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… J1561; J1562; J1568; J1569; J1571; J1572; J1573; J1575; J1599; J1670; J1566; J2791: Prior authorization is required … Shield of Massachusetts Pre-certification Request Form MP 159 Gene Therapies for Bladder Cancer No LCD or NCD BCBSMA … lower extremity Trachea Shave/Thyroid Cartilage Reduction 31599 Unlisted procedure, larynx Chest and Genital Surgery …
… high probability of usual interstitial pneumonia [UIP]) 81595 Cardiology (heart transplant), mRNA, gene expression … primary procedure) (Use 0158U in conjunction with 81292) 0159U MSH2 (mutS homolog 2) (eg, hereditary colon cancer, … separately in addition to code for primary procedure) (Use 0159U in conjunction with 81295) 0160U MSH6 (mutS homolog 6) …
746 Vitamin D Assay Testing prn.pdf623.96 KB
1 Medical Policy Vitamin D Assay Testing Table of Contents • Policy: Commercial • Description • Information Pertaining to All Policies • Authorization Information • Policy History • Endnotes • Coding Information • References Policy Number: 746 BCBSA …
… Interv Card Electrophysiol. Nov 2011; 32(2): 125-35. PMID 21594629 14. Wells G, Parkash R, Healey JS, et al. Cardiac … Failure Patients (B-LEFT HF) trial. Am Heart J. Jun 2010; 159(6): 1052-1058.e1. PMID 20569719 42. Martinelli Filho M, … design. Am Heart J. Apr 2005; 149(4): 600-5. PMID 15990740 53. Chung ES, Leon AR, Tavazzi L, et al. Results of …
1 Medical Policy Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid and Artificial Pancreas Device Systems Table of Contents • Policy: Commercial • Description • Information Pertaining to All Policies • Authorization Information • …
1 Medical Policy Monoclonal Antibodies for Treatment of Alzheimer's Disease Table of Contents • Policy: Commercial • Background • Information Pertaining to All Policies • Authorization Information • Policy History • References • Coding Information Policy …
… a systematic review. Mayo Clin Proc. Feb 2007; 82(2): 159-65. PMID 17290721 124. Antonopoulos AS, Angelopoulos A, … events in women. JAMA. Feb 17 2010; 303(7): 631-7. PMID 20159871 146. Zethelius B, Berglund L, Sundström J, et al. Use … Eur Heart J. Sep 07 2021; 42(34): 3227-3337. PMID 34458905 159. Jacobson TA, Ito MK, Maki KC, et al. National Lipid …
522 Low-Level Laser Therapy prn.pdf682.77 KB
… dysfunction. Rev. Bras. Fisioter. 2008;12:3742. doi: 10.1590/S1413- 35552008000100008. 38. da Cunha LA, Firoozmand … Lasers Med Sci. Nov 2014; 29(6): 1815-9. PMID 24801056 159. Matsutani LA, Marques AP, Ferreira EA, et al. …
… Injury Of Anterior Tibial Artery, Left Leg, Sequela S85.159A Other Specified Injury Of Anterior Tibial Artery, Unspecified Leg, Initial Encounter S85.159D Other Specified Injury Of Anterior Tibial Artery, Unspecified Leg, Subsequent Encounter 46 S85.159S Other Specified Injury Of Anterior Tibial Artery, …
004 Immune Modulating Drugs prn.pdf644.88 KB
… with early rheumatoid arthritis. NEJM. 2000;343:1586-1593. … with Concomitant Therapy Study Group. NE JM. 2000;343:1594-1602. 45. Maini R, St Clair EW, Breedveld F, et al. …
219 Carotid Stent Placement.pdf172.57 KB
… registries. Circ Cardiovasc Interv. Jun 2009; 2(3): 159- 66. PMID 20031712 63. White CJ, Iyer SS, Hopkins LN, et … J Neurointerv Surg. Jan 2015; 7(1): 32-9. PMID 24391159 70. Brott TG, Halperin JL, Abbara S, et al. 2011 … Eur J Vasc Endovasc Surg 2018 Jan;55(1):3-81. PMID: 28851594 79. Eckstein HH. European Society for Vascular Surgery …
190 Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias prn.pdf251.14 KB
… anaemia. Br J Haematol. Jul 2005; 130(1): 99-106. PMID 15982351 30. Wagner JE, Eapen M, MacMillan ML, et al. … National Marrow Donor Program. Blood. Mar 15 2001; 97(6): 1598-603. PMID 11238097 47. Moratto D, Giliani S, Bonfim C, … Br J Haematol. Jan 2016; 172(2): 187-207. PMID 26568159 66. Barone A, Lucarelli A, Onofrillo D, et al. Diagnosis …
… Lesion At C8 Level Of Cervical Spinal Cord, Sequela S14.159A Other Incomplete Lesion At Unspecified Level Of Cervical Spinal Cord, Initial Encounter S14.159D Other Incomplete Lesion At Unspecified Level Of Cervical Spinal Cord, Subsequent Encounter S14.159S Other Incomplete Lesion At Unspecified Level Of …
… burned children. Burns. Aug 2001; 27(5): 447-52. PMID 11451596 54. Moyle GJ, Schoelles K, Fahrbach K, et al. Efficacy … AIDS Read. Jun 2005; 15(6): 301-3, 306-8, 310, 314. PMID 15962453 56. Wales PW, Nasr A, de Silva N, et al. Human … hormone. J Pediatr Endocrinol Metab. Nov-Dec 2000; 13(9): 1595-602. PMID 11154155 87. Coutant R, Rouleau S, Despert F, …
1 Medical Policy Hematopoietic Cell Transplantation for Solid Tumors of Childhood Table of Contents • Policy: Commercial • Description • Information Pertaining to All Policies • Authorization Information • Policy History • Coding Information • References …
… (nadofaragene firadenovec-vncg), #193 Medical Policy #159 Gene Therapies for Bladder Cancer CLINICAL … cal-policies/sites/g/files/csphws2091/files/acquiadam-assets/159%20Gene%20Therapies%20for%20Bladder%20Cancer.pdf …
1 Medical Policy Multispectral Digital Skin Lesion Analysis Table of Contents • Policy: Commercial • Coding Information • Information Pertaining to All Policies • Policy: Medicare • Description • References • Authorization Information • Policy History …
069 Esophageal pH Monitoring prn.pdf223.68 KB
… effect of omeprazole. Gastroenterology. Jun 2001; 120(7): 1599-606. PMID 11375942 16. Gyawali CP, Tutuian R, Zerbib F, …
… between women and men. Eur Heart J 2000; 21(19):1598-606. 9. Versaci F, Gaspardone A, Tomai F et al. …
1 Medical Policy Multimarker Serum Testing Related to Ovarian Cancer Table of Contents • Policy: Commercial • Description • Information Pertaining to All Policies • Authorization Information • Policy History • Coding Information • References Policy …