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.
- 7.01.130 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
- 7.01.174 Stationary Ultrasonic Diathermy Devices
- 7.01.175 Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia
- 7.03.01 Kidney Transplant
- 7.03.02 Allogeneic Pancreas Transplant
- 7.03.04 Isolated Small Bowel Transplant
- 7.03.05 Small Bowel/Liver and Multivisceral Transplant
- 7.03.06 Liver Transplant and Combined Liver-Kidney Transplant
- 7.03.07 Lung and Lobar Lung Transplant
- 7.03.08 Heart/Lung Transplant
- 7.03.09 Heart Transplant
- 7.03.11 Total Artificial Hearts and Implantable Ventricular Assist Devices
- 7.03.12 Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes
- 7.03.13 Composite Tissue Allotransplantation of the Hand and Face
- 8.01.01 Adoptive Immunotherapy
- 8.01.02 Chelation Therapy for Off-Label Uses
- 8.01.08 Intraoperative Radiotherapy
- 8.01.10 Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions
- 8.01.11 Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
- 8.01.16 Chemical Peels
- 8.01.40 Manipulation Under Anesthesia
- 8.01.43 Radioembolization for Primary and Metastatic Tumors of the Liver
- 8.01.46 Intensity-Modulated Radiotherapy of the Breast and Lung
- 8.01.48 Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid
- 8.01.49 Intensity-Modulated Radiotherapy: Abdomen, Pelvis and Chest
- 8.01.52 Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used With Autologous Bone Marrow)
- 8.01.55 Stem Cell Therapy for Peripheral Arterial Disease
- 8.01.57 Baroreflex Stimulation Devices
- 8.01.58 Cranial Electrotherapy Stimulation and Auricular Electrostimulation
- 8.01.59 Intensity-Modulated Radiotherapy: Central Nervous System Tumors
- 8.01.61 Focal Treatments for Prostate Cancer
- 8.01.64 Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and Failure
- 8.01.67 Medical Management of Obstructive Sleep Apnea Syndrome
- 8.03.01 Functional Neuromuscular Electrical Stimulation