Acute Inpatient Rehabilitation Services* | |
Airway Clearance Devices in the Ambulatory Setting* | C.11.01 |
Ambulatory ECG Monitoring* | |
Artificial Disc* | |
Bariatric Surgery* | |
Bioengineered Skin Substitutes* | |
Bone Anchored Hearing Aid (BAHA)* | C.5.20 |
Bone Growth Stimulation* | C.11.05 |
Breast Reconstruction Post Mastectomy or Partial Mastectomy* | C.5.03 |
Breast Reduction Surgery* | |
CAR T Cell Therapy | C.6.30 |
Cell-free DNA Testing for Fetal Aneuploidy | C.6.17 |
Cochlear Implants* | |
Continuous Glucose Monitoring Devices | C.11.09 |
Continuous Passive Motion (CPM) Devices* | C.11.15 |
Cosmetic and Reconstructive Surgery | C.5.14 |
Cranial Orthotic Devices* | |
Criteria for Rental, Replacement, Repair, Upgrade or Purchase of Durable Medical Equipment (DME) | C.11.18 |
Deep Brain Stimulation* | |
Dynamic Low-Load Prolonged-Duration Stretch (LLPS) Devices for Treatment of Contracture and Joint Stiffness | C.11.12 |
Electric Tumor Treatment Fields (TTF) Device | C.11.23 |
Endoscopic Myotomy Procedures for Treatment of Esophageal Achalasia and Gastroparesis | C.5.32 |
Endoscopic Procedures & Non-Endoscopic Devices for Gastroesophageal Reflux Disease | C.5.27 |
External Electrical Stimulators: Neuromuscular Electrical Stimulation (NMES), and Transcutaneous Electrical Nerve Stimulator (TENS)* | |
Excimer Laser for Treatment of Psoriasis | C.6.28 |
Endoscopic Procedures and Non-endoscopic Devices for Gastroesophageal Reflux Disease* | |
Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions | C.5.11 |
Gender Affirming Surgery | C.5.29 |
Gender Affirming Surgery – ETF | C.5.36 |
Genetic Testing | C.6.07 |
Genetic Testing for Breast, Ovarian, Pancreatic or Prostate Cancer Syndromes including BRCA | C.6.21 |
Heart Failure-Remote Monitoring (CardioMEMS™) | C.6.23 |
Home Health Care* | |
Home Phototherapy Devices (Narrowband UVB) | C.11.25 |
Hospice Services | C.12.01 |
Hospital Bed Rental/Purchase and Accessories* | |
Hyperbaric Oxygen Therapy (HBOT)* | |
Infertility Services | C.6.12 |
Insulin Pump and Continuous Glucose Monitoring Systems* | |
Left Atrial Appendage Closure | |
Life-Sustaining Enteral Nutrition | C.6.05 |
Long Term Acute Care (LTAC) | |
Lymphedema* | |
Manual Wheelchairs* | |
Motorized Wheelchairs/Power Operated Vehicles (Scooters)* | |
Negative Pressure Wound Therapy for Adults* | |
Obstructive Sleep Apnea – Non-Surgical Treatment with Oral Appliance | C.11.06 |
Obstructive Sleep Apnea – Surgical Treatment | C.5.04 |
Patient Lift Equipment* | |
Pectus Carinatum Orthotic Devices and Surgical Correction | C.11.27 |
Pediatric Standing Frames or Stander* | |
Penile Implants | |
Peripheral Nerve Stimulation* | |
Photodynamic Therapy* | |
Platelet-Rich Plasma (PRP) Injections | C.13.01 |
Prenatal/Preconception Genetic Testing to Determine Carrier State of a Parent or Prospective Parent | C.6.18 |
Prolotherapy | C.16.13 |
Proton Beam Therapy* | |
Ptosis – Surgical Procedures* | |
Radioembolization with Yttrium-90 Microspheres (TheraSphere and SIR-Spheres) | C.6.24 |
Recurrent Pregnancy Loss | C.6.29 |
Rhinoplasty / Septorhinoplasty* | |
Robotic Procedures | C.5.19 |
Skilled Nursing Facility (SNF) Services* | |
Solid Organ and Hematopoietic Stem Cell Transplantation | C.5.17 |
Spinal Cord Stimulation* | |
Surgical Repair of Cartilage, Ligament, and Meniscal Defects of the Knee | C.5.33 |
Surgical Treatment for Varicose Veins and Venous Insufficiency* | |
Surgical Treatment of Temporomandibular Joint (TMJ) Disorders* | |
Thermal Intradiscal Procedures | C.5.22 |
Transcatheter Closure of Septal Defect | C.11.22 |
Treatment of Obstructive Sleep Apnea Non-surgical* | |
Treatment of Urinary and Fecal Incontinence | C.5.13 |
Tumor Marker Genetics | C.6.34 |
Vagus Nerve Stimulation for Seizure Disorders* | |
Wearable Cardioverter Defibrillator* | |
Whole Exome and Whole Genome Sequencing | C.6.35 |