Medical Policies
Policies that are included in the FEP Medical Policy Manual.
The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member.
- 6.01.65 Oncologic Applications of Positron Emission Tomography Scanning (Lung)
- 6.01.66 Oncologic Applications of Positron Emission Tomography Scanning (Thyroid, Neuroendocrine, Head and Neck)
- 6.01.67 Oncologic Applications of Positron Emission Tomography Scanning (Brain, Melanoma, Unknown Primary)
- 7.01.05 Cochlear Implant
- 7.01.07 Electrical Bone Growth Stimulation of the Appendicular Skeleton
- 7.01.13 Surgical Treatment of Bilateral Gynecomastia
- 7.01.15 Meniscal Allografts and Other Meniscal Implants
- 7.01.18 Automated Percutaneous and Percutaneous Endoscopic Discectomy
- 7.01.19 Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence
- 7.01.21 Reduction Mammaplasty for Breast-Related Symptoms
- 7.01.29 Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy
- 7.01.44 Implantable Cardioverter Defibrillators
- 7.01.47 Bariatric Surgery
- 7.01.48 Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
- 7.01.58 Intraoperative Neurophysiologic Monitoring
- 7.01.66 Allograft Injection for Degenerative Disc Disease
- 7.01.68 Extracranial Carotid Artery Stenting
- 7.01.72 Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, Biacuplasty and Intraosseous Basivertebral Nerve Ablation
- 7.01.73 Gastric Electrical Stimulation
- 7.01.75 Cryosurgical Ablation of Primary or Metastatic Liver Tumors
- 7.01.81 Nerve Graft with Radical Prostatectomy
- 7.01.84 Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
- 7.01.85 Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- 7.01.87 Artificial Intervertebral Disc: Lumbar Spine
- 7.01.91 Radiofrequency Ablation of Primary or Metastatic Liver Tumors
- 7.01.92 Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone
- 7.01.93 Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency-Coblation (Nucleoplasty)
- 7.01.95 Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
- 7.01.96 Computer-Assisted Navigation for Orthopedic Procedures
- 7.01.101 Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
- 7.01.102 Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
- 7.01.104 Subtalar Arthroereisis
- 7.01.105 Balloon Ostial Dilation for Treatment of Chronic and Recurrent Acute Rhinosinusitis
- 7.01.106 Percutaneous and Subcutaneous Tibial Nerve Stimulation
- 7.01.107 Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
- 7.01.108 Artificial Intervertebral Disc: Cervical Spine
- 7.01.109 Magnetic Resonance Imaging-Guided Focused Ultrasound
- 7.01.110 Vertical Expandable Prosthesis: Titanium Rib
- 7.01.112 Transanal Endoscopic Microsurgery
- 7.01.113 Bioengineered Skin and Soft Tissue Substitutes
- 7.01.116 Facet Joint Denervation
- 7.01.118 Surgical Treatment of Femoroacetabular Impingement
- 7.01.120 Facet Arthroplasty
- 7.01.121 Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
- 7.01.122 Electromagnetic Navigational Bronchoscopy
- 7.01.123 Plugs for Anal Fistula Repair
- 7.01.124 Treatment of Varicose Veins/Venous Insufficiency
- 7.01.126 Image-Guided Minimally Invasive Decompression for Spinal Stenosis
- 7.01.127 Bronchial Thermoplasty
- 7.01.128 Bronchial Valves