Excellus BCBS

  • Hyperthermia as a Cancer Treatment: Extracorporeal Whole Body, Intraperitoneal, Local, Regional, Whole Body (PDF) Policy 2.01.25 (posted 7/23/14)
  • Viscosupplementation of the Knee for Osteoarthritis: Euflexxa (formerly Nuflexxa), Gel-One, Hyalgan, Hyaluronan, Orthovisc, Supartz, Synvisc, Synvisc One (PDF) Policy 7.01.02 (posted 4/8/14)
  • Total Hip Resurfacing, Metal-on-Metal (PDF) Policy 7.01.74 (posted 3/4/14)
  • Temporomandibular Joint (TMJ) Disease (PDF) Policy 11.01.17 (posted 1/8/14)
  • Surface Electromyography in Muscoloskeletal Conditions (Paraspinal EMG, Scanning EMG, SEMG) (PDF) Policy 2.01.46 (posted 7/7/14)
  • Manipulation Under Anesthesia (MUA), Manipulation under Joint Anesthesia (MUJA), Manipulation Under Sedation (MUS) (PDF) Policy 7.01.76 (posted 6/16/14)
  • Radiofrequency Facet Denervation (PDF) Policy 7.01.42 (posted 1/23/14)
  • Prolotherapy (e.g., Sarapin) (PDF) Policy 8.01.10 (posted 10/2/14)
  • Percutaneous Vertebroplasty or Kyphoplasty (e.g., Kyphon Inflatable Bone Tamp) (PDF) Policy 6.01.17 (posted 1/23/14)
  • Percutaneous Intradiscal Electrothermal Annuloplasty (IDET, IDTA, PIRFT, Biacuplasty) (PDF) Policy 7.01.17 (posted 5/1/14)
  • Osteochondral Grafting (Allograft, Autograft): Chondrofix®, Mosaicplasty, OATS (PDF) Policy 7.01.59 (posted 3/4/14)
  • Orthotics (e.g., OttoBock E-Mag Active KAFO, OttoBock SensorWalk Electronic KAFO, MYOMO mPower 1000 arm brace) (PDF) Policy 1.01.25 (posted 5/12/14)
  • Minimally Invasive Techniques for Lumbar Interbody Fusion: Anterior Lumbar(ALIF), Axial Lumbar (AxiaLIF), Direct Lateral (DLIF), Extreme Lateral (XLIF), Laparoscopic Anterior Lumbar (LALIF), Posterior Lumbar (PLIF), Transforaminal Lumbar (TLIF) (PDF) Policy 7.01.83 (posted 9/15/14)
  • Lumbar Traction: Vertebral Axial Decompression and Home Lumbar Traction Devices - ComfortTrac, Decompression Reduction Stabilization (DRS) System, HomeTrac, Orthotrac, VAX-D (PDF) Policy 1.01.50 (posted 10/2/14)
  • Intervertebral Disc Decompression: Laser (Laser Discectomy) and Radiofrequency Coblation (Disc Nucleoplasty™) Techniques (PDF) Policy 7.01.62 (posted 1/23/14)
  • Intervertebral Disc Decompression: Laser (Laser Discectomy) and Radiofrequency Coblation (Disc Nucleoplasty™) Techniques (PDF) Policy 7.01.62 (posted 1/23/14)
  • Interspinous and Interlaminar Stabilizatio/Distraction Implants (e.g., Coflex®, Interspinous Spacer, Spinal Distraction, X STOP) (PDF) Policy 7.01.75 (posted 9/15/14)
  • Interspinous and Interlaminar Stabilizatio/Distraction Implants (e.g., Coflex®, Interspinous Spacer, Spinal Distraction, X STOP) (PDF) Policy 7.01.75 (posted 9/15/14)
  • Interspinous and Interlaminar Stabilizatio/Distraction Implants (e.g., Coflex®, Interspinous Spacer, Spinal Distraction, X STOP) (PDF) Policy 7.01.75 (posted 9/15/14)
  • Ilizarov Method of Distraction Osteosynthesis (Bone Lengthening Procedure) (PDF) Policy 7.01.08 (posted 1/14/14)
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