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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
Topic
Complexity
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Simple
Medium
Complex
Acknowledgement Date
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Month
-
Day
Year
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Assigned Analyst
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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
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Lynda Shrom
Kathleen Kimball
Christine ODonnell
Paula Yonker
Sonja (Michelle) Canady
Diane Hutchinson
Magen Hopkins
Rosemary Poyet
Patricia Jones
Christi Lipinski
Debra Difilippo
Amanda Loveland
Becky Zook
Anita Ciconte
Lindsey Motter
Brian Harter
Nicole Gallagher
Terri Norman
Irene Swartwood
Pam Ross
Tonya Stowers
Tammy Micelli
Scheduled/Unscheduled
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Scheduled
Unscheduled
Workup Source
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N/A
Annual Review
CPMC
FIPR
Medical Director
Pharmacy
Physician Advisor
Provider Relations
Vendor
Provider
Other
Targeted CPMC Date
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Targeted Sub Com. Date
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Comments
BCBS Checked?
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BCBS Comments
Progress Status
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Workup Scheduled
Work Up In Progress
Delivered to Supervisor
Sub Com Prep
Sub Com Meeting
CPMC Prep
All Files in CPMC Folder
CPMC Approval
Meeting Minutes Approved!
Delete this Workup
Waiting On
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Frequency Report
Literature
Supervisor Approval
Other
Result
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Policy Revision
Policy Replacement
New Policy
Policy Reimbursement
Active No Longer Reviewed
Archived Policy
Progress Notes
Completed Date
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