Anda di halaman 1dari 12

Research And Markets: Study This Medical Review Criteria

Guidelines For Managing Care, 4th Edition 2005 Now

Modification associated for you to local clinical circumstances as well as regards to applicable
certificates associated with coverage or perhaps provider contracts could be suitable along with
Hyperbaric Oxygen Therapy; Immunizations; Injectable Medications; Laser procedures;
Miscellaneous services - Medicare Schedule regarding Payment Denial; Multiple Chemical
Sensitivity Syndrome or perhaps Idiopathic Environmental Intolerances (IEI); Organ as well as
Tissue Transplantation - bone marrow, intestinal, strong organs; Outmoded assessments as well as
procedures; Pain rehabilitation programs; Outpatient Hospital Pain Rehabilitation Programs;
Physician's office within an Institution--Coverage involving Solutions along with Provides Incident
into a Physician's Services; 'Second opinions'; Sleep disorders- testing; Transportation,
medical/Ambulance transports;
Back and Neck: Acute cervical pain; artificial Intervertebral Disc; Laminectomy ; low again pain;
Machines to be able to test along with treat low back again pain; Chymopapain Chemonucleolysis;
Endoscopic Anterior Spinal Surgery; Epidural injection involving steroids regarding back pain; Facet
Joint Injections; Facet Denervation, Facet Neurotomy, Facet Rhizotomy, or perhaps Articular
Rhizolysis; Hypertonic saline for your remedy associated with epidural adhesions, adhesive
arachnoiditis, or even failed back syndrome; Implantable Infusion Pumps for Treatment Method
regarding Chronic Severe Again Pain; Intradiscal Electrothermal Therapy (IDET); Laminectomy;
Meniscectomy; Microdiscectomy; Percutaneous Lumbar Discectomy, such as laser procedures;
Percutaneous vertebroplasty and kyphoplasty; Prolotherapy; Spinal instability - Pedicle screw
fixation; Spinal stenosis; Sacro-iliac Joint Injections; Chiropractic Medicine; Distraction
osteosynthesis, Ilizarov method; Spinal manipulation under anesthesia;
Morbid Obesity/Bariatric Surgery; Variety pertaining to surgery depending on comorbid diabetes
along with hypertension in addition for you to BMI;
Transendoscopic gastroplasty; Stretta along with EndoCinch Procedures; Fecal Occult Blood test,
screening - positive; Fiberoptic endoscopy for that evaluation involving swallowing; Gastric freezing
for your treatment involving active peptic ulcers; Gastrostomy/PEG tubes; Capsule Imaging
Endoscopy/Wireless - Medicare LMRP; Injection Sclerotherapy for bleeding esophageal varices;
Gastric Pacing; Liver Biopsy; Liver assist or perhaps assistance devices; Motility Disorders: Upper GI
- Diagnosis/Evaluation; Transesophageal Endoscopic Treatments pertaining to Gastroesophageal
Reflux (GERD); Transjugular Intrahepatic Portosystemic Shunt; Transplantation; Urea breath testing
regarding H. The Actual manual will be accompanied from the entire contents on the CD. Most
should be reviewed along with approved by a Health-related Policy Committee in the purchasing
organization just before use. The Particular manual is actually designed for use as either the
prospective utilization management reference, an educational tool, or for retrospective claims
payment review resource.
Research and Markets ( has announced
incorporating Healthcare Review Criteria Guidelines with regard to Managing Care, 4th edition
2005 to their offering
- Detection, Biopsy; Melanoma/Breast Cancer Staging; Scans with regard to Infection along with

Inflammation; SPECT scans; Thyroid studies; Tumor Scintigraphy (Gamma Camera).

Durable Healthcare Equipment (DME): Definitions; pressure Decreasing Assistance Surfaces, groups
1, 2, along with 3; Air Fluidized Beds; Bathroom as well as Toilet Equipment along with Supplies;
Beds and Bed Accessories/Trapeze Bars; Mattress as well as Pillow Insures for Asthmatics; Bedwetting Alarm; Breast Pumps; Catheters, urinary; --Cervical traction; Chairs, therapeutic;
Communication devices/aides; Compression Garments inside the Remedy regarding Venous Stasis
Ulcers; continuous Passive Motion device; Cranial Remodeling Band/Helmet regarding infants;
Dorsal Column Stimulators - pertaining to chronic intractable pain control; Diabetes mellitus-related
DME - Glucose monitors, blood; GlucoWatch(R) Biographer - automatic glucose values without a new
needle-stick; Jet Injectors pertaining to insulin administration; Insulin pens; Sleep sentry in order to
detect hypoglycemia; Constant Glucose Monitoring;
Oxygen coverage guidelines; Peak expiratory flow meter; Pneumatic Compression Therapy - Enddiastolic for non-healing extremity ulcers; Strain Lowering support Surfaces, Team one and also 2;
Computerized lower limb prostheses; Prothrombin time House Screening Systems;
- multiple gestation reduction; Amniocentesis; Cervical cerclage; Cervicography (cervigram);
Cesarean section - elective; Chorionic villus sampling; Colposcopy Immediate access regarding
OB/GYN services, Dilation and also Curettage (D & C), D & C plus hysteroscopy, D & C,
Hysteroscopy as well as pelvic laparoscopy - same day; Family Members Planning Solutions - birth
control devices and genetic counseling, Norplant, Oral contraceptives - sterilization - tubal
ligation/vasectomy, Sterilization - Tubal ligation or Free Tranny Cams even vasectomy, OTC
products; Fetal fibronectin screening for preterm labor and delivery risk; Genetic Counseling and
also Testing; home births; Hysterectomy; Outpatient hysterectomy;
Temporomandibular Joint Disorders (TMJ); Tinnitus Retraining Therapy; Tonsillectomy and/or
adenoidectomy; Transcutaneous electrical stimulators for severe tinnitus; Transtympanic Gentamicin
Injection regarding therapy regarding Meniere's disease; Tympanometry; Tympanostomy tubes;
Ultrasonic Surgery with regard to Meniere's; Uvulopalatopharyngoplasty (UPPP) and also
palatopharyngoplasty (PPP); Vestibular Perform Testing; Vestibular Rehabilitation; Vocal Cord
Examination using Videostroboscopy; Vocal Cord Injections for you to Avoid Recurrent Aspiration.
- Nephrology: Nephrology Consultation/Referral regarding ongoing care; Dialysis Therapy for Renal
Failure; Laboratory tests with regard to CAPD; Arteriovenous fistulae for dialysis; ESRD coverage by
simply Medicare vs. they needs to end up being able to be dispersed to relevant physicians and other
providers with regard to review, input and then any required adjust ahead of implementation.
referrals; Guidelines; 'Evaluate along with Treat' orders and authorization requests; Health-related
Necessity - Exactly what is actually it?; Case law citations related in order to healthcare necessity;
AHRQ Prevention High Quality Indicators; Speed up the actual review procedure simply by ...;
Hospital Inpatient Admission Criteria, general principles; 'Automatic' approval associated with
authorization requests;
Intrahepatic Chemotherapy regarding Liver metastasis - Chemoembolization; Isolated limb perfusion
(ILP); Mitoxantrone hydrochloride (Novantrone (R)); Monoclonal Antibody (Mab) Imaging or perhaps
Radioimmunoscintigraphy - colorectal cancer staging; Photodynamic Therapy; Radiofrequency
tumor ablation; Therapeutic phlebotomy; Vaccines for you to treat numerous cancers; Cancerrelated web sites; Photodynamic Therapy; Vaccines to be able to treat various cancers; Vitamin B12

