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160 documents have been found for your search on: local coverage determination


Type
Title
78%
Policy; 05.00.50k
Ostomy Supplies
76%
Policy; 05.00.37f
Compression Garments
75%
Policy; 05.00.43f
Seat Lift Mechanisms
74%
Policy; 05.00.61f
Cervical Traction Devices for In-home Use
73%
Policy; 03.02.12c
Electrocardiogram (ECG/EKG) Reported with Single Photon Emission Computed Tomography (SPECT) for Myocardial Perfusion Imaging (MPI)
72%
Policy; 09.00.11d
Contrast Agents Used in Conjunction with Echocardiography
72%
Policy; 05.00.38j
Negative-Pressure Wound Therapy (NPWT) Systems
71%
Policy; 05.00.55i
Wheelchair Cushions and Seating
71%
Policy; 08.01.08d
Coverage of Prescription Oral Anticancer Drugs and/or Biologics as Provided Under the Company's Medical Benefit
71%
Policy; 08.00.15e
Off-label Coverage for Prescription Drugs and/or Biologics
71%
Policy; 05.00.32i
Speech and Non-Speech Generating Devices
70%
Policy; 05.00.74d
Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
70%
Policy; 07.03.14o
Intraoperative Neurophysiological Monitoring (INM)
70%
Notification
Electrocardiogram (ECG/EKG) Reported with Single Photon Emission Computed Tomography (SPECT) for Myocardial Perfusion Imaging (MPI)
70%
Policy; 05.00.60h
Pressure-Reducing Support Surfaces
70%
Policy; 05.00.42g
Patient Lifts
70%
Policy; 07.00.09d
Topical Oxygenation
70%
Policy; 05.00.11i
Therapeutic Shoes and Orthopedic Shoes
69%
Policy; 05.00.73c
Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
69%
Policy; 07.03.21k
Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
69%
Policy; 05.00.12g
Manual Wheelchairs
69%
Policy; 12.01.03
Cosmetic Procedures
69%
Policy; 05.00.56i
Hospital Beds and Accessories
69%
Policy; 00.01.19d
Facility Reporting of Observation Services
68%
Policy; 01.00.09c
Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump
68%
Policy; 11.14.07u
Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
68%
Policy; 07.00.01i
Biofeedback Therapy
68%
Policy; 05.00.58l
Home Oxygen Therapy
68%
Policy; 05.00.54g
Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
68%
Policy; 05.00.14j
High-Frequency Chest Wall Oscillation Devices
67%
Policy; 08.00.17h
Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)
67%
Policy; 05.00.67p
Wheelchair Options and Accessories
67%
Policy; 05.00.30m
Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices (Independence Administrators)
67%
Policy; 11.16.01h
Septoplasty, Rhinoplasty, and Septorhinoplasty
67%
Policy; 05.00.59j
Lower Limb Prostheses
67%
Policy; 11.11.03d
Cryosurgical Ablation of the Prostate Gland
67%
Policy; 05.00.01l
Pneumatic Compression Therapy Devices
67%
Policy; 11.08.14j
Removal of Breast Implants
66%
Policy; 06.02.26d
In Vitro Allergy Testing
66%
Policy; 07.13.08e
Partial Coherence Interferometry
66%
Policy; 05.00.29k
Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
66%
Policy; 11.08.06j
Panniculectomy, Abdominoplasty, and Other Excisions of Redundant Skin
66%
Policy; 07.03.23b
Autonomic Nervous System Testing
65%
Policy; 07.00.05g
In Vivo Allergy Sensitivity Testing
65%
Policy; 07.02.21e
Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
65%
Policy; 07.00.03n
Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy
65%
Policy; 05.00.26i
Home Prothrombin Time Monitoring
65%
Policy; 08.00.18m
Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk
65%
Policy; 11.06.09d
Labiaplasty
65%
Policy; 08.01.21c
Blinatumomab (Blincyto®)
65%
Policy; 05.00.47n
Knee Orthoses
64%
Policy; 07.03.05w
Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (Independence)
64%
Policy; 10.06.01l
Speech Therapy
64%
Policy; 08.00.57n
Treatments for Complex Regional Pain Syndrome (CRPS)
64%
Policy; 11.05.01f
