Medical Necessity Guidelines (CAMNGs)
 
 

ALPHABETICAL VIEW

A   B   C   D   E   F   G   H   I   K   L   M   N   O   P   Q   R   S   T   U   V   W   X  


A

Abdominoplasty and Panniculectomy (02/15/10) (PDF, 71KB)

Acne Procedures (03/15/10) (PDF, 103KB)

Acupuncture (03/15/10) (PDF, 210KB)

Actinic Keratosis Treatments (11/15/09) (PDF, 173KB)

Adoptive Immunotherapy (11/15/09) (PDF, 161KB)

Adrenal-to-Brain and Fetal Mesencephalic Transplantation for Parkinson Disease (12/15/09) (PDF, 161KB)

Airway Clearing Device in the Ambulatory Setting (05/15/10) (PDF, 150KB)

Allergy Testing (05/15/10) (PDF, 155KB)

Allograft Transplant of the Knee, Including Anterior Cruciate, Osteochondral and Meniscal (06/15/10) (PDF, 189KB)

Ambulatory Assist Devices (03/15/09) (PDF, 93KB)

Ambulatory Blood Pressure Monitoring with Automatic Portable Monitors (06/15/10) (PDF, 141KB)

Amnioinfusion (11/15/06) (PDF, 156KB)

Amniotic Membrane Transplant for the Treatment of Ocular Conditions (05/15/10) (PDF, 122KB)

Anesthesia and Facility Services for Dental Treatment (11/15/09) (PDF, 113KB)

Anodyne Therapy (05/15/09) (PDF, 113KB)

Apheresis for Hypercholesterolemia (01/15/10) (PDF, 132KB)

Arthroscopic Lavage and Debridement of the Knee for the Treatment of Osteoarthritis and Other Knee Conditions (02/15/10) (PDF, 113KB)

Assays of Genetic EXpression in Tumor Tissue as a Prognosis in Patients with Breast Cancer (03/15/10) (PDF, 283KB)

Attention-Deficit/Hyperactivity Disorder (ADHD) (11/15/09) (PDF, 241KB)

Aural Rehabilitation (09/15/09) (PDF, 110KB)

Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment (12/15/09) (PDF, 248KB)

Autologous Chondrocyte Transplantation (06/15/10) (PDF, 91KB)

Autologous Skeletal Myoblast Transplant/Autologous Cell Therapy for Damaged Myocardium (02/15/10) (PDF, 174KB)

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B

Balloon Valvuloplasty (01/15/10) (PDF, 157KB)

Bariatric Surgery (05/15/10) (PDF, 255KB)

Barnett Continent Intestinal Reservoir (05/15/09) (BCIR) (PDF, 97KB)

Bathroom and Toilet Equipment and Supplies (05/15/09) (PDF, 178KB)

Benign Prostatic Hypertrophy (BPH) Treatments (09/15/08) (PDF, 187KB)

Benign Skin Lesion Removal (03/15/09) (PDF, 75KB)

Biofeedback (02/15/09) (PDF, 299KB)

Biventricular Pacing/Cardiac Resynchronization Therapy (CRT) (08/15/09) (PDF, 204KB)

Blepharoplasty, Blepharoptosis Repair and Brow Lift (04/15/10) (PDF, 133KB)

Bone Graft Substitutes for Use in Bone Repair (03/15/10) (PDF, 316KB)

Bone Growth Stimulators: Invasive, Noninvasive, Ultrasound (04/15/10) (PDF, 184KB)

Bone Mineral Density Measurement (03/15/10) (PDF, 168KB)

Botulinum Toxin Type A (Botox® A) (08/15/09) (PDF, 155KB)

Botulinum Toxin Type B (Myobloc®) (09/15/08) (PDF, 152KB)

Brachytherapy Following Femoropopliteal Percutaneous Transluminal Angioplasty (PTA) (06/15/10) (PDF, 61KB)

Brachytherapy of The Prostate (11/15/09) (PDF, 212KB)

