Medical and Payment Policies

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Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
Patient-Controlled End of Range Motion Stretching Devices
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy
Peripheral Subcutaneous Field Stimulation
Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
Phototherapeutic Keratectomy
Phototherapy for the Treatment of Seasonal Affective Disorder
Phototherapy in the Home for the Treatment of Dermatological Conditions
Phrenic Nerve Stimulation for Central Sleep Apnea
Plugs for Anal Fistula Repair
Post-Partum Hospital Stays Mandate
Powered Exoskeleton for Ambulation in Patients with Lower-Limb Disabilities
Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia
Prostatic Stent - Temporary
Proteomic Testing for Targeted Therapy in Non-Small-Cell Lung Cancer
Pulsed Radiofrequency for the Treatment of Chronic Pain
Payment Adjustments for Serious Reportable Events (also known as SRE or Never Events) and Hospital Acquired Conditions
Payments for Outpatient Service Performed when a Member is Admitted as an Inpatient to a Different Hospital
Pharmacy Prescription Early Refill
Physical and Occupational Therapy
Physical and Occupational Therapy Payment Cap
Physician Concierge Services
Place of Service (POS) 10 Telemedicine
Post Payment Audits
Preventive Medicine and Other Evaluation and Management Office/Outpatient Services
Preventive Services for Commercial Members
Preventive Services for Medicare Advantage Plans
Professional Reporting Requirements for Services Not Personally Performed (AKA Incident to Services)
Prolonged Physician Services
Prostate Specific Antigen (PSA) Screening/Testing Mandate
Provider Credentialing and Recredentialing Process
Provider Guidelines for Requesting Point of Service Payment and Maintaining Patient Credit Card Information
Psychological and Neuropsychological Testing
Prior Authorization
Pediatric Dental Services Essential Health Benefit -Dental Review
Percutaneous and Subcutaneous Tibial Nerve Stimulation
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Peripheral Artery Disease (PAD) Rehabilitation
Preimplantation Genetic Testing - Effective 1/1/24
Prior Authorization of Cardiology and Radiology Services
Prior Authorization of Drugs
Prior Authorization of Spinal Procedures
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME)
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME), Effective 7/1/2024
Prior Authorization via Web-Based Tool for Procedures
Private Duty Nursing
Progesterone Therapy as a Technique to Reduce Preterm Birth in High-Risk Pregnancies
Prognostic and Predictive Molecular Classifiers for Bladder Cancer
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA)
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA) - Effective 7.1.2024
Prostatic Urethral Lift
Proteogenomic Testing for Patients with Cancer