Medical Clinical Policy Bulletins
What's New in the Clinical Policy Bulletins
Additions, Revisions, Updates, and Deletions Sorted by Date
New:
- May 17, 2013 - 0846 - Near-Infrared Vascular Imaging
- May 17, 2013 - 0847 - Radiofrequency Ablation of the Renal Sympathetic Nerve for Hypertension
- April 23, 2013 - 0845 - Carfilzomib (Kyprolis)
- March 26, 2013 - 0843 - Focal Laser Ablation for the Treatment of Prostate Cancer
- March 26, 2013 - 0844 - Fecal Microbiota Transplantation
- March 19, 2013 - 0841 - Non-invasive Measurement of Advanced Glycation End-products in the Skin
- February 15, 2013 - 0839 - Tofacitinib (Xeljanz)
- February 15, 2013 - 0840 - Devices for Post-Operative Use Following Endoscopic Sinus Surgery
- February 15, 2013 - 0842 - Ziv-Aflibercept (Zaltrap)
- January 18, 2013 - 0837 - Shoulder Arthroplasty
- January 18, 2013 - 0838 - Stem Cell Transplantation for Myelofibrosis
Revised:
- May 17, 2013 - 0247 - Autologous Chondrocyte Implantation
- May 17, 2013 - 0249 - Inflammatory Bowel Disease: Serologic Markers and Pharmacogenomic and Metabolic Assessment of Thiopurine Therapy
- May 17, 2013 - 0251 - Dermabrasion, Chemical Peels, and Acne Surgery
- May 17, 2013 - 0253 - Vocal Cord Paralysis/Insufficiency Treatments
- May 17, 2013 - 0262 - External Counterpulsation (ECP)
- May 17, 2013 - 0264 - Multiple Sclerosis
- May 17, 2013 - 0268 - Liver and Other Neoplasms - Treatment Approaches
- May 17, 2013 - 0269 - Breast Biopsy Procedures
- May 14, 2013 - 0088 - Antepartum Fetal Surveillance
- May 14, 2013 - 0142 - Breast Implant Removal
- May 14, 2013 - 0226 - Hospitalization for the Initiation of Ketogenic Diet for the Treatment of Intractable Seizures
- May 14, 2013 - 0227 - BRCA Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy
- May 14, 2013 - 0229 - Iontophoresis
- May 14, 2013 - 0234 - Chelation Therapy
- May 14, 2013 - 0235 - Plantar Fasciitis Treatments
- May 14, 2013 - 0238 - Chronic Vertigo
- May 14, 2013 - 0241 - Extracorporeal Photochemotherapy (Photopheresis)
- May 14, 2013 - 0244 - Wound Care
- May 14, 2013 - 0245 - Tumor Chemosensitivity Assays
- May 3, 2013 - 0670 - Xolair (Omalizumab)
- April 30, 2013 - 0206 - Parenteral Immunoglobulins
- April 30, 2013 - 0208 - Deep Brain Stimulation
- April 30, 2013 - 0211 - Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair
- April 30, 2013 - 0213 - Gastroesophageal Reflux Disease (GERD): Treatment Devices
- April 30, 2013 - 0214 - Cognitive Rehabilitation
- April 30, 2013 - 0221 - Quantitative EEG (Brain Mapping)
- April 30, 2013 - 0223 - Urinary Incontinence Treatments
- April 30, 2013 - 0289 - Grid Monitoring and Intraoperative Electroencephalography
- April 30, 2013 - 0404 - Interferons
- April 30, 2013 - 0598 - Lung Transplantation
- April 30, 2013 - 0697 - Intraoperative Electromyographic Monitoring
- April 26, 2013 - 0179 - Viscosupplementation
- April 26, 2013 - 0180 - Vertebral Axial Decompression
- April 26, 2013 - 0181 - Evoked Potential Studies
- April 26, 2013 - 0182 - Ventricular Remodeling Operation (Batista Procedure) and Surgical Ventricular Restoration (Dor Procedure)
- April 26, 2013 - 0184 - Pulmonary Hypertension Treatments and Selected Indications of Prostanoids
- April 26, 2013 - 0185 - Breast Reconstructive Surgery
- April 26, 2013 - 0188 - Total Body Photography and Dermoscopy
- April 26, 2013 - 0191 - Vagus Nerve Stimulation
- April 26, 2013 - 0194 - Dorsal Column Stimulation
- April 26, 2013 - 0195 - Erythropoiesis Stimulating Agents
- April 26, 2013 - 0199 - Ultrasound for Pregnancy
- April 26, 2013 - 0204 - Manipulation Under General Anesthesia
- April 26, 2013 - 0205 - Phototherapy and Photochemotherapy (PUVA) for Skin Conditions
