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.
- 7.01.174 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
- 8.01.10 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
- 8.01.61 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
- 8.03.05 Outpatient Pulmonary Rehabilitation
- 8.03.08 Cardiac Rehabilitation in the Outpatient Setting
- 8.03.09 Vertebral Axial Decompression
- 8.03.10 Cognitive Rehabilitation
- 8.03.13 Sensory Integration Therapy and Auditory Integration Therapy
- 9.03.06 Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma
- 9.03.15 Retinal Prosthesis
- 9.03.18 Optical Coherence Tomography of the Anterior Eye Segment
- 9.03.20 Intraocular Radiotherapy for Age-Related Macular Degeneration
- 9.03.29 Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome