Medical and Payment Policies

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Draft Medical Policies
ST2 Assay for Chronic Heart Failure and Heart Transplant Rejection
Medical
Salivary Estriol as Risk Predictor for Preterm Labor and Management of Menopause and/or Aging
Saturation Biopsy for Diagnosis, Staging and Management of Prostate Cancer
Scintimammography and Gamma Imaging of the Breast and Axilla
Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
Sensory Integration Therapy and Auditory Integration Therapy
Serum Biomarker Human Epididymis Protein 4
Serum Tumor Markers for Breast and Gastrointestinal Malignancies
Signal-Averaged Electrocardiography (SAECG)
Skin Contact Monochromatic Infrared Energy as a Technique to Treat Cutaneous Ulcers, Diabetic Neuropathy, and Miscellaneous Musculoskeletal Conditions
Smoking Cessation Mandate
Speech Therapy
Sphenopalatine Ganglion Block for Headache
Steroid-Eluting Sinus Stents
Surgery for Groin Pain in Athletes
Surgical Deactivation of Migraine Headache Trigger Sites
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Surgical Treatments for Breast Cancer-Related Lymphedema
Surgical Ventricular Restoration
Sympathetic Therapy for the Treatment of Pain
Synthetic Cartilage Implants for Joint Pain
Payment
Self-Treatment or Treatment of Immediate Family Members
Specimen Provenance Error Testing
Structured Screening and Brief Intervention Services
Prior Authorization
Skilled Nursing Facilities:Admission and Concurrent Review
Soliris (Eculizumab)
Spinraza (Nusinersen)
Spravato (esketamine)
Stelara (Ustekinumab) Intravenous Use for Crohns Disease
Stereotactic Body Radiation Therapy
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