Brachytherapy of the Breast (11/15/09) (PDF, 188KB)

Breast Implant Removal (02/15/10) (PDF, 94KB)

Breast Pumps (06/15/10) (PDF, 119KB)

Breast Reconstruction Following Mastectomy or Lumpectomy (09/15/09) (PDF, 204KB)

Breath Test for Detection of Heart Transplantation Rejection (06/15/10) (PDF, 89KB)

Bunionectomy (03/15/10) (PDF, 131KB)

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C

Capsule Endoscopy (02/15/10) (PDF, 126KB)

Cardiac Event Monitors (04/15/10) (PDF, 145KB)

Cardiac Rehabilitation (Phase II Outpatient) (03/15/10) (PDF, 137KB)

Cardiovascular Magnetic Resonance (CMR) (09/15/09) (PDF, 112KB)

Carotid Artery Stenting for Carotid Artery Stenosis (10/15/09) (PDF, 194KB)

Chelation Therapy (11/15/09) (PDF, 98KB)

Chiropractic Care (12/15/09) (PDF, 143KB)

Cineradiography/Videofluoroscopy (09/15/08) (PDF, 72KB)

Cochlear and Auditory Brainstem Implants (05/15/10)(PDF, 214KB)

Cognitive Rehabilitation (07/15/10) (PDF, 137KB) (07

Colorectal Cancer Screening and Surveillance (06/15/10) (PDF, 216KB)

Complementary and Alternative Medicine (06/15/10) (PDF, 189KB)

Complex Lymphedema Therapy (Complete Decongestive Therapy) (05/15/09) (PDF, 130KB)

Computed Tomography Angioraphy (CTA) (09/15/09) (PDF, 231KB)

Computed Tomographic Colonography/Virtual Colonoscopy (06/15/10) (PDF, 146KB)

Computed Tomography for Whole-Body Screening (12/15/09) (PDF, 115KB)

Computer-Assisted Guidance for Orthopedic Surgery (06/15/10) (PDF, 141KB)

Continuous Passive Motion (CPM) Devices (08/15/09) (PDF, 140KB)

Cooling Devices for Multiple Sclerosis (06/15/09) (PDF, 124KB)

Corneal Remodeling (09/15/09) (PDF, 162KB)

Corneal Pachymetry (03/15/10) (PDF, 136KB)

Cryoablation of Breast Lesions (04/15/10) (PDF, 161KB)

Cryoablation of Liver Tumors (03/15/10) (PDF, 156KB)

Cryounits/Cooling Devices (03/15/10) (PDF, 121KB)

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D

Deep Brain Stimulation (09/15/09) (PDF, 156KB)

Devices for Voice Rehabilitation Following Total Laryngectomy (09/15/07) (PDF, 125KB)

Diabetic Supplies (08/15/08) (PDF, 157KB)

Diaphragmatic/Phrenic Nerve Stimulation (07/15/10) (PDF, 133KB)

Dielectical Behavior Therapy (07/15/09) (PDF, 145KB)

Discography (07/15/07) (PDF, 145KB)

Distraction Osteogenesis (DO) for Craniofacial Deformities (09/15/08) (PDF, 174KB)

Donor Leukocyte Infusion (01/15/10) (PDF, 148KB)

Drug-Eluting Stents for Ischemic Heart Disease (06/15/10) (PDF, 214KB)

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E

Electrical Stimulation for Wound Healing (05/15/10) (PDF, 160KB)

Electrical Stimulators (08/15/08) (PDF, 257KB)

Electromyography Studies (07/15/10) (PDF, 114KB)

Electron Beam Computed Tomography (EBCT) and Multidetector Comuter Tomography (MDCT) for Coronary Artery Calcification (12/15/09) (PDF, 175KB)

Endometrial Ablation (01/15/10) (PDF, 174KB)

Endoscopic Anti-Reflux Procedures (12/15/09) (PDF, 181KB)