- Radiology: Documentation requirements; Imaging guidance during surgical procedures; Bone Mass
Measurement/Bone mineral density (BMD) testing; Skeletal surveys inside children; Cardiac scans
with regard to CAD; Cerebral angiography; Chest x-rays, routine; Distinction media; Spine diagnostic radiology in adults and children; Imaging studies within acute low back pain;
Myelography along with Cisternography; Discography; Scoliosis in youngsters - indications
regarding radiography; Epidurogram/Epiduroscopy;
- Allergy testing and also Desensitization: Allergy referral, Allergy screening and desensitization
therapy; Serial Endpoint Allergy Testing; Immunotherapy for malignant disease; Leukocyte
Histamine release Test (LHRT); Screening with regard to Hypersensitivity Reactions for you to Food
Items as well as Chemicals, in Vitro Particle Dimension Measurement; Nasal Challenge Test;
Rhinitis, allergic - referral criteria; Transfer factor.
Environmental Manage Systems; Vaporizers; Exercise Equipment; Hearing aids; Bone-anchored
Hearing Aid; Hospital beds, Infusion pumps, external or even implantable; Intrapulmonary
Percussive Ventilator (IPV); Jobst Burn Off Garments;
Speech aids, electronic; Thairapy O vest with regard to cystic fibrosis; Thairapy Bronchial Drainage
System; Therabite Jaw Motion Rehabilitation System; Therapeutic Electrical Stimulation/TES;
Transcutaneous Electrical Nerve Stimulation/TENS; Inferential present stimulation; NonImplantable Pelvic floor Electrical Stimulator; Implanted Peripheral Electrical Nerve Stimulation;
Percutaneous Electrical Nerve Stimulation/PENS; Electrical Stimulation pertaining to Chronic
Musculo-cutaneous Ulceration; Respiratory Assist Devices; Standers, Boards and also Tables;
Vitrectomy Deal With Support; Wheelchairs, Power-type and Power-operated vehicles (POVs); Wigs;
DME Screening Record - a grid listing 290 additional DME/DMS review guidelines; Reuse
information Notice.
- Neurology/Neurosurgical: Autism along with Additional Pervasive Developmental Disorders;
Sensory Stimulation regarding Coma; Facial Nerve Paralysis (Bell's Palsy) - Electrotherapy;
Electroencephalogram (EEG) - standard, ambulatory, sleep-deprived, surgical, video;
Electrocorticography (ECoG); Mind mapping or Quantitive EEG for that diagnosis involving
psychiatric disorders; Electromyelogram (EMG)/Nerve Conduction Velocity (NCV); Spinal Cord
Injury Neuropsychological testing (NPT); Stroke and other CNS Disorders; Somatosensory Evoked
Responses, Vision Evoked Reaction test (VER), Deep Mind electrical Stimulation for intractable
tremors; Vision Evoked response test (VER); Multiple Sclerosis (MS) - Therapy, Net Sites; Multiple
Sleep Latency Test (MSLT); Neuropsychological testing (NPT);
- Obstetrics/Gynecology: Ablation - cervical lesion; Abortion/pregnancy termination
- Dermatology: Dermatology referral management; Acne vulgaris; Actinic keratosis; Alopecia areata;
Atopic dermatitis; Basal cell carcinoma; Biopsy/excision of benign skin along with subcutaneous
lesions, Cysts involving your skin along with subcutaneous structures; Decubitus Ulcers, treatment;
Digital Epiluminescence Microscopy (DELM)/Total body Photography; Fungus infections, skin along
with nails; Dermatophytosis; Grenz Ray Therapy; Herpes Simplex; Herpes Zoster; Impetigo and
pyoderma; Inflammatory dermatosis/'Rashes'; hair Loss/Alopecia; Keloids;
Non-contact Normothermic Wound Therapy (NNWT); 'Second Look' surgical procedures;
Thyroidectomy; Post-op LOS simply by procedure, list; Inpatient Times Prior to a Surgical
Procedure; where must the higher-risk procedure become performed inside a certain patient or even
population involving patients?

