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A

• Abecma (Idecabtagene Vicleucel)*
• Ablative Procedures for the Peripheral Nerves to Treat Pain*
• Ablative Treatments for Occipital Neuralgia, Chronic Headaches and Atypical Facial Pain*
• Aduhelm
• Air Ambulance*
• Airway Clearance Devices
• Allergy Immunotherapy
• Allergy Testing
• Ambulatory Cardiac Event Monitoring and Real-Time Outpatient Cardiac Telemetry
• Ambulatory Esophageal pH Monitoring
• Amniotic Ophthalmic Grafts, Amniotic Fluid, and Amniotic Injection
• Amondys 45
• Analysis of MGMT Promoter Methylation
• Anesthesia Services for Gastrointestinal Endoscopic Procedures
• Artificial Intervertebral Disc
• Autologous Chondrocyte Implant
• Automated Nerve Conduction Tests

B

• Balloon Ostial Dilation (BOD)/Balloon Sinuplasty for the Treatment of Chronic and Recurrent Rhinosinusitis as a Stand-Alone Procedure or as an Adjunctive Procedure to Functional Endoscopic Sinus Surgery (FESS)
• Bio-Engineered Skin and Soft Tissue Substitutes
• Biofeedback
• Bioimpedance Devices for Detection and Management of Lymphedema
• Biomarker and Multiplex Autoantigen Microarray Testing for Autoimmune Disease
• Biomarker Testing for Barrett's Esophagus and Other Esophageal Disorders PDF File
• Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Other Conditions
• Breyanzi (Lisocabtagene Maraleucel)
• Bronchial Thermoplasty

C

• Cardiovascular Disease Risk Tests
• Cellular Immunotherapy for Prostate Cancer - Provenge (Sipuleucel-T)
• Chemical Peels and Dermabrasion
• Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsies)
• Circulating Tumor DNA for Management of Non-Small Cell Lung Cancer (Liquid Biopsy)
• Cochlear Implant Replacement*
• Cognitive Rehabilitation
• Computer-Assisted Navigation for Orthopedic Surgery
• Continuous Passive Motion (CPM) Devices in the Home Setting
• Corneal Cross-Linking
• Corneal Topography, Computer Assisted Photokeratoscopy, Video-keratography, and Optical Coherence Tomography
• Coronary Artery Calcium Scoring
• Cosmetic and Reconstructive Services
• Cranial Remolding

D

• Deep Brain Stimulation (DBS)
• Dermatologic Applications of Photodynamic Therapy
• Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems
• Donor Lymphocyte Infusion (DLI) and Hematopoietic Progenitor Cell (HPC) Boost
• Drug Testing in Pain Management and Substance Use Disorder Treatment
• Dry Needling
• Dynamic/Static Posturography

E

• Electrical Stimulation for the Treatment of Muscle Rehabilitation, Pain and Miscellaneous Conditions
• Enteral Therapy and Oral Formula
• Enzyme Replacement Therapy for Lysosomal Storage Diseases
• Epidermal Growth Factor Receptor (EGFR) Mutation Analysis Excluding Non-Small Cell Lung Cancer
• Eustachian Tube Dysfunction Treatment
• Exhaled Nitric Oxide and Exhaled Breath Condensate
• Exondys 51 (eteplirsen)
• Expanded Genetic Panels to Identify Targeted Cancer Therapy

F

• Fecal Bacteriotherapy (Fecal Transplant)
• Fecal Incontinence Management

G

• Gastric Electrical Stimulation
• Gene Expression Based Assays for Cancer of Unknown Primary
• Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
• Gene Expression Profiling for Cutaneous Melanoma
• Gene Expression Profiling for the Management of Breast Cancer
• Gene Expression Profiling for Uveal Melanomas
• Genetic and Laboratory Testing for 5-fluorouracil (5-FU) Sensitivity
• Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
• Genetic Testing for BCR-ABL Fusion Gene
• Genetic Testing for Familial Cutaneous Malignant Melanoma
• Genetic Testing for Inherited Thrombophilia
• Genetic Testing for Variants Found in Leukemia
• Genetic Testing in Myeloproliferative Disease
• Genetic Testing to Determine Cardiac Conditions

H

• Heart/Lung Transplant*
• Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant) Autologous and Allogeneic*
• Hereditary Cancer Syndrome Multigene Panels Using Messenger RNA (mRNA)
• High Cost Naloxone Injectables
• High Dollar Drug Review
• High Intensity Focused Ultrasound (HIFU)
• Home Sleep Studies - Pediatric
• Homocysteine Testing
• Hormone Replacement Using Subcutaneous Pellet Implantation
• Humanitarian Use Devices
• Hyperbaric Oxygen Therapy (HBOT) Systemic and Topical Hyperbaric Oxygen Therapy (THOT) and Continuous Topical Oxygen Therapy (CTOT)

I

• Implantable Bone Conduction Hearing Devices*
• Implantable Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
• Implantable Peripheral Nerve Stimulation for the Treatment of Chronic Pain
• Implants for Metatarsal Joint Pain PDF File
• Injection Therapy for Headache Management
• Interspinous Distraction Devices and Interspinous Fixation (Fusion) Devices

K

• Ketamine
• KRAS/NRAS and BRAF Mutation Analysis
• Kymriah (Tisagenlecleucel)*

L

• Laboratory Testing for Transplant Rejection
• Laser Interstitial Thermal Therapy (LITT)
• Laser Treatment for Nail Fungus
• Leadless Cardiac Pacemaker
• Low Frequency, Non-Contact Ultrasound for Wounds
• Low-Level/Cold Laser and High Powered Laser Therapy
• Lung and Lobar Lung Transplant*
• Lutathera (Lutetium Lu 177 Dotatate)*