- April 23, 2013 - 0171 - MRI of the Extremities
- April 23, 2013 - 0172 - Hyperbaric Oxygen Therapy (HBOT)
- April 23, 2013 - 0173 - Prothrombin Time (INR) Home Testing Devices
- April 23, 2013 - 0175 - High-Frequency Pulsed Electromagnetic Stimulation
- April 23, 2013 - 0177 - Helicobacter Pylori Infection Testing
- April 23, 2013 - 0327 - Infertility
- April 23, 2013 - 0421 - Breast Pumps
- April 23, 2013 - 0443 - Cervical Cancer Screening and Diagnosis
- April 23, 2013 - 0453 - Cervical Traction Devices
- April 23, 2013 - 0594 - Visudyne (Verteporfin) Photodynamic Therapy
- April 23, 2013 - 0657 - Tubal Sterilization
- April 23, 2013 - 0684 - Cetuximab (Erbitux)
- April 19, 2013 - 0002 - Oxygen
- April 19, 2013 - 0035 - Influenza Vaccine
- April 19, 2013 - 0084 - Ptosis Surgery
- April 19, 2013 - 0130 - Computerized Corneal Topography
- April 19, 2013 - 0131 - Clotting Factors
- April 19, 2013 - 0132 - Biofeedback
- April 19, 2013 - 0134 - Bone Mass Measurements
- April 19, 2013 - 0135 - Acupuncture
- April 19, 2013 - 0157 - Obesity Surgery
- April 19, 2013 - 0161 - Infusion Pumps
- April 19, 2013 - 0166 - Fetal Fibronectin, Inflammatory Biomarkers, and Salivary Estriol Testing for Preterm Labor
- April 19, 2013 - 0168 - Tumor Scintigraphy
- April 19, 2013 - 0170 - Growth Hormone (GH) and Growth Hormone Antagonists
- March 26, 2013 - 0111 - Indocyanine Green Angiography
- March 26, 2013 - 0113 - Botulinum Toxin
- March 26, 2013 - 0115 - Varicella and Herpes Zoster Vaccines
- March 26, 2013 - 0116 - Frenectomy or Frenotomy for Ankyloglossia
- March 26, 2013 - 0388 - Complementary and Alternative Medicine
- March 26, 2013 - 0729 - Diabetic Neuropathy: Selected Treatments
- March 26, 2013 - 0779 - Plerixafor Injection (Mozobil)
- March 26, 2013 - 0796 - Near-Infrared (NIR) Spectroscopy
- March 22, 2013 - 0055 - Hematopoietic Colony-Stimulating Factors (CSFs)
- March 22, 2013 - 0061 - Nutritional Support
- March 22, 2013 - 0067 - Chest Physiotherapy and Airway Clearance Devices
- March 22, 2013 - 0069 - Lymphedema
- March 22, 2013 - 0071 - Positron Emission Tomography (PET)
- March 22, 2013 - 0073 - Cardiac Event Monitors
- March 22, 2013 - 0079 - Benign Prostatic Hypertrophy (BPH) Treatments
- March 22, 2013 - 0094 - Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV)
- March 22, 2013 - 0100 - Cryoablation
- March 22, 2013 - 0107 - Chiropractic Services
- March 19, 2013 - 0004 - Obstructive Sleep Apnea in Adults
- March 19, 2013 - 0007 - Erectile Dysfunction
- March 19, 2013 - 0008 - Color-Flow Doppler Echocardiography in Adults
- March 19, 2013 - 0009 - Orthopedic Casts, Braces and Splints
- March 19, 2013 - 0010 - Continuous Passive Motion (CPM) Machines
- March 19, 2013 - 0011 - Electrical Stimulation for Pain
- March 19, 2013 - 0016 - Back Pain - Invasive Procedures
- March 19, 2013 - 0022 - Calcitriol and Paricalcitol Injections
- March 19, 2013 - 0024 - Interleukin-2 (Aldesleukin, Proleukin, IL-2)
- March 19, 2013 - 0025 - Automated Ambulatory Blood Pressure Monitoring
- March 19, 2013 - 0028 - Temporomandibular Disorders
- March 19, 2013 - 0031 - Cosmetic Surgery
- March 19, 2013 - 0032 - Pulmonary Rehabilitation
- March 19, 2013 - 0038 - Allergy and Hypersensitivity
- March 19, 2013 - 0743 - Spinal Surgery: Laminectomy and Fusion
- March 19, 2013 - 0827 - Electric Tumor Treatment Fields
- February 15, 2013 - 0037 - Pneumococcal Vaccine
- February 15, 2013 - 0270 - Proton Beam and Neutron Beam Radiotherapy
- February 15, 2013 - 0352 - Tumor Markers
- February 15, 2013 - 0404 - Interferons
- February 15, 2013 - 0421 - Breast Pumps
- February 15, 2013 - 0650 - Polymerase Chain Reaction Testing: Selected Indications
- February 15, 2013 - 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Neovascularization