- Educational materials: General educational materials, Affected Person education materials Policy Development, Approval along with Review, Institutional as well as home Treatment Affected Person
Schooling Programs; Health-related 'Self Care' Educational Programs; Schooling courses for OB
patients; the 'Not Now!' Program; Institutional and also House care Individual Training Programs;
Medicare Coverage involving Diabetes Self-management Training.
DUBLIN, Ireland--(BUSINESS WIRE)--Feb. Well Being Plan; Darbepoetin Alfa (Aranesp); Intravenous
Iron Therapy; Medicare ESRD Coverage - algorithm; Hemodialysis for that treatment of hepatorenal
syndrome; Hemodialysis for your treatment method regarding schizophrenia; L-carnitine
supplementation; Nephrology web sites.
- Pharmacy: Pharmacy benefits; State regarding California Knox-Keene act requirements;
Foot and ankle: Bunionectomy; Foot treatment - routine; Mycotic nails; Some Other covered
solutions for the foot along with ankle; Ingrown toe nails; Olecranon bursa aspiration; Plantar
Keratosis; Interdigital Neuroma; Plantar fasciitis and also heel spurs; Consultation solutions by a
podiatrist - skilled nursing facility; Hammertoe surgery; Fractures in the toe; Maxwell-Brancheau
Arthroereisis (MBA) Implant - regarding flat-foot;
- Skeletal-muscular system: Knee region: Arthroscopy - knee; Arthroscopic lavage or perhaps
debridement, knee; Total Knee Replacement; Autologous chondrocyte transplantation surgery of
Teen Shemale Webcam the knee; Hyaluronidase, intra-articular injections with regard to
- Radiology Advantage Management: Web helpful details on radiology, nuclear medicine and also
radiation therapy provider manuals.
Cognitive Rehabilitation Therapy; Constraint-induced movement therapy (CIMT);
Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy; Hypothermia next acute brain
injury; Induced Lesions involving Nerve Tracts; Intra-operative Electromyographic Monitoring
associated with Cranial Nerves; Invasive Intracranial Stress Monitoring; Ulnar Nerve Transposition,
Decompression or Release; Monitoring; Ulnar Nerve Transposition, Decompression or even Release;
Vagus Nerve Stimulation for the remedy involving refractory seizures; Vagus Nerve Stimulation for
the remedy regarding depression; Videopupillography/Tropicamide Drop Test for the Diagnosis
regarding Alzheimer's Disease; Perception Threshold/Sensory Nerve Conduction Threshold (SNCT);
- Ophthalmology: A-scans, B-scans; Blepharoplasty, ptosis correction as well as eyelid
reconstruction; Capsulotomy; YAG laser; Cataract surgery; Preoperative Evaluation and also testing
regarding Cataract Extraction; Computer-assisted corneal topography; Conjunctivitis;
Conjunctivodacryocystorhinostomy; Balloon Dacryocystoplasty/Dacryoplasty for Nasolacrimal Duct
Obstruction; contact Lenses; Corneal graft utilizing amniotic membrane transplantation (AMT);
Corneal pachymetry; Corneal post-transplant wound revisions; Corneal wedge resection;
MRI and also CT scans - Computerized Tomography (CT) as well as Computerized Axial Tomography
(CAT) - Overview; Computerized Tomography (CT or perhaps CAT) which includes extracranial head,
brain as well as thoracic scans; High-resolution CT (HRCT) pertaining to Pulmonary Studies; CT with
regard to appendicitis; Spiral CT Scans for Lung Cancer Screening; Helical CT regarding Pulmonary
Embolism Detection; Computerized Axial Tomography (CT) Scans: Pelvis, Abdomen, Abdomen as
well as Pelvis - about the identical day; Electron-beam CT screening pertaining to coronary artery
disease; Ultrasound involving peripheral sites (tibia, phalanges) for your choice of patients for
pharmacologic treatment of osteoporosis;

- Urology - review criteria: Referral guidelines; BCG therapy pertaining to bladder cancer; Urinary
FISH Test for Recurrent Bladder Cancer; Valrubicin pertaining to carcinoma in-situ in the bladder;
Bladder stimulator/Pacemaker implantation; Bladder pacemakers; Bladder Capacity Ultrasound
(Post-void Residual Measurements); Circumcision with the adult male; Cystoscopy; Bladder biopsy,
Neuroimaging Studies pertaining to Headaches; Metastatic bone disease - radiologic evaluation;
Percutaneous Drainage/Aspiration involving Abscesses along with Fluid Collection; Percutaneous
Permanent Inferior Vena Cava Placement; Percutaneous Transcatheter Embolization; Percutaneous
Transluminal Angioplasty (PTA); Peripheral Vascular Disease Evaluation; Renal Artery Stenosis Angiography and Stent Placement; Spiral CT regarding Lung Cancer Screening; Thermography;
- ENT, Oral Surgery and also Dental Services: Acoustic neuroma; Audiological Testing; Aural
Rehabilitation Therapy; Mind stem auditory evoked response (BER, BAER); Carbogen Inhalation
Therapy for that treatment involving Sudden Hearing Loss; Cleft lip/Cleft Palate Repairs; Cochlear
Implantation; CPAP pertaining to obstructive sleep apnea; Noninvasive Positive Pressure/Bi- PAP;
Dental services; Dental hospitalization; Damage to be able to sound and Organic Teeth; Intra-oral
appliances for the management involving migraine headache syndromes; Dynamic Posturography;
Canadian drugs; Formulary; MAC pricing; Generic substitution; Alpha 1-antitrypsin inhibitor
therapy; Anticoagulant Therapy - Monitoring; Biologicals; Hepatitis vaccines; Growth hormone
replacement (adults along with children); Botulinum toxin; Calcitriol; Cancer chemotherapy;
Erythropoeitin Therapy; Experimental Drug Therapy; Chelation therapy; Diabetes management
therapy/supplies; Diabetic foot ulcers - Regranex gel therapy;
Papanicolaou tests/'Pap smears' along with HPV DNA Screening for Cervical Cancer;
Perineorrhaphy, Preimplantation Genetic Diagnosis; Pregnancy; Recurrent pregnancy loss; Presacral
neurectomy (PSN) for that remedy involving chronic pelvic pain; Salivary estriol test with regard to
preterm labor, Salpingectomy/salpingostomy, VABRA aspirator; Ultrasonography within pregnancy,
Ultrasonongraphy screen for Down Syndrome, Uterine activity Monitoring (UAM), Uterine Fibroid
(Leiomyomata) Therapy; Uterine artery embolization for that treatment of fibroids; VABRA aspirator;
Zinc blood ranges in pregnancy.
Cardiovascular Nuclear Medicine studies; Congestive Coronary Heart Failure - admission, discharge
criteria guidelines; CT scans for you to screen regarding coronary artery disease; Congestive
Coronary Heart Failure - Hospital admission criteria; Defibrillator devices, automatic implantable
cardioverter; Immediate present cardioversion, elective; Directional coronary atherectomy (DCA);
- Radiation Therapy/Oncology: Radiation oncology; Mixture Chemotherapy and Radiation Therapy;
Brachytherapy; Brachytherapy for the Prevention of Restenosis in Peripheral Arteries Next PTA in
the Femoropopliteal System; Intracoronary Brachytherapy; Breast Conservation Therapy in the
Management regarding Invasive Breast Cancer; Neutron Beam Radiotherapy; Proton Beam
Radiotherapy; Stereotactic radiosurgery; Transperineal Brachytherapy regarding prostate cancer;
Boron Neutron Capture Therapy (BNCT) Regarding Glioblastoma Multiforme; Intensity Modulated
Radiation Therapy; Radiation Therapy web sites.
- Gastroenterology: Balloon Dilation regarding Gastrointestinal Tract Strictures; Colonoscopy, direct
& Virtual: screening, diagnostic; Dysphagia - Evaluation associated with swallowing mechanism;
Electrogastrography (EGG); Endoscopic Retrograde Cholangiopancreatography (ERCP); Magnetic
resonance cholangiopancreatography (MRCP); Endoscopic Ultrasonography; Upper, Lower;
Esophagogastroduodenoscopy (EGD); flexible sigmoidoscopy; Gastroesophageal reflux disease