Refractive Keratoplasty
64%
Policy; 08.00.13v
Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
64%
Policy; 07.02.05j
External Counterpulsation (ECP)
64%
Policy; 07.13.05k
Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
64%
Policy; 07.13.13c
Prescription Lenses and Visual Devices
64%[Replication or Save Conflict]
63%
Policy; 09.00.46z
High-Technology Radiology Services (Independence)
63%
Policy; 11.04.01d
Islet Cell Transplantation
63%
Policy; 11.17.06n
Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
63%
Policy; 11.14.02o
Trigger Point Injections
63%
Notification
Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
63%
Policy; 11.14.21h
Microprocessor-Controlled Prostheses for Lower-Extremity Amputees
63%
Policy; 08.00.92aa
Coagulation Factors
63%
Policy; 11.08.17i
Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
63%
Policy; 07.07.07g
Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
63%
Policy; 11.08.23j
Mohs' Micrographic Surgery
63%
Policy; 11.14.13g
Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
63%
Policy; 11.15.03j
Insertion of Implantable Infusion Pumps
63%
Policy; 07.00.20f
Routine Costs Associated with Qualifying Clinical Trials
62%
Policy; 11.15.23h
Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
62%
Policy; 08.00.75n
Erythropoiesis-Stimulating Agents (ESAs)
62%
Policy; 05.00.05l
Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
62%
Policy; 08.01.33b
Gonadotropin-Releasing Hormone Agonist (Eligard®, Lupron Depot®)
62%
Policy; 07.07.01o
Routine Foot Care for Certain Medical Conditions
62%
Policy; 10.01.01n
Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
62%
Policy; 08.01.36d
Nusinersen (Spinraza®)
62%
Policy; 00.01.44h
Never Events and Preventable Adverse Events
61%
Policy; 07.00.21i
Allergy Immunotherapy
61%
Policy; 10.03.01j
Physical Medicine, Rehabilitation, and Habilitation Services
61%
Policy; 06.02.43b
Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
61%
Policy; 11.08.05g
Application and Removal of Tattoos
61%
Policy; 06.02.54
Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
61%
Policy; 07.03.15d
Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)
61%
Policy; 11.05.02i
Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
61%
Policy; 10.02.02i
Chiropractic Spinal and Extraspinal Manipulation Therapy
61%
Policy; 07.03.22c
Transcranial Magnetic Stimulation (TMS)
60%
Policy; 11.01.07e
Cataract Surgery
60%
Policy; 12.04.02i
Ground Ambulance Services (Emergency and Nonemergency) (Independence)
60%
Policy; 10.03.01k
Physical Medicine, Rehabilitation, and Habilitation Services
60%
Policy; 07.03.07t
Evaluation and Management of Autism Spectrum Disorder (ASD)
60%
Policy; 03.00.15o
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
60%
Policy; 03.00.16o
Modifier 57 Decision for Surgery
60%
Policy; 07.06.01b
Complete Decongestive Therapy (CDT)
60%
Policy; 07.03.18o
Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
60%
Policy; 07.03.10e
Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
60%
Notification
Implantable Infusion Pumps
60%
Policy; 07.12.01e
Pelvic Floor Stimulation as a Treatment of Incontinence
60%
Policy; 11.14.14e
Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
60%
Policy; 11.08.02h
Reduction Mammoplasty
60%
Policy; 05.00.09h
Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System
59%
Policy; 07.07.09g
Stem-Cell Therapy for Orthopedic Applications and Autologous Platelet-Derived Growth Factors (PDGFs)/Platelet-Rich Plasmas (PRPs) for Acute or Chronic Wound Healing and Other Miscellaneous Conditions
59%
Policy; 11.02.16r
Ventricular Assist Devices (VADs)
59%
Notification
Transcranial Magnetic Stimulation (TMS)
59%
Policy; 07.03.09p
Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