M

• Management of Dry Eye Syndrome
• Manipulation under Anesthesia
• Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Atherosclerosis Using Ultrasound
• Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics
• Mechanical Stretching Devices including Dynamic Splinting Devices
• Medical Foods and Specialized Formula for the Treatment of Inborn Errors of Metabolism
• Miscellaneous Bariatric Procedures
• Miscellaneous Cardiac Treatments and Monitors
• Miscellaneous Surgical Treatments of Back Pain
• Miscellaneous Treatments for Varicose Veins/Venous Insufficiency
• Molecular Analysis for Targeted Therapy of Non-Small Cell Lung Cancer
• Molecular Markers in Fine Needle Aspirates of the Thyroid
• Molecular Testing in the Management of Pulmonary Nodules
• MRI-Guided High-Intensity Focused Ultrasound (MRgFUS) Ablation
• Multigene Expression Assays for Predicting Recurrence of Colon Cancer
• Multimarker Serum Testing Related to Ovarian Cancer

N

• Nasal Implants for Nasal Vestibular Lateral Wall Collapse PDF File
• Next Generation Sequencing for the Assessment of Measurable Residual Disease (MRD)
• Non-Powered Negative Pressure Wound Therapy
• Non-invasive Measurement of Cardiac Bioimpedance in the Outpatient Setting
• Non-invasive Glucose Monitoring Devices

O

• Occipital Nerve Stimulation
• Off-label Drug Use
• Osteochondral Allografts and Autografts
• Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion

P

• Pancreas (Including Simultaneous Pancreas-Kidney, Pancreas alone, and Pancreas after Kidney) Transplants*
• Pancreatic Islet Cell Transplant
• Percutaneous Intracranial Angioplasty and Stenting
• Percutaneous Kyphoplasty, Percutaneous Vertebroplasty, and Sacroplasty
• Peripheral Subcutaneous Field Stimulation (PSFS)
• Peroral Endoscopic Myotomy (POEM) Procedures
• Pharmacogenomic and Pharmacogenetic Testing for Drug Metabolism Status - Non-Cancer Indications
• Plasmapheresis/Plasma Exchange PDF File
• Platelet - Rich Plasma and Autologous Protein Solution for Orthopedic Applications
• Platelet - Rich Plasma for the Treatment of Non-Orthopedic Indications
• Pneumatic Compression Devices in the Home Setting
• Positron Emission Tomography (PET) for Surveillance of Oncologic Indications*
• Prenatal Screening; Cell-Free Fetal DNA Testing
• Prolotherapy
• Prostate-Specific Antigen Screening for Prostate Cancer
• Proteomic Testing for Systemic Therapy in Non-Small Cell Lung Cancer
• Proton Beam Radiation Therapy*
• Pulsed Radiofrequency

Q

• Quantitative Sensory Testing

R

• Radiofrequency Ablation and Alternative Ablative/Denervation Methods for Chronic Facet Joint Mediated Neck, Back and Sacroiliac Joint Pain*
• Radium Ra 223 Dichloride (Xofigo)
• Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy

S

• Sacral Nerve Stimulation/Neuromodulation
• Saliva Hormone Tests
• Scintimammography/Breast Specific Gamma Imaging (BSGI)/Molecular Breast Imaging (MBI)/Positron Emission Mammography (PEM)
• Screening for Lung Cancer Using Low Dose Computed Tomography (LDCT)
• Sensory Integration Therapy and Auditory Integration Therapy
• Serum Tumor Markers in the Management of Malignancies
• Single Photon Emission Computed Tomography (SPECT) of the Brain for Behavioral Disorders
• Small Bowel Transplant*
• Small Bowel/Liver and Multivisceral Transplant*
• Spinal Cord and Dorsal Root Ganglion Stimulation
• Stem Cell Therapy for Lung Disease*
• Stem Cell Therapy for Orthopedic Indications (Including Allograft Bone Products Used with Stem Cells)*
• Stem Cell Therapy for Peripheral Arterial Disease
• Stereotactic Surgery and Stereotactic Radiosurgery
• Steroid – Eluting Sinus Stents and Implants PDF File
• Subtalar Arthroereisis
• Surface Electromyography (sEMG)
• Surgical Treatment of Lymphedema

T

• Tecartus (Brexucabtagene Autoleucel)*
• Temporomandibular Joint Dysfunction (TMJ/TMD) Treatment
• Testing in the Diagnosis and Management of Inflammatory Bowel Disease (IBD)
• Thermography and Temperature Gradient Studies
• Topographic Genotyping<
• Transcranial Magnetic Stimulation
• Treating Benign Prostatic Hyperplasia
• Treatment for Barrett's Esophagus PDF File
• Treatment for Gastroesophageal Reflux Disease (GERD)
• Treatment of Speech and Language Disorders*
• Tumor Treatment Fields Therapy

U

• Ultrasound in Maternity Care
• Urinary Incontinence/ Voiding Dysfunction Treatments and Devices
• Use of Common Genetic Variants (Single Nucleotide Variants) to Predict Risk of Non-familial Breast Cancer

V

• Vagus Nerve Stimulation (VNS) and Vagal Blocking Therapy
• Vascular Endothelial Growth Factor (VEGF) Inhibitors for Ophthalmic Use
• Vertebral Axial Decompression
• Vertebral Fracture Assessment
• Viltepso (viltolarsen)
• Vision Therapy/Orthoptic Training
• Vitamin D Testing
• Vivitrol (naltrexone for extended-release injectable suspension)
• Vyondys 53

W

• Whole Body Dual X-Ray Absorptiometry (DXA) and Bioelectrical Impedance Analysis (BIA) to Determine Body Composition
• Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders

Y

• Yescarta (Axicabtagene Ciloleucel)*