(GERD); Intestinal Rehabilitation Programs; Implanted Ladyboy Live Cams Capsule pH Monitoring
with regard to GERD;
- Complementary along with Alternative Medicine: Alternative medicine criteria;
Acupuncture/Acupressure; Ayurvedic medicine; Biofeedback; Biofeedback regarding Urinary
Incontinence; Magnetic and also Bioelectromagnetic Therapy; Diet Plan and also Nutrition; Guided
imagery; Homeopathy; Hypnotherapy; Manual/massage therapy; Naturopathy; Relaxation therapy;
Transcendental meditation; Alternative medicine resources; references; web sites; useful resource
Stimulators: Chronic pain, Angina pectoris; Treatment Method involving Motor function Disorders
using Electric Nerve Stimulation; Neuromuscular electrical stimulation (NMES) pertaining to disuse
atrophy; Neuromuscular as well as Therapeutic Electrical Stimulation (TES); Transcutaneous
electrical nerve stimulation (TENS); 'Sympathetic Therapy'; Inferential present stimulation; Nonimplantable Pelvic Floorboards Electrical Stimulator; Percutaneous electrical nerve stimulation
(PENS); ReliefBand; Implanted Peripheral Electrical Nerve Stimulation; Pulsed electrical stimulation
regarding osteoarthritis of the knee; Electrical Stimulation for your Treatment Method associated
with Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations; Surface electrical muscle
mass stimulation; Bone stimulators: electrical as well as low-intensity ultrasound; Electrogalvanic
Stimulators regarding Levator Syndrome; H-wave stimulation for the treatment method associated
with diabetic neuropathy;
- General Surgery: Clinical Guidelines regarding Office-based Surgery; Anal fissure, chronic;
Appendectomy; Breast surgery - biopsy; Mastectomy; Cholecystectomy, open up or even
laparoscopic; Colon resection - Colectomy, Debridement, Wound; Gastroesophageal Reflux Device
Implantation, Gastroesophageal Reflux (GERD) Surgery; Hemorrhoidectomy - internal and external,
Hiatal Hernia repair, Incisional Hernia Repair, Inguinal Hernia Repair, Umbilical Hernia Repair,
Incision along with Drainage (I & D) Procedures; Laparoscopy as well as Peritoneoscopy;
Lifts - seat along with patient; Mild Emitting Diode (LED) or perhaps Infrared Therapy; Lymphedema
'Pump'/Manual lymph drainage; Magnetic Pelvic floor Stimulation (MPFS); Nebulizers; Wound Care;
Negative pressure wound therapy (NPWT) Pumps; Radiant Heat Wound Therapy Systems;
Neuromuscular electrical stimulation (NMES);
- Disposable Health-related Supplies/Durable Healthcare Equipment: Medicare Coverage Criteria for
DME; Disposable Healthcare Materials (DMS): Incontinence supplies; Urinary Drainage Systems;
Porcine Skin and Gradient Strain Dressings; Ostomy supplies; Unna boot;
- Nuclear Medicine: Bone scan; CEA scans; Cardiac Scans - Introduction/Overview, Medicare LMRP;
Cardiac scans - thallium as well as gated pool scans; Cerebral Scintigraphy pertaining to brain
Death; Cholecystokinin Cholescintigraphy/Hepato-biliary scintigraphy; Gastrointestinal scintigraphy;
Gated Pool Scan; Indium-III Oxine labeled white blood cells scan; Liver spleen scan; Monoclonal
Antibody (Mab) Imaging/Radioimmunoscintigraphy which includes Scintimammography; Parathyroid
Electrical Stimulation DME include: Dorsal Column Stimulators/Spinal Cord
Breast imaging studies: Diaphanography with the breast; Mammography, screening or
diagnostic/Digital/CAD mammography; Magnetic Resonance Imaging with the Breast: Differential
Diagnosis; Breast Ultrasound along with Echography; Stereotactic Breast Biopsy;

