Definitions and Variations
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Two- to 6-year follow-up was reported on 85 of 100 consecutive patients treated with thermal capsulorrhaphy for glenohumeral instability in 2007.10 Thirty-seven patients (43.5%) were c[r] ...
10
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... mutations are independently predicted by early age at onset, being present in 6 to 10% of breast cancer cases diagnosed at ages younger than various premenopausal age cutoffs (age range[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... 806.32 Fracture of vertebral column with spinal cord injury; Dorsal [thoracic], open; T1-T6 level with anterior cord syndrome. 806.33 Fracture of vertebral column with spinal cord inj[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Explantation &/or capsulotomy of a breast implant associated with a Baker Class III contracture may be considered medically necessary only in those patients who had originally unde[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose v[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... 9901A 9902A Randomized double-blind, placebo- controlled Metastatic prostate cancer by imaging, asymptomatic and progressing by imaging or rising PSA Exp: 3 infusions of va[r] ...
12
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Cognitive rehabilitation may be considered medically necessary for treatment of the cognitive deficits acquired only as a result of neurologic impairment due to traumatic brain injury, [r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Some external insulin infusion pumps (e.g., Paradigm Real-Time Insulin Pump and Continuous Glucose Monitoring System) are able to take results of the blood glucose reading, calculate th[r] ...
7
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... recommended, sensitivity analyses suggested that these findings were robust. QOL, as assessed by the Functional Assessment of Cancer Therapy (FACT) fatigue scale, was improved in patients receiving ESAs, but the ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... There is a lack of evidence that repository corticotropin injection is at least as safe and effective as synthetic ACTH for diagnostic testing of adrenocortical function and thus, this [r] ...
13
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... In 2008, Usichenko et al performed a systematic review of controlled trials to evaluate the evidence of efficacy of auricular acupuncture for postoperative pain control.. (42) Nine RCTs[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Impact of DaTscan SPECT imaging on clinical management, diagnosis, confidence of diagnosis, quality of life, health resource use and safety in patients with clinically uncertain parkin[r] ...
17
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... For other respiratory conditions, there is also a lack of published evidence; however national guidelines published by the American Academy of Pediatrics (AAP) have identified specific[r] ...
11
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... A 1993 randomized trial of lymphokine-activated killer (LAK) cell therapy in patients with metastatic renal cell cancer or melanoma unresponsive to standard therapy failed to show that [r] ...
22
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Implantation of intrastromal corneal ring segments may be considered medically necessary for the treatment of keratoconus in patients 21 years of age or older who meet the following..[r] ...
15
Policy Product Variations Description/Background Rationale Definitions Benefit Variations Disclaimer Coding Information References Policy History
... The evidence for genetic testing for mutations in the CHD7 gene in individuals who have signs/symptoms of CHARGE syndrome in whom a definitive diagnosis cannot be made with clinical [r] ...
10
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Centers for Medicare and Medicaid Services (CMS) Medicare Benefit Policy Manual. Chapter15- Covered Medical and Other Health Services. Section 150- Dental Services. American Association[r] ...
5
POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... Seifert et al reported on a series of patients with colorectal liver metastases that were treated from 1996-2002.27 In this series, 168 patients underwent resection and 55 had cryosurgi[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... A systematic review of the available literature on urine drug screening in the chronic pain management setting, alone or as part of a treatment agreement, was published in 2010 by Star[r] ...
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POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
... T24.392S Burn of third degree of multiple sites of left lower limb, except ankle and foot, sequela T24.611A Corrosion of second degree of right thigh, initial encounter. T24.611D Cor[r] ...
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