Excellus BCBS

  • Erectile Dysfunction: Caverject, Edex, ErecAid, Intracavernosal Therapy, Intraurethral Therapy, MUSE (Medicated Urethral System for Erection), Penile Prosthesis, Penile Vein Ligation, Vacuum Erection Device, Vascular Revascularization (PDF) Policy 7.01.30 (posted 7/29/14)
  • Endoscopic Injection of Bulking Agents for the Treatment of Vesicoureteral Reflux (e.g., Deflux, STING) (PDF) Policy 7.01.68 (posted 1/23/14)
  • Cryosurgery or Cryosurgical Ablation of the Prostate (PDF) Policy 7.01.01 (posted 9/15/14)
  • Balloon Dilatation of the Prostatatic Urethra (Balloon Urethroplasty) (PDF) Policy 12.01.16 (posted 10/2/14)
  • Small Bowel and Multivisceral Transplants in Adults and Children (PDF) Policy 7.02.05 (posted 3/4/14)
  • Placental and Umbilical Cord Blood as a Source of Stem Cells (PDF) Policy 7.01.48 (posted 8/4/14)
  • Pancreas Transplant (Pancreas Transplant Alone, Pancreas After Kidney Transplant, Simultaneous Pancreas Kidney Transplant) (PDF) Policy 7.02.01 (posted 8/4/14)
  • Lung and Lobar Lung Transplant (PDF) Policy 7.02.10 (posted 3/4/14)
  • Liver/Hepatic Transplantation (PDF) Policy 7.02.07 (posted 1/23/14)
  • Kidney (Renal) Transplantation (PDF) Policy 7.02.04 (posted 3/4/14)
  • Heart and Heart/Lung Transplants (PDF) Policy 7.02.06 (posted 3/4/14)
  • Autologous Stem Cell Transplantation (PDF) Policy 7.02.03 (posted 10/24/13)
  • Allogeneic Stem Cell Transplantation (PDF) Policy 7.02.02 (posted 10/24/13)
  • Speech/Language Pathology and Therapy (e.g., Fast ForWord, Lee Silverman Voice Therapy [LSVT-LOUD™],Voice Therapy) (PDF) Policy 8.01.13 (posted 7/29/14)
  • Pulmonary/Respiratory Rehabilitation (PDF) Policy 8.01.15 (posted 3/17/14)
  • Physical Therapy (PT): e.g., Aquatic Therapy, Biodex, Cybex, Gait Analysis, Hippotherapy, Hydrotherapy, Isokinetic Dynamometry/Testing, Myowave, Vibromyography (VMG) (PDF) Policy 8.01.12 (posted 9/15/14)
  • Occupational Therapy (OT): Constraint Induced Movement Therapy (CIMT), Gait Analysis, Sensory Integration Therapy (PDF) Policy 8.01.17 (posted 9/15/14)
  • Cognitive Rehabilitation, Attention Rehabilitation, Sensory Integration Therapy (PDF) Policy 8.01.19 (posted 9/15/14)
  • Cardiac Rehabilitation (PDF) Policy 8.01.14 (posted 7/29/14)
  • Negative Pressure Wound Therapy (Vacuum Assisted Closure) (PDF) Policy 1.01.38 (posted 10/24/13)
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