Surgery

Document Title Document Type Document Size Effective Date
Ablative Treatment for Malignant Breast Tumor - (0540)  PDF 321kB 03/15/2026
Alveoloplasty - (0586)  PDF 214kB 08/15/2026
Athletic Pubalgia Surgery - (0522)  PDF 210kB 07/15/2026
Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation - (0480)  PDF 500kB 04/15/2026
Bariatric Surgery and Procedures - (0051)  PDF 1307kB 07/15/2026
Benign Prostatic Hyperplasia (BPH) Surgical Treatments - (0159)  PDF 364kB 09/15/2026
Blepharoplasty, Reconstructive Eyelid Surgery, and Brow Lift - (0045)  PDF 284kB 06/15/2026
Bone Graft Substitutes - (0118)  PDF 340kB 10/01/2026
Breast Implant Removal - (0048)  PDF 300kB 04/15/2026
Breast Reconstruction Following Mastectomy or Lumpectomy - (0178)  PDF 166kB 04/15/2026
Breast Reduction - (0152)  PDF 267kB 11/15/2025
Breast Reduction - (0152) ---- future effective policy  PDF 354kB 11/15/2026
Cardiac Ablation of Abnormal Electrical Rhythms - (0529)  PDF 375kB 04/15/2026
Cardiac Resynchronization Therapy (CRT) - (0174)  PDF 534kB 12/15/2025
Circumcision - (0582)  PDF 319kB 05/15/2026
Cochlear Implants - (0190)  PDF 482kB 11/15/2025
Corneal Remodeling for Refractive Errors - (0141)  PDF 324kB 11/15/2025
Deep Brain, Motor Cortex and Responsive Cortical Stimulation - (0184)  PDF 573kB 11/15/2025
Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy - (0554)  PDF 543kB 09/15/2026
Diaphragmatic/Phrenic Nerve Stimulation - (0391)  PDF 269kB 07/15/2026
Endometrial Ablation - (0013)  PDF 261kB 02/15/2026
Fetal Surgery - (0175)  PDF 414kB 07/15/2026
Gender Dysphoria Treatment - (0266)  PDF 371kB 09/15/2026
Glaucoma Surgical Procedures - (0035)  PDF 410kB 04/15/2026
Gynecomastia Surgery - (0195)  PDF 203kB 08/15/2026
Headache, Occipital, and/or Trigeminal Neuralgia Treatment - (0063)  PDF 481kB 06/15/2026
High Intensity Focused Ultrasound (HIFU) - (0274)  PDF 377kB 12/15/2025
Hyperhidrosis: Surgical Treatments - (0037)  PDF 251kB 01/15/2026
Intraocular Lens Implant - (0125)  PDF 265kB 09/15/2026
Intraoperative Monitoring - (0509)  PDF 609kB 09/15/2025
Lymphedema and Lipedema Surgical Treatments - (0531)  PDF 649kB 10/01/2026
Male Sexual Dysfunction Treatment: Non-pharmacologic - (0403)  PDF 281kB 07/15/2026
Mammary Ductoscopy, Aspiration and Lavage - (0057)  PDF 298kB 01/15/2026
Manipulation Under Anesthesia - (0276)  PDF 332kB 09/15/2026
Metatarsophalangeal Joint Replacement - (0446)  PDF 278kB 10/15/2026
Open Neuroplasty Lumbar Plexus - (0587) ---- future effective policy  PDF 222kB 12/15/2026
Orthognathic Surgery - (0209)  PDF 252kB 10/15/2026
Otoplasty and External Ear Reconstruction - (0335)  PDF 232kB 07/15/2026
Panniculectomy and Abdominoplasty - (0027)  PDF 239kB 06/15/2026
Partial Rhinectomy, Rhinoplasty, Vestibular Stenosis Repair and Septoplasty - (0119)  PDF 454kB 07/01/2026
Pelvic Denervation Procedures - (0368)  PDF 226kB 06/15/2026
Peripheral Nerve Destruction for Pain Conditions - (0525)  PDF 684kB 09/15/2026
Redundant Skin Surgery - (0470)  PDF 333kB 09/15/2026
Subtalar Joint Implantation (Subtalar Arthroereisis) - (0486)  PDF 230kB 10/15/2026
Surgical Treatment for Chest Wall Deformities - (0309)  PDF 278kB 04/15/2026
Surgical Treatments for Obstructive Sleep Apnea - (0158)  PDF 519kB 06/15/2026
Surgical Treatments for Obstructive Sleep Apnea - (0158) - future effective policy  PDF 519kB 12/15/2026
Temporomandibular Joint (TMJ) Disorder Surgery - (0156)  PDF 283kB 12/15/2025
Tissue Engineered Skin Substitutes - (0068)  PDF 1582kB 10/01/2026
Total Ankle Arthroplasty/Replacement - (0285)  PDF 263kB 03/15/2026
Transcatheter Closure of Cardiovascular Defects - (0011)  PDF 512kB 11/15/2025
Transcatheter Heart Valve Procedures - (0501)  PDF 872kB 12/15/2025
Transcranial Magnetic Stimulation - (EN0383)  PDF 697kB 03/15/2026
Treatment of Cutaneous and Vascular Lesions - (0313)  PDF 376kB 10/15/2026
Vagus Nerve Stimulation (VNS) - (0350)  PDF 441kB 02/15/2026
Ventricular Assist Devices (VADs), Percutaneous Cardiac Support Systems and Total Artificial Heart - (0054)  PDF 427kB 12/15/2025
Wide-Area Transepithelial Tissue Sampling with Computer-Assisted 3D Analysis (WATS3D) - (0578)  PDF 290kB 12/15/2025