Pediculosis ('lice'); Photochemotherapy for that therapy involving scleroderma, extracorporeal;

Pityriasis rosea; Psoriasis; PUVA Therapy; Rosacea; Scabies; Sclerotherapy regarding varicose veins,
Seborrheic dermatitis/'Dandruff'; Seborrheic keratosis; Squamous cell carcinoma; Tattoos; Verruca
Vulgaris/ Warts; Vitiligo; Ultraviolet A New Mild Therapy; Ultraviolet B light Therapy.
Age-related Macular Degeneration (AMD); Macular degeneration: Laser Therapy; Radiation
Treatment; Macular Fovea Translocation with regard to AMD; Ocular Photodynamic Therapy (OPT) Visudyne (Verteporfin) Therapy regarding Age-related Macular Degeneration; Opthalmoscopy,
extended using retinal drawing Orbitotomy; Photocoagulation; Pterygium; Ptosis; Punctal
dilation/snipping; Punctal Plugs as well as Punctoplasty regarding 'Dry Eyes' Syndrome; Corneal
remodeling methods - Refractive Keratoplasty/Radial Keratotomy/Phototherapeutic Keratectomy;
Refractive Keratoplasty/Radial keratotomy; Prosthesis, eye; Eye Examinations - Medicare; Routine
vision exam; Scleral buckle; Strabismus correction; Tarsorrhaphy; Transpupillary Thermal Therapy;
Viscocanalostomy; Visual field Testing; Visual coaching (Orthoptics); Visual Rehabilitation Program;
Vitrectomy; Referral criteria summary sheet/grid regarding typical complaints.
- References and also Resources: found throughout the actual manual - conveniently following each
along with every criteria as well as topic.
Ultrasonography: Overview; Noninvasive cerebrovascular studies of extracranial arteries; Paranasal
sinus ultrasonography; Spinal canal and contents ultrasonography; Peripheral Arterial Ultrasound
Examination Making Use Of Pulsed Doppler; Peripheral Venous Ultrasound Examination; Thyroid as
well as Parathyroid Ultrasonography;
- Pulmonary: Pulmonary operate tests; Quantitative pilocarpine iontophoresis sweat test; Duration IV
antibiotics regarding pneumonia; Electrophrenic Pacemaker; Fiberoptic bronchoscopy; Lung volume
reduction surgery; Sleep apnea studies/Polysomnography; Sleep apnea studies, portable; BiPap;
Phrenic nerve pacing/Diaphragm pacing; Positive Expiratory Strain (PEP) with regard to Cystic
Fibrosis Therapy; Noninvasive Positive-Pressure Ventilation (NPPV) regarding COPD; Postural
Drainage Methods and Pulmonary Exercises; Pulmonary Rehabilitation; Outpatient Pulmonary
Rehabilitation (PR); COPD guideline resources as well as links; 'Virtual' Lung Scans.. 10, 2005--949
pages consist of more than 1,200 clinical 'benefit interps'/ review criteria clinical guidelines.
- Laboratory: Medicare Coverage involving Laboratory Testing; Diagnostic testing, indications,
coverage (HIV, PSA, Thyroid examples); Tau, BA-42 as well as Apolipoprotein E exams pertaining to
Alzheimer's disease; high Sensitivity C-Reactive Protein (hsCRP); Anti-MAG as well as Anti-GM1
Antibody Exams pertaining to Neurologic Disease; Cytogenetic studies; Human tumor cell assays
(Fluorescent Cytoprint assay, extreme Drug Resistance assay); Genetic/Molecular Susceptibility
Screening/Testing; Genetic screen regarding thyroid carcinoma as well as MEN; Genetic screen with
regard to breast as well as ovarian cancer (BRCA1, 2); Genetic testing for cystic fibrosis; Genetic
screening with regard to hereditary nonpolyposis colorectal cancer; Curly Hair analysis; Hefty
metals along along with other minerals, test indications; Histocompatibility (HLA) testing;
Iron/Ferritin Studies, Serum; Tumor markers; Lipid Profiles/Testing; Lyme Disease Testing;
Laboratory References, general.
Gonadotropin-releasing hormone therapy; HIV Drug susceptibility along with resistance testing;
Hyaluronidase, intra-articular injections; Intravenous immunoglobulins (IVIG); IVIG to prevent RSV;
Cytomegalovirus Immune Globulin Intravenous, Human (CMV-IVIG); Interferon therapy; Intrathecal
Baclofen pertaining to spasticity; Intravenous Histamine Therapy; Iontophoresis - programs within
transdermal medication delivery;

