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.
- 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
- 7.01.130 Axial Lumbosacral Interbody Fusion
- 7.01.133 Microwave Tumor Ablation
- 7.01.136 Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension
- 7.01.137 Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease
- 7.01.139 Peripheral Subcutaneous Field Stimulation
- 7.01.140 Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery
- 7.01.149 Amniotic Membrane and Amniotic Fluid
- 7.01.151 Prostatic Urethral Lift
- 7.01.153 Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast
- 7.01.158 Balloon Dilation of the Eustachian Tube
- 7.01.160 Synthetic Cartilage Implants for Joint Pain
- 7.01.162 Surgical Treatments for Breast Cancer-Related Lymphedema
- 7.01.163 Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
- 7.01.166 Allograft Injection for Degenerative Disc Disease
- 7.01.168 Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis
- 7.01.170 Laser Interstitial Thermal Therapy for Neurological Conditions
- 7.01.171 Remote Electrical Neuromodulation for Migraines