition of Medical Necessity
WVMA-Z-14/Non-covered Category III CPT Codes
WVMA-Z-3/Hyperbaric Oxygen (HBO) Therapy
WVMA-Z-3/Hyperbaric Oxygen (HBO) Therapy
WVMA-Z-4/Transcranial Magnetic Stimulation for Severe Depression
WVMA-Z-56/Trigger Point Injections
WVMA-Z-6/Chiropractic Services
WVMA-Z-61/Paravertebral Facet Joint Nerve Block
WVMA-Z-67/Posterior Tibial Nerve Stimulation
WVMA-Z-68/Telemedicine/Telehealth Services
WVMA-Z-8/Sleep Disorder Testing
WVMA-Z-81/Respiratory Therapy and Oximetry Services
WVMA-Z-82/Spinal Cord Stimulation (Dorsal Column Stimulation)
WVMA-Z-83/Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
WVMA-Z-84/Peripheral Nerve and Peripheral Nerve Field Stimulation
WVMA-Z-85/Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
WVMA-Z-87/Glaucoma Screening
WVMA-Z-88/Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications (LCA A54880.)
WVMA-Z-89/Billing and Coding of Drug and Biological Infusions
WVMA-Z-90/CPT Modifier 59 Gastroenterology
WVMA-Z-94/Repeat or Duplicate Services on the Same Day (A53482)
WVMA-Z-95/Percutaneous Ventricular Assist Device
WVMA-Z-96/Special Histochemical Stains and Immunohistochemical Stains
Assigned Analyst
Please Select
Kathleen Kimball
Cheryl Mowery
Paula Yonker
Sonja (Michelle) Canady
Magen Hopkins
Patricia Jones
Christi Lipinski
Amanda Loveland
Anita Ciconte
Amanda Baatote
Casey Knaub
Irene Swartwood
Jenna Sladicka
Tammy Sharp
Jacob Erdman
Christine Marshall
Assigned By
Please Select
Kathleen Kimball
Cheryl Mowery
Paula Yonker
Sonja (Michelle) Canady
Magen Hopkins
Patricia Jones
Christi Lipinski
Amanda Loveland
Anita Ciconte
Amanda Baatote
Casey Knaub
Irene Swartwood
Jenna Sladicka
Tammy Sharp
Jacob Erdman
Christine Marshall
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Allegheny Health Network
Dr. Marylou Buyse
Tammy Micelli
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