59%
Policy; 09.00.17o
Intensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)
59%
Policy; 11.02.01s
Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
59%
Policy; 11.08.20u
Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
59%
Policy; 05.00.39o
Ankle-Foot/Knee-Ankle-Foot Orthoses
59%
Policy; 08.01.38c
Ocrelizumab (Ocrevus®)
59%
Policy; 11.03.12r
Colorectal Cancer Screening
59%
Policy; 11.15.20o
Deep Brain Stimulation (DBS)
59%
Policy; 06.02.55
Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
59%
Policy; 05.00.24q
Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)
59%
Policy; 06.03.04n
Apheresis Therapy
58%
Policy; 12.01.01au
Experimental/Investigational Services
58%
Notification
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
58%
Policy; 03.00.06q
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
58%
Policy; 11.14.19n
Artificial Intervertebral Disc Insertion
58%
Policy; 11.08.15x
Reconstructive Breast Surgery
58%
Policy; 06.02.44l
Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
58%
Not. Att.
Attachment B (Healthcare Common Procedure Coding System (HCPCS) Codes To Which Multiple Surgery Payment Reduction Applies) to 11.00.10w Multiple Surgery Payment Reduction
58%
Policy; 11.17.04s
Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
58%
Policy; 05.00.15q
Nebulizers and Inhalation Solutions
58%
Policy; 08.00.67l
Cetuximab (Erbitux®)
58%
Policy; 07.13.07j
Corneal Pachymetry Using Ultrasound
58%
Policy; 11.15.01v
Spinal Cord and Dorsal Root Ganglion Stimulation
58%
Policy; 06.02.27l
Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)
58%
Policy; 07.03.24a
Laboratory-Based Vestibular Function Testing
58%
Policy; 11.08.04h
Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
58%
Policy; 11.11.06h
Saturation Needle Biopsy of the Prostate
58%
Policy; 06.02.49b
VeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer
58%
Policy; 11.11.01i
Evaluation and Treatment of Erectile Dysfunction (ED)
58%
Policy; 11.00.06j
Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
57%
Policy; 11.03.02s
Bariatric Surgery
57%
Policy; 11.02.25g
Transcatheter Cardiac Valve Procedures
57%
Policy; 07.08.03e
Medical and Surgical Treatment of Temporomandibular Joint Disorder
57%
Policy; 11.14.08d
Orthognathic Surgery
57%
Policy; 07.07.03m
Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
57%
Policy; 11.06.04k
Uterine Artery Embolization
57%
Policy; 08.00.34m
Infliximab and Related Biosimilars
57%
Policy; 07.00.02i
Intravenous Chelation Therapy
57%
Policy; 11.03.11n
Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
57%
Policy; 01.00.08c
Preoperative Consultations Performed by Providers in Anesthesia Specialties
56%
Policy; 07.05.02n
Wireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon
56%
Notification
Preoperative Consultations Performed by Providers in Anesthesia Specialties
56%
Policy; 07.00.10i
Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
56%
Policy; 11.07.01t
Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)
56%
Policy; 08.00.22m
Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
55%
Policy; 07.13.06k
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
55%
Policy Att.
Attachment A (Dosing and Frequency Requirements) to 08.00.13v Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
55%
Policy; 11.14.10q
Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
54%
Policy; 06.02.39d
Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics
54%
Policy; 08.00.26v
Botulinum Toxin Agents
54%
Policy; 11.14.22d
Spinal Decompression with Interspinous and Interlaminar Devices
54%
Policy; 11.15.16n
Vagus Nerve Stimulation (VNS)
54%
Policy; 06.02.51c
Testing Serum Vitamin D Levels

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.