Selective peripheral denervation (Bertrand procedure) with regard to spastic torticollis; Spinal tap,
diagnostic, Stereotactic Cingulotomy, for severe and also intractable pain due in order to terminal
cancer; Sympathetic therapy for chronic pain management; Sympathetic therapy regarding chronic
pain management; Sympathectomy, Thoracoscopic; Thalamic Electrical Stimulation, for that therapy
regarding intractable tremors; Transcranial Doppler Ultrasonography; Transient Ischemic Attack
(TIA) - Hospitalization Indications; Trigeminal Neuralgia, Cryosurgery;
Diagnostic radiology - general; Extremity x-rays; Knee trauma; Diagnostic Arteriography Indications; Cervicocerebral angiography; Digital subtraction angiography (DSA); Infusion
Venography; Sources pertaining to Angiography Indications; Abdominal along with
Gastroenterological X-ray Procedures; Cholescintigraphy (HIDA); Cinedefecography; Herniography;
Urological: Intravenous Pyelography (IVP); Cystography and Urethrography; Voiding
cystourethrography within Children;
- Emergency healthcare services: Emergency services/authorization system, Emergency room
authorization/claims processing matrix, Emergency treatment criteria; Relationship of ER
admissions to insurance status; Ambulance as well as other healthcare transportation;
monitoring; Ambulatory electrocardiography (Holter monitor); Brachytherapy, Coronary; Cardiology
consultation or referral; Chest pain - admission criteria, Cardiac catheterization, proper heart;
Central venous strain monitoring, Cardiac Catheterization, proper heart, Central venous pressure
monitoring; Cardiac Catheterization, left heart; Coronary Arteriography; Angiography as well as
Ventriculography; Cardiac Event Monitors; Implanted Loop Recorders; Catheter ablation for atrial
fibrillation along with HF; Cardiac Output Monitoring by Electrical Bioimpedance ;
- Cardiology: Acoustic heart Scans/Recordings; Ambulatory blood pressure
- Addenda: Operational Standards; Delegation in order to PCPs; Delegation to end up being able to
SCPs; New Healthcare Technologies Assessment - Policy/Procedure, Performance standards:
QI/UM/Provider relations/Customer service; Critical care - Medicare LMRP; Worker's Compensation;
Hospital treatment 'length regarding stay' targets, by get older range; Frequency by
Diagnostic/Procedural Group, Size associated with stay targets by DRG; NY State Medicaid ALOS
simply by DRG 2004; Surgical Procedures, LOS benchmarks; Outpatient methods or perhaps 'Sameday discharge' authorization list;
Orthotic/prosthetic devices; Breast prosthesis, specialized bras for ladies post-mastectomy; Corset
used as Hernia Support; Dynamic Splinting Devices; Foot orthotics/therapeutic shoes; Magnetic
insoles regarding plantar heel pain; Myoelectric prosthesis, upper extremity;
Shoulder: Shoulder Arthrography; Arthroscopy, shoulder; Electrothermal arthroscopic repair with
regard to shoulder instability; Impingement Syndromes, Shoulder Bursitis, Rotator Cuff Tendinitis &
Tears; Ultrasound therapy for calcific tendinitis in the shoulder;

Endothelial cell photography; Entropion; Ectropion; Enucleation; External Ocular Photography;

Glaucoma treatment; Optic Nerve Head Topography - Confocal Laser Scanning Tomography,
Stereophotogrammetry; Argon Laser Trabeculoplasty; Aqueous drainage/shunt implants regarding

refractory main open-angle glaucoma; Gold Excess Weight Upper Eye Lid Implants; Grave's Disease
Ophthalmopathy; Indocyanine Green Angiography; Intraocular Lens Implant; Iridotomy/Iridectomy;
Keratoconus; Keratoplasty; Keratoprosthesis or Synthetic Cornea;
Echocardiograms, adult and pediatric; Doppler Echocardiography; Electrocardiograms;
Electrophysiology testing (ET); Endocardial electrical recording along with stimulation (EES),
diagnostic; Enhanced external counterpulsation (ECP) - therapy pertaining to severe angina;
Workout Treadmill Test (ETT), routine screening; Exercise Treadmill Test (ETT) - routine, screening;
ETT with Thallium imaging; Pacemakers - permanent cardiac/Resynchronization Therapy;
Pacemaker monitors; Pacemakers/External manually activated devices for you to terminate
tachyarrhythmias; Percutaneous Transluminal Coronary Angioplasty (PTCA); Radiofrequency
Catheter Ablation; Stents, coronary artery; Thoracic electrical bioimpedance; Thrombolysis for acute
myocardial infarction; Tilt Table Testing; T-Wave Alternans (TWA) testing; Cardiac Rehabilitation
Programs; Phonocardiography and also Vectorcardiography; LOS benchmarks/targets for cardiology
diagnoses; References re: AMI LOS; Screening for cardiac disease; Cardiology guideline resources,
web links.
Positron Emission Tomography (PET scans); Pulmonary Scintigraphy; Prostate cancer staging scan;
Renal Scintigraphy; Scrotal scintigraphy; Sentinel Lymph Node
- Note: Review criteria My Shemale Cams guidelines as well as 'benefit interps' are helpful resources
for claims payment choices for you to base health-related necessity decisions, particularly when little
or even no preauthorization operate or information exists as well as utilization management,
educational and precertification tools. pylori infection.
Other Skeletal-muscular: Extracorporeal Shock Wave Therapy (ESWT) with regard to musculoskeletal conditions; Apligraft (R) (Graftskin) Medicare LMRP; Carpal tunnel release; Trigger Point
Injections; Total Hip Replacement (THR) - Primary, excluding hip fracture, indications, LOS; Bone
stimulators, electrical and low-intensity ultrasound; Gait analysis or the electrodynogram; Injection,
tendon sheath, ligament, or trigger points or ganglion cyst; Injection regarding joints; Osteogenic
protein-1 for your therapy associated with nonunion fractures;
Transrectal ultrasound for prostate or perhaps rectal cancer - biopsy/staging; Pelvic Ultrasound
within Females; Sonohysterosalpingraphy; Obstetrical Ultrasonography; Scrotal Ultrasonography;
Retroperitoneal Ultrasonography; Developmental Hip Dysplasia Detection through Ultrasonography;
Ultrasound involving peripheral web sites (tibia, phalanges) for the collection of patients regarding
pharmacologic treatment method involving osteoporosis; Radiology guideline resources/web links.
Impedance plethysmography; Intermittent claudication; Intraoperative Ventricular Mapping; Left
Ventricular Assist Devices; Maze Procedure for atrial fibrillation/flutter; Microsurgical
lymphaticovenous anastomosis operation for lymphedema; Pectus excavatum and Pectus carinatum Surgical Correction; Photophoresis, extracorporeal - Therapy with regard to Coronary Heart
Transplant Rejection; Post-thoracotomy Pain - Intraoperative, Intercostal Nerves, Cryoanalgesia;
Pulmonary vein isolation with regard to atrial fibrillation; Renal Artery Stenosis - Angioplasty, Stent
Placement; Transcoronary ablation associated with septal hypertrophy (TASH); Transjugular
Intrahepatic Portosystemic Shunt; Transmyocardial laser revascularization; Varicose vein treatments
which includes Endovenous Ablation Therapy; Ventricular Assist Devices; Ventricular
Reduction/Remodeling or perhaps Partial Ventriculectomy; Vertebral artery surgery; Peripheral
vascular rehabilitation programs.
- Vascular Laboratory: Noninvasive cerebrovascular studies of extracranial arteries; Carotid function

