Medical Policies - Surgical

Accidental Dental Services Commercial - Surgical 19

Benign Prostatic Hypertrophy Treatments as an Alternative to Transurethral Resection of the Prostate (TURP) Commercial - Surgical 83

Benign Prostatic Hypertrophy Treatments as an Alternative to Transurethral Resection of the Prostate (TURP) Medicaid - Surgical 83

Breast Procedures Commercial - Surgical 10

Breast Procedures Medicaid - Surgical 10

Capsular Plication of the Hip Commercial - Surgical 232

Capsular Plication of the Hip Medicaid - Surgical 232

Capsular Plication of the Hip Medicare - Surgical 232

Cervical Fusion Procedures Commercial - Surgical 117

Cervical Fusion Procedures Medicaid - Surgical 117

Cervical Laminectomy Commercial - Surgical 122

Cervical Laminectomy Medicaid - Surgical 122

Cervical Laminectomy Medicare - Surgical 122

Coccygectomy Medicaid - Surgical 114

Coccygectomy Medicare - Surgical 114

Computer Assisted Navigation Commercial - Surgical 233.pdf

Computer Assisted Navigation Medicaid - Surgical 233.pdf

Computer Assisted Navigation Medicare - Surgical 233.pdf

Core Decompression for Avascular Necrosis of the Knee, Ankle, Elbow and Shoulder Commercial - Surgical 214

Core Decompression for Avascular Necrosis of the Knee, Ankle, Elbow and Shoulder Medicaid - Surgical 214

Core Decompression for Avascular Necrosis of the Knee, Ankle, Elbow and Shoulder Medicare - Surgical 214

