In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Policy: 03.00.20i:Modifiers 26 (Professional Component) and TC (Technical Component)
Policy: 07.05.06g:Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Policy: 11.02.10n:Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Policy: 11.02.12i:Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery
Policy: 11.02.17f:Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Policy: 11.06.04k:Uterine Artery Embolization
Policy: 11.11.01i:Evaluation and Treatment of Erectile Dysfunction (ED)
Policy: 11.14.10q:Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
Policy: 11.15.09m:Denervation of the Spinal Nerves for Chronic Pain
Policy: 12.01.01au:Experimental/Investigational Services