- non-invasive tests: Duplex scan involving carotid arteries; vertebral arteries; Ocular
Plethysmography (OPG) and Ophthalmodynamometry; Transcranial doppler, Penile doppler as well
as Corpora Cavernosography, Peripheral arterial non-invasive studies: Segmental Doppler Pressures
along with Pulse Volume Recording; Workout (Stress) Doppler Test; Visceral arterial duplex
imaging; Peripheral Arterial Duplex Scan; Digital Arterial Evaluation; Peripheral venous and arterial
non-invasive studies/ultrasonography; Peripheral Arterial Ultrasound Examination Utilizing Pulsed
Doppler; AcuTect/Scintigraphic Imaging With Regard To Detection/Localization associated with
Lower Limb Deep Vein Thrombosis;-- Hemorheograph.
Carpal Tunnel Syndrome - conservative therapy; Carpal Tunnel Release; Cranial Electrical
Stimulation; Embolization involving intracranial aneurysms; Electromyelogram (EMG)/Nerve
Conduction Velocity (NCV); Anal or perhaps Urethral Sphincter Electromyography; Sensory Evoked
Potentials; Ketogenic diet program for your charge of intractable seizures inside children; Peripheral
neuropathy using loss of protective sensation (LOPS); H-wave stimulation for that management
regarding chronic diabetic peripheral neuropathy;
Electroencephalographic biofeedback for intractable seizures; Epiduroscopy; Fetal Tissue
Transplantation for your Treatment Method associated with Parkinson's disease; Pallidotomy for that
treatment involving Parkinson's disease; Fetal Tissue Transplantation for that Remedy regarding
Parkinson's disease; Surgical evaluation regarding intractable seizure disorders - Grid monitoring;
Deep Mind electrical Stimulation with regard to intractable tremors; Mind mapping (quantitative
EEG) for diagnosis associated with TS Cams psychiatric disorders;
Laser regarding actinic lesions; Malignant melanoma; Mohs Micrographic Surgery;
Incontinence - defined; artificial Urinary Sphincter; Strain incontinence - Electrical stimulation of
the pelvic floor; Sacral nerve stimulation regarding urge incontinence; Transurethral/Periurethral
collagen implantation pertaining to anxiety urinary incontinence; Marshall-Marchetti Kranz, Burch,
Stamey as well as comparable procedures; References - Urinary Incontinence; Transrectal
ultrasound pertaining to prostate kind of cancer - biopsy/staging; Renal Cryoablation; Transrectal
ultrasound with regard to prostate cancer; Transsexual surgery; Urethral Dilation - female;
Urodynamic Testing;
- Plastic Surgery: Abdominoplasty/Panniculectomy Breast surgery - Implant removal and/or
replacement; Gynecomastia reconstruction in the male patient; Augmentation mammoplasty;
Reduction mammoplasty or even breast reduction surgery; Liposuction: Lipectomy, Suction-assisted;
cosmetic surgery; Chemical exfoliation as well as peel; Plastic laser surgery; Cutaneous Ulcer,
Chronic - Electrical Stimulation; Ear lobe deformities; Locks transplantation; Mentoplasty (Chin
Augmentation, Genioplasty); Plastic Surgery to Appropriate "Moon Face"; Porcine Skin as well as
Gradient Stress Dressings; Reconstructive surgery - general criteria; Scar revisions; Skin
redundancy next huge weight loss.
Prostate Cancer therapy; prostate Cancer Screening Assessments and Procedures; Prostate specific
Antigen (PSA); Benign Prostatic Hypertrophy - Remedy options; UroLume(R) endourethral
prosthesis (urethral stent) pertaining to BPH, stenosis, strictures; Cryosurgical ablation in the
prostate; Microwave therapy with regard to BPH; Transurethral Resection with the Prostate (TURP);
Transurethral Microwave Thermotherapy (TUMT) with regard to BPH; Transurethral
Radiofrequency Thermotherapy/Needle Ablation with the Prostate (TUNA); Water-Induced
Thermotherapy (WIT); Shock wave lithotripsy (Extracorporeal shock wave lithotripsy);
- Nutritional: Nutrition Counseling/Educational Programs; Specialty foods, Liquid nutrition products;

