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Search HIPusa.com Powered by Medical Policies All Guidelines Administrative Durable Medical Equipment (DME) Laboratory Medical Pharmacology Radiology Surgery Transplant	All Policies [ A \| B \| C \| D \| E \| G \| H \| I \| L \| M \| N \| O \| P \| R \| S \| T \| U \| V \| W ] A Abdominoplasty/Panniculectomy Autologous Chondrocyte Implantation Automatic External Defibrillators B BRCA 1 and 2 Genetic Testing Bariatric Surgery Blepharoplasty Breast Implants and Reconstruction Breast Reduction Mammoplasty Bone-Anchored Hearing Aids Botulinum Toxin Types A & B C Capsule Endoscopy (camera pill) Cochlear Implants Complex Decongestion Physiotherapy Continuous Glucose Monitoring - Insulin Delivery Devices Continuous Passive Motion Devices Cosmetic Surgery Procedures Cryosurgery for Liver Tumors Cryosurgical and Radiofrequency Ablation for Renal Tumors D Deep Brain Stimulation Dorsal Column Stimulator E Extracorporeal Shockwave Therapy for Musculoskeletal Indications - MEDICARE External Counterpulsation G Genetic Testing for Long QT Syndrome Gender Reassignment Surgery Gynecomastia Surgery H High Frequency Chest Wall Oscillation Device Home Birth Midwifery Services Home Pulse Oximetry for Infants and Children Home Uterine Activity Monitoring Hyperbaric Oxygen Therapy I Ilizarov Bone Lengthening Technique Implantable Cardioverter Defibrillators Infliximab Injectable (Remicade®) Intestinal/Multivisceral Transplantation Intrathecal Baclofen for Spinal Spasticity Intravenous Immune Globulin L Liver Transplant Lung Volume Reduction Surgery Lymphedema Treatment M Mechanical Stretching Devices Metal on Metal Hip Resurfacing N Neuropsychological Testing O Obstructive Sleep Apnea Treatment Off-Label Use of FDA-Approved Drugs and Biologicals Omalizumab (Xolair®) Oncotype DX Orthopedic Footwear Osteogenesis Stimulators Outpatient Cardiac Rehabilitation P Penile Implants Phototherapy, Photochemotherapy and Photodynamic Therapy for Dermatologic Conditions Protein A Column for Immunoabsorption Apheresis Pulsed Dye Laser Therapy for Cutaneous Vascular Lesions R Resynchronization Therapy (biventricular pacing) Risk-Reduction Mastectomy (formerly Prophylactic Mastectomy) Rhinoplasty S Selective Internal Radiation Treatment Selective Dorsal Rhizotomy for Cerebral Palsy Sentinel Lymph Node Biopsy for Breast Cancer Sentinel Lymph Node Biopsy for Melanoma Septoplasty Stereotactic Radiosurgery Sympathectomy for Hyperhidrosis T Therapeutic Shoes for Diabetics Topical Oxygen Wound Therapy (Medicaid/FHP) U Uterine Artery Embolization V Vacuum-Assisted Wound Closure Vagus Nerve Stimulation for Epilepsy Varicose Vein Treatment Virtual Colonoscopy W Wigs (Medicaid/FHP)

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