Cosmetic and Reconstructive Surgery Commercial - Surgical 03

Cosmetic and Reconstructive Surgery Medicaid - Surgical 03

Cryoablation Commercial - Surgical 82

Cryoablation Medicaid - Surgical 82

Cryoablation Medicare Surgical 82

Cytoreductive Surgery (Tumor Debulking) Commercial - Surgical 02

Cytoreductive Surgery (Tumor Debulking) Medicaid - Surgical 02

Cytoreductive Surgery (Tumor Debulking) Medicare - Surgical 02

Dermatologic Conditions Commercial - Surgical 09

Dermatologic Conditions Medicaid - Surgical 09

Endometrial Ablation Commercial - Surgical 15

Endometrial Ablation Medicaid - Surgical 15

Endometrial Ablation Medicare - Surgical 15

Eyelid Procedures and Brow Lift - Surgical 13

Eyelid Procedures and Brow Lift Medicaid - Surgical 13

FF - Lumbar Laminectomy Medicare Surgical 121

Gastrointestinal Procedures Commercial - Surgical 205

Gastrointestinal Procedures Medicaid - Surgical 205

Gender Affirming Surgery Commercial - Surgical 108

Gender Affirming Surgery Medicaid - Surgical 108

Hand and Foot Surgeries Commercial - Surgical 52

Hand and Foot Surgeries Medicaid - Surgical 52

Hand and Foot Surgeries Medicare - Surgical 52

Hearing Aids, Implants And Wearable Devices Commercial - Surgical 20

Hearing Aids, Implants And Wearable Devices Medicaid - Surgical 20

Hematopoietic Stem Cell Transplantation (HSCT) Commercial - Surgical 08

Hematopoietic Stem Cell Transplantation (HSCT) Medicaid - Surgical 08

Hyperhidrosis Treatments Commercial - Surgical 107

Hyperhidrosis Treatments Medicaid - Surgical 107

Hyperhidrosis Treatments Medicare - Surgical 107

Intraoperative Neurophysiological Monitoring Commercial - Surgical 40

Intraoperative Neurophysiological Monitoring Medicaid - Surgical 40

Leadless Cardiac Pacemaker Commercial - Surgical 126

Leadless Cardiac Pacemaker Medicaid - Surgical 126

Left Atrial Appendage Occlusion Commercial - Surgical 102

Left Atrial Appendage Occlusion Medicaid - Surgical 102

Lumbar Discectomy Commercial - Surgical 120

Lumbar Discectomy Medicaid - Surgical 120

Lumbar Discectomy Medicare - Surgical 120

Lumbar Fusion Commercial - Surgical 118

Lumbar Fusion Medicaid - Surgical 118

Lumbar Laminectomy Commercial - Surgical 121

Lumbar Laminectomy Medicaid - Surgical 121

Medical Dental Surgery Commercial - Surgical 128

Nasal Repair Commercial Surgical 230

Nasal Repair Medicaid Surgical 230

Non-Oncology Embolization Commercial Surgical 235

Non-Oncology Embolization Medicaid Surgical 235

Non-Oncology Embolization Medicare Surgical 235

Ophthalmic Procedures Commercial - Surgical 60

Ophthalmic Procedures Medicaid - Surgical 60

Oral Incontinence Treatments Commercial - Surgical 220

Oral Incontinence Treatments Medicaid - Surgical 220

Oral Incontinence Treatments Medicare - Surgical 220

Orthognathic Surgery Commercial - Surgical 34

Orthognathic Surgery Medicaid - Surgical 34

Pectus Surgery and Devices Commercial - Surgical 05

Pectus Surgery and Devices Medicaid - Surgical 05

Pectus Surgery and Devices Medicare - Surgical 05

Penile Prosthesis Surgery Commercial - Surgical 23

Percutaneous Spinal Augmentation Commercial - Surgical 231

Percutaneous Spinal Augmentation Medicaid - Surgical 231

Sacroiliac Fusion, Open and Percutaneous Commercial - Surgical 116

Sacroiliac Fusion, Open and Percutaneous Medicaid - Surgical 116

Shoulder-Elbow Joint Resurfacing Arthroplasty with Allograft Tissue Commercial - Surgical 111

Shoulder-Elbow Joint Resurfacing Arthroplasty with Allograft Tissue Medicaid - Surgical 111

Shoulder-Elbow Joint Resurfacing Arthroplasty with Allograft Tissue Medicare - Surgical 111

Skin and Tissue Substitutes Commercial - Surgical 73

Skin and Tissue Substitutes Medicaid - Surgical 73

Solid Organ Transplantations Commercial Surgical 236

Solid Organ Transplantations Medicaid Surgical 236

Spinal and Other Pain Management Procedures Commercial - Surgical 119

Spinal and Other Pain Management Procedures Medicaid - Surgical 119

Spinal Arthroplasty Commercial - Surgical 35

Spinal Arthroplasty Medicaid - Surgical 35

Spinal Cord Electrical Stimulator and Dorsal Motor Ganglion Stimulator Commercial Surgical 69

Spinal Cord Electrical Stimulator and Dorsal Motor Ganglion Stimulator Medicaid - Surgical 69

Subcutaneous and Substernal Implantable Cardioverter Defibrillator Commercial - Surgical 106.pdf

Subcutaneous and Substernal Implantable Cardioverter Defibrillator Medicaid - Surgical 106

Surgical Assisted Liposuction Commercial - Surgical 131

Surgical Assisted Liposuction Medicaid - Surgical 131

Surgical Assisted Liposuction Medicare - Surgical 131

Surgical Treatments for Obstructive Sleep Apnea Commercial - Surigcal 18

Surgical Treatments for Obstructive Sleep Apnea Medicaid - Surgical 18

Thermal Capsulorrhaphy Commercial - Surgical 86

Thermal Capsulorrhaphy Medicaid - Surgical 86

Tissue Transplantation of the Knee, Ankle and Talus Commercial - Surgical 39

Tissue Transplantation of the Knee, Ankle and Talus Medicaid - Surgical 39

Tissue Transplantation of the Knee, Ankle and Talus Medicare - Surgical 39

Total Ankle Replacement Commercial - Surgical 96

Total Ankle Replacement Medicaid - Surgical 96

Total Ankle Replacement Medicare - Surgical 96

Transvenous Implantable Cardioverter Defibrillator Commercial - Surgical 133

Transvenous Implantable Cardioverter Defibrillator Medicaid - Surgical 133

Treatment for Varicose Veins of the Lower Extremities Commercial Surgical 04

Treatment for Varicose Veins of the Lower Extremities Medicaid Surgical 04