Medicine (Medical Treatments/Diagnostic Tests)

Document Title Document Type Document Size Effective Date
Airway Clearance Devices in the Ambulatory Setting - (0069)  PDF 1116kB 10/15/2026
Allergy Testing and Non-Pharmacologic Treatment - (0070)  PDF 272kB 04/15/2026
Atrial Fibrillation: Nonpharmacological Treatments - (0469)  PDF 573kB 11/15/2025
Atrial Fibrillation: Nonpharmacological Treatments - (0469) ---- future effective policy  PDF 429kB 01/15/2027
Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment - (0447)  PDF 476kB 05/15/2026
Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]) - (0507)  PDF 553kB 10/15/2026
Bone Mineral Density Measurement - (0300)  PDF 275kB 04/15/2026
Cardiac Rehabilitation (Phase II Outpatient) - (0073)  PDF 355kB 05/15/2026
Cell-based Therapies for Cardiac and Peripheral Arterial Disease - (0287)  PDF 325kB 05/15/2026
Cervical Plexus Block - (0579)  PDF 260kB 05/15/2026
Chromoendoscopy - (0148)  PDF 269kB 11/15/2025
COVID-19: In Vitro Diagnostic Testing - (0557)  PDF 387kB 05/15/2026
Donor Lymphocyte Infusion and Hematopoietic Progenitor Cell HPC Boost - (0261)  PDF 232kB 05/15/2026
Electroencephalography - (0521)  PDF 348kB 02/15/2026
Electromagnetic Field and Alternating Electric Field Therapy for Cancer Treatment - (0581)  PDF 236kB 09/15/2026
Excimer Laser, Dermabrasion and Chemical Peels for Dermatologic Conditions - (0505)  PDF 415kB 07/15/2026
Gait Analysis - (0315)  PDF 270kB 06/15/2026
Gastric Pacing/Gastric Electrical Stimulation (GES) - (0103)  PDF 290kB 11/15/2025
Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD)  Online Resource
Headache, Occipital, and/or Trigeminal Neuralgia Treatment - (0063)  PDF 481kB 06/15/2026
Head and Neck Ultrasound - (0549)  PDF 513kB 09/15/2026
Infant Nutritional Formula - (0136)  PDF 251kB 09/15/2026
Laser Interstitial Thermal Therapy - (0528)  PDF 344kB 08/15/2025
Laser Interstitial Thermal Therapy - (0528) ---- future effective policy  PDF 377kB 11/15/2026
Mucosal Integrity Testing - (0577)  PDF 184kB 10/15/2026
Percutaneous Electrical Nerve Field Stimulation (PENFS) - (0589)  PDF 299kB 09/15/2026
Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation - (0539)  PDF 410kB 03/15/2026
Plantar Fasciitis Treatments - (0097)  PDF 388kB 05/15/2026
Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028)  PDF 347kB 09/15/2026
Radiofrequency Ablation (RFA) Thyroid Nodules - (0575)  PDF 191kB 10/15/2026
Radiofrequency Therapy for Fecal Incontinence - (0576)  PDF 191kB 10/15/2026
Serum Folate and Red Blood Cell Folate Testing - (0567)  PDF 364kB 12/15/2025
Surgical Treatments for Obstructive Sleep Apnea - (0158)  PDF 519kB 06/15/2026
Tilt Table Testing - (0270)  PDF 218kB 12/15/2025
Transthoracic Echocardiography in Children - (0523)  PDF 856kB 09/15/2026
Transvaginal Ultrasound, Non-Obstetrical - (0398)  PDF 398kB 03/15/2026