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Medicine Section

Policy Name	Date Modified
Acoustic Cardiography	10/01/2011
Actigraphy	12/01/2011
Anterior Eye Segment Optical Imaging	06/01/2011
Autologous Blood-Derived Growth Factors as a Treatment for Wound Healing and Other Miscellaneous Conditions	11/01/2011
Automated Point-of-Care Nerve Conduction Studies	04/01/2012
Breast Duct Endoscopy (Ductoscopy)	05/01/2011
Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting	03/01/2011
Charged Particle (Proton or Helium Ion) Radiation Therapy	01/01/2012
Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease	03/01/2012
Enhanced External Counterpulsation (EECP)	04/01/2011
Epiretinal Radiation Therapy for Age-Related Macular Degeneration	06/01/2011
Epithelial Cell Cytology in Breast Cancer Risk Assessment and High Risk Patient Management (Ductal Lavage and Suction Collection Systems)	05/01/2011
Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions	10/01/2011
Gait Analysis	01/01/2011
Gene Therapy	02/01/2011
Hyperbaric Oxygen Pressurization (HBO)	11/01/2011
In Vivo Analysis of Colorectal Polyps	11/01/2011
Ingestible pH and Pressure Capsule	11/01/2011
Intensity Modulated Radiation Therapy (IMRT) of the Abdomen and Pelvis	08/01/2011
Intensity Modulated Radiation Therapy (IMRT) of the Breast and Lung	04/01/2012
Intensity Modulated Radiation Therapy (IMRT) of the Head and Neck Cancers and Thyroid Cancer	08/01/2011
Intensity Modulated Radiation Therapy (IMRT) of the Prostate	01/11/2012
Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation	03/01/2012
Low Level Laser Treatment of Neuromuscular Pain Disorders and Other Miscellaneous Conditions	07/01/2011
Manipulation Under Anesthesia for the Treatment of Pain	06/01/2011
Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensates in the Diagnosis and Management of Patients with Asthma and Other Respiratory Diagnoses	01/01/2011
Microwave Thermotherapy for Primary Breast Cancer	01/01/2012
Neurofeedback	02/01/2011
Non-Contact Ultrasound Treatments for Wounds	06/01/2011
Orthopedic Applications of Stem-Cell Therapy	12/01/2011
Outpatient Cardiac Telemetry	01/01/2011
Outpatient Intravenous Insulin Therapy (OIVIT)	09/01/2011
Paraspinal Surface Electromyography (EMG) to Evaluate and Monitor Back Pain	04/01/2011
Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia	11/01/2011
Prolotherapy	02/01/2011
Quantitative Sensory Testing	04/01/2011
Radioembolization for Primary and Metastatic Tumors of the Liver	09/14/2011
Research Urgent Treatments	02/01/2012
Retinal Prosthesis	04/01/2011
Signal-Averaged Electrocardiography (SAECG)	05/01/2011
Stem-cell Therapy for Peripheral Arterial Disease	12/01/2011
Sublingual Immunotherapy as a Technique of Allergen Specific Therapy	02/01/2011
Suprachoroidal Delivery of Pharmacologic Agents	03/01/2011
Temporary Prostatic Stent	07/01/2011
Transcutaneous Electrical Modulation Pain Reprocessing	01/01/2012
T-Wave Alternans	01/01/2012
Vertebral Axial Decompression	03/01/2011


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