- February 15, 2013 - 0785 - Peripheral Artery Stents
- February 15, 2013 - 0787 - Comparative Genomic Hybridization (CGH)
- February 15, 2013 - 0804 - Denosumab (Prolia and Xgeva)
- February 15, 2013 - 0817 - Propranolol for Infantile Hemangioma
- February 4, 2013 - 0464 - Serum Marker Screening for Down Syndrome
- February 1, 2013 - 0807 - Eculizumab (Soliris)
- January 18, 2013 - 0091 - Endometrial Ablation
- January 18, 2013 - 0140 - Genetic Testing
- January 18, 2013 - 0356 - Meningococcal Vaccine
- January 18, 2013 - 0653 - Diphtheria, Tetanus, and Pertussis Vaccines
- January 18, 2013 - 0689 - Ocular Photoscreening
- January 4, 2013 - 0179 - Viscosupplementation
Updated:
- May 7, 2013 - 0174 - Pool Therapy, Aquatic Therapy or Hydrotherapy
- May 7, 2013 - 0189 - Genetic Counseling
- May 7, 2013 - 0190 - Stem Cells for Bone Marrow Transplant
- May 7, 2013 - 0198 - Work Hardening Programs
- May 7, 2013 - 0200 - Coumadin (Warfarin) to Heparin Conversion Before and After Elective Surgery
- May 7, 2013 - 0201 - Skilled Home Health Care Nursing Services
- May 7, 2013 - 0202 - Magnetic Resonance Spectroscopy (MRS)
- May 7, 2013 - 0207 - Prolotherapy
- May 7, 2013 - 0210 - Phonophoresis
- May 7, 2013 - 0212 - Skeletal Analysis Systems
- May 7, 2013 - 0215 - Lyme Disease and other Tick-Borne Diseases
- May 7, 2013 - 0218 - Home Health Aides
- May 7, 2013 - 0220 - Distraction Osteosynthesis
- May 7, 2013 - 0225 - Maze Procedure
- May 3, 2013 - 0160 - Lung Volume Reduction Surgery
- May 3, 2013 - 0163 - Transmyocardial and Endovascular Laser Revascularization
- May 3, 2013 - 0165 - Cardiac Catheter Ablation Procedures
- May 3, 2013 - 0169 - Outpatient Medical Self-Care Programs
- April 16, 2013 - 0126 - Contact Lenses and Eyeglasses
- April 16, 2013 - 0127 - Home Uterine Activity Monitoring
- April 16, 2013 - 0136 - Skilled Home Private Duty Nursing Care
- April 16, 2013 - 0145 - Alpha 1-Antitrypsin Inhibitor Therapy
- April 16, 2013 - 0147 - Reflex Sympathetic Dystrophy Diagnosis
- April 16, 2013 - 0151 - Hippotherapy
- April 16, 2013 - 0153 - Thalamotomy
- April 16, 2013 - 0155 - Ribavirin (Virazole)
- March 15, 2013 - 0049 - Nutritional Counseling
- March 15, 2013 - 0059 - Peak Flow Meters
- March 15, 2013 - 0062 - Burn Garments
- March 15, 2013 - 0065 - Nebulizers
- March 15, 2013 - 0078 - Learning Disabilities, Dyslexia, and Vision
- March 15, 2013 - 0082 - Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans
- March 15, 2013 - 0083 - Stereotactic Radiosurgery
- March 15, 2013 - 0093 - Open Air, Low Field Strength, and Positional MRI Units
- March 15, 2013 - 0095 - Orthognathic Surgery
- March 15, 2013 - 0097 - External Breast Prosthesis
- March 15, 2013 - 0105 - Magnetic Resonance Imaging (MRI) of the Breast
- March 15, 2013 - 0106 - Fetal Echocardiograms
- March 15, 2013 - 0112 - Surface Scanning and Macro Electromyography
- March 15, 2013 - 0124 - General Anesthesia and Monitored Anesthesia Care for Oral and Maxillofacial Surgery and Dental Services
- March 8, 2013 - 0001 - Transrectal Ultrasound
- March 8, 2013 - 0003 - Apnea Monitors for Infants
- March 8, 2013 - 0005 - Septoplasty and Rhinoplasty
- March 8, 2013 - 0019 - Holter Monitors
- March 8, 2013 - 0020 - Injectable Medications
- March 8, 2013 - 0021 - Cardiac Rehabilitation
- March 8, 2013 - 0027 - Implantable Vas Deferens Occlusion Devices
- March 8, 2013 - 0029 - Thermography
- March 8, 2013 - 0034 - Aural Rehabilitation
- March 8, 2013 - 0039 - Weight Reduction Medications and Programs
- March 8, 2013 - 0046 - Routine Foot Care
- March 8, 2013 - 0047 - Prenatal Care Provided by Primary Care Physicians
- March 8, 2013 - 0048 - Hepatitis A Vaccine