Ketogenic diet program counseling for refractory seizure control; low protein food products;
Extremely reduced excess fat diets to become able to treat or perhaps stop coronary heart disease;
Supplemental Fasting Regimens; Enteral Nutrition/Tube feeding; Parenteral nutrition/Total
Parenteral Nutrition (TPN); Internet helpful info on food and also nutrition;
- Cardiovascular/Peripheral Vascular Surgery: Alcohol Septal Ablation pertaining to Hypertrophic
Obstructive Cardiomyopathy; Aortic Aneurysm Repair - Criteria and also Options; Aortic and/or valve
replacement; Atherectomy, peripheral; Atrial septal defect, repair; Carotid physique tumor resection
(Glomectomy); Carotid endarterectomy - Indications, LOS; Carotid/Vertebral Artery Angioplasty
along with Stenting Procedures; Coronary artery bypass graft(s) surgery (CABG) - Indications, LOS;
Extracranial-Intracranial arterial bypass surgery; Coronary Heart volume reduction surgery;
Impotence evaluation and treatments: Viagra; Noninvasive suction devices; Papaverine injections;
Penile prosthesis implantation; Electroejaculation; Internal Pudendal Arteriography (Angiography)
pertaining to Erectile Dysfunction; Percutaneous Nephrostomy;
Electronystagmogram (ENG); Ernest or Eagle's Syndrome/Stylomandibular Ligament Pain - Therapy
together with Radiofrequency Thermoneurolysis; Frenulectomy; Hearing Tests,; Impacted teeth extraction; Intra-operative Electromyographic Monitoring regarding Cranial Nerves; Laser assisted
Uvulopharyngoplasty (LAUP); Myringotomy with Tympanostomy Tubes/Laser Myringotomy; Meniett
twenty pertaining to overpressure therapy involving Meniere's Disease;
Oral surgery; Oral biopsy regarding malignancy; Orthodontia; Orthognathic surgery; Distraction
osteogenesis pertaining to craniofacial abnormalities; Otitis media, recurrent; Otoplasty; Positional
vertigo; Rhinomanometry along with acoustic rhinometry/Nasal Operate Studies; Septoplasty;
Septorhinoplasty; Sialorrhea (drooling) - Surgical Treatment; Sinusitis, acute; Sinus endoscopy,
together with or even with out computer-augmentation; Smell and Taste - Evaluation coverage;
Low molecular weight heparin; Lyme disease vaccine; Meningococcal vaccine; Mifepristone
(Mifeprex(TM), RU 486); Nicotine patch, gum or perhaps nasal apply therapy for smoking cessation;
Off-label drug therapy; Oral contraceptives; Phonophoresis; Prior authorization checklist
w/indications; Platelet-derived Growth Aspect pertaining to Wound Healing (Regranex, Procuren);
Prophylactic antibiotics; Prostacyclin infusion therapy; Sexual function therapy; Smallpox
Vaccination; Topical steroids; Transfer Factor; Tumor Necrosis Aspect Inhibitors - Ankylosing
Spondylitis, Ulcerative Colitis, Psoriasis; Injectable drugs; Pharmacy web sites.
- Hematology/Medical Oncology: Hem-Onc Authorization Guideline Notes; Adjuvant Chemotherapy;
Adoptive immunotherapy (AIT); Bone marrow/Stem cell transplant (BMT); Umbilical cord blood
compatibility testing; Chemoresistance assays/Tumor chemosensitivity; Chemotherapy vs Endocrine
Therapy for Metastatic Breast Cancer; Cryosurgical ablation hepatic lesions; Dendritic cell
immunotherapy for cancer; Donor Lymphocyte Infusions; Epithelial Cell Cytology within breast
Cancer risk Assessment and also High-Risk Affected Person Management; Extracorporeal
Immunoadsorption; Extracorporeal Photopheresis; Hematopoietic colony-stimulating
factor/Granulocyte-macrophage colony-simulating factor; Hyperalimentation for patients receiving
chemotherapy; Hyperthermia; Hypothermia (regional scalp cooling) - chemotherapy-associated head
of hair loss;
- Blood Bank: Autologous Blood-Derived products pertaining to Chronic Non-Healing Wounds; Blood
transfusions; autologous, allogeneic, donor directed; Cord blood storage; Granulocyte and Platelet
Transfusions; Plasmapheresis, plasma exchange, apheresis and related procedures; Lipid apheresis;
Nonselective (random) transfusions along with living-related donor certain transfusions within

kidney transplantation; Therapeutic Phlebotomy

MRI Research - Overview; 'Standing' as well as 'Sitting' MRI Scans; MRI Brain; MRI Orbit, Face,
along with Neck; MRI Spine; MRI/MRA - Cardiovascular studies; MRI Abdomen and also Pelvis;
Tumor staging; Table citing optimal imaging studies simply by region; CT Angiogram; MRI and also
CT-guided biopsies; Magnetic Resonance Angiography (MRA) which includes Venography; Magnetic
resonance spectroscopy/Nuclear magnetic resonance; Magnetic Supply Imaging
(MSI)/Magnetoencephalography (MEG);
- Miscellaneous: Assisted Suicide; Autopsies; Cryoanalgesia and Cold Laser (low-energy) Therapy
with regard to wound healing, pain therapy, and other disorders; Complications following Noncovered Solutions - Coverage; Hospital Costs with regard to Noncovered Services; Death-related
Services; Electrosleep Therapy; Experimental/Investigative Services; Histamine desensitization
therapy for intractable headache; Hospital Admission Guidelines with regard to Diabetic Adults;
Immunotherapy to diminish the particular risk of spontaneous abortion; Infertility management:
Coverage criteria pertaining to females, Coverage criteria with regard to males, Infertility
treatment, artificial insemination, Ova sticks - ovum transfer/uterine lavage - sperm
donor/storage/washing; Intracytoplasmic sperm injection; In-Vitro Fertilization (IVF) along with
Gamete Intra-Fallopian Transfer (GIFT); Multifetal pregnancy reduction (MFPR); Recurrent
Pregnancy Loss; Transcervical balloon tubuloplasty; Intra-uterine device (IUD) - removal,
Laparoscopy - pelvic; Myomectomy; Nerve Ablation Processes with regard to Dysmenorrhea,
Laparoscopic; Laparoscopic, Oophorectomy;
- Pediatric: Pediatric authorization guidelines with regard to Lengths associated with stay; Apnea
monitor; Circumcision of the newborn male; Cord blood testing; Cystic fibrosis screening inside
newborns; Diabetes mellitus - Assessment of Require regarding Hospitalization for your Stabilization
associated with newly Diagnosed children with Diabetes; Diabetes Management using 'Hepatic
Activation' or even 'PIVIT' Therapy; Comprehensive pediatric case management services; Early
Intervention Programs; Extracorporeal membrane oxygenation (ECMO); Hearing Screening,
Newborn; Immunizations, Lead screening - blood - children; Newborn LOS - when infant healthy,
Mother needs continued hospital care; Phototherapy; Physician Attendance from Delivery with
regard to Evaluation and also Management regarding Newborn; Port Wine Stains.
For more info visit
- Introduction: Introduction to referral authorization management guidelines and also criteria; CMS
national policies; Ranges of danger throughout capitation; Fundamental elements of the utilization
management plan; Consultants vs