Effective July 1, 2017, we're lifting medical necessity review requirements for 101 experimental and investigational (EIV) codes. 

>> View the complete list of affected codes

Medical Protocol Introduction


Our Corporate Medical Protocols provide a concise overview of the criteria used for clinical determinations for a member’s coverage.

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Medical Protocol Search

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You searched in the "Surgery" category.

 Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias
 Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
 Allogeneic Pancreas Transplant
 Aqueous Shunts and Stents for Glaucoma
 Artificial Intervertebral Disc: Cervical Spine
 Artificial Intervertebral Disc: Lumbar Spine
 Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
 Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
 Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non-Orthopedic Conditions
 Automated Percutaneous and Percutaneous Endoscopic Discectomy


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Medical Protocols


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Gastric Electrical Stimulation
Gender Reassignment Surgery
Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease
Gene Expression-Based Assays for Cancers of Unknown Primary
General Approach to Evaluating the Utility of Genetic Panels
General Approach to Genetic Testing
Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing
Genetic Testing for Alpha1-Antitrypsin Deficiency
Genetic Testing for Alzheimer Disease
Genetic Testing for Breast Cancer Gene Expression Prognosis Assay
Genetic Testing for Cardiac Ion Channelopathies
Genetic Testing for Cystic Fibrosis
Genetic Testing for Developmental Delay and Autism Spectrum Disorder
Genetic Testing for Duchenne and Becker Muscular Dystrophy
Genetic Testing for Epilepsy
Genetic Testing for Familial Cutaneous Malignant Melanoma
Genetic Testing for FAP and Lynch Syndrome
Genetic Testing for Hereditary Breast and Ovarian Cancer Syndrome
Genetic Testing for Hereditary Hearing Loss
Genetic Testing for Hereditary Hemochromatosis
Genetic Testing for Human Leukocyte Genes (HLA)
Genetic Testing for Lactase Insufficiency
Genetic Testing for Leukemia and Lymphoma
Genetic Testing for Li-Fraumeni Syndrome
Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
Genetic Testing for Mental Health Conditions
Genetic Testing for Mitochondrial Disorders
Genetic Testing for Noninvasive Prenatal Testing
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
Genetic Testing for PTEN Hamartoma Tumor Syndrome
Genetic Testing for Statin-Induced Myopathy
Genetic Testing for Tamoxifen Treatment
Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
Genetic Testing for Warfarin Dose
Genetic Testing of CADASIL Syndrome

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