Surgery Section
Adipose-derived Stem Cell Enrichment in Autologous Fat Grafting to the Breast
Automated Percutaneous and Percutaneous Endoscopic Discectomy
Cosmetic and Reconstructive Procedures
Devices for Treatment of Benign Prostatic Hyperplasia, Urethral Stricture, and Urethral Stenosis
Femoroacetabular Impingement (FAI) Surgery
Gastric Electrical Stimulation
Gastroesophageal Reflux Surgery
Interspinous Fixation (Fusion) Devices
Intracardiac Ischemia Monitoring
Laser Trabeculotomy and Trabeculostomy
Policy Version Effective 05/01/2024: Micro-Invasive Glaucoma Surgery (MIGS) and Laser Trabeculectomy and Trabeculostomy
Magnetic Resonance (MR) Guided Focused Ultrasound (MRgFUS) and High Intensity Focused Ultrasound (HIFU) Ablation
Nerve Graft with Radical Prostatectomy
Occipital Nerve Stimulation (ONS)
Orthognathic Surgery
Percutaneous Axial Lumbosacral Fusion (LIF)
Percutaneous Transluminal Angioplasty (PTA) and Stenting
Peripheral Nerve Stimulation (PNS) and Peripheral Nerve Field Stimulation (PNFS)
Plugs for Enteric and Anorectal Fistula Repair
Radiofrequency Ablation (RFA) of Tumors Other Than the Liver
Sacral Nerve Stimulation (Neuromodulation) for Pelvic Floor Dysfunction
Surgeries for Snoring, Obstructive Sleep Apnea Syndrome, and Upper Airway Resistance Syndrome
Surgical Ventricular Restoration
Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (GERD)
Vagus Nerve Stimulation (VNS)