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 "Radiology" category.

 Intensity-Modulated Radiotherapy: Central Nervous System Tumors
 Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas
 Magnetic Resonance Imaging‒Targeted Biopsy of the Prostate
 Magnetoencephalography/Magnetic Source Imaging
 Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease
 Optical Coherence Tomography of the Anterior Eye Segment
 Radioembolization for Primary and Metastatic Tumors of the Liver
 Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
 Scintimammography and Gamma Imaging of the Breast and Axilla
 Stereotactic Radiosurgery and Stereotactic Body Radiotherapy


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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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