External Insulin Pump (03/15/10) (PDF, 274KB)

Extracorporeal Immunoadsorption With Protein A Column (07/15/09) (PDF, 166KB)

Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions (10/15/09) (PDF, 166KB)

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F

Fetal Surgery (08/15/09) (PDF, 214KB)

Foot Care Services (02/15/09) (PDF, 72KB)

Functional Magnetic Resonance Imaging (MRI), Brain (07/15/10) (PDF, 126KB)

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G

Gastric Pacing/Gastric Electrical Stimulation (GES) (05/15/10) (PDF, 104KB)

Gender Reassignment Surgery (01/15/10) (PDF, 96KB)

Genetic Testing for Susceptibility to Breast and Ovarian Cancer BRCA1 & BRCA2 (07/15/10) (PDF, 175KB)

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H

Hammer Toe Surgery (03/15/10) (PDF, 127KB)

Heart Transplantation (08/15/08) (PDF, 87KB)

Home Apnea Monitoring for Infants (03/15/09) (PDF, 132KB)

Home Blood Glucose Monitoring (03/15/10) (PDF, 190KB)

Home Phototherapy for Hyperbilirubinemia (04/15/10) (PDF, 151KB)

Home Traction Devices: Cervical and Lumbar (01/15/10) (PDF, 179KB)

Home Uterine Activity Monitoring (09/15/09) (PDF, 109KB)

Hospice Care (03/15/10) (PDF, 109KB)

Hospital Beds and Accessories (01/15/10) (PDF, 138KB)

Hospitalization for the Initiation of a Ketogenic Diet for Intractable Seizure Disorder (06/15/10) (PDF, 112KB)

Hydroxyprogesterone Caproate (17á- Hydroxy-progesterone) (04/15/10) (PDF, 122KB)

Hyperbaric Oxygen Therapy (04/15/10) (PDF, 205KB)

Hyperhidrosis Treatments (01/15/10) (PDF, 148KB)

Hysterectomy (04/15/10) (PDF, 354KB)

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I

Immune Globulin Intravenous (Human) (IGIV): Carimune™ NF, Flebogamma®, Gammagard™, Gammar® P.I.V., Gamunex®, Iveegam® EN, Octagam®, Panglobulin® NF, Polygam® S/D, Privigen® (04/15/10) (PDF, 436KB)

Implantable Cardioverter Defibrillator (ICD)(01/15/10) (PDF, 187KB)

Implantable Infusion Pumps (06/15/10) (PDF, 223KB)

Infertility Services (06/15/10) (PDF, 223KB)

Inpatient Acute Rehabilitation (02/15/07) (PDF, 146KB)

Inpatient Admission for Radiation Therapy (08/15/07) (PDF, 175KB)

Intensity-Modulated Radiation Therapy (IMRT) (04/15/10) (PDF, 135KB)

Interspinous Process Decompression System (e.g., X STOP®) (04/15/09) (PDF, 222KB)

Intervertebral Disc (IVD) Prosthesis (12/15/09) (PDF, 281KB)

Intestinal and Multivisceral Transplant (02/15/10 (PDF, 170KB)

Intestinal Rehabilitation Programs (03/15/09) (PDF, 103KB)

Intradiscal Electrothermal Therapy (IDET)(02/15/10) (PDF, 103KB)

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K

Kidney Transplantation (09/15/09) (PDF, 146KB)

Knee Arthroplasty (05/15/10) (PDF, 177KB)

Knee Braces (05/15/08) (PDF, 173KB)

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L

Liver Transplant (05/15/09) (PDF, 227KB)

Lower Limb Orthoses (08/15/09) (PDF, 202KB)

Lower Limb Prosthetic Devices (Including Vacuum-Assisted Socket System and Microprocessor/Computer-Controlled Lower Limb Prostheses) (08/15/08) (PDF, 180KB)

Lumbar Fusion for Spinal Instability and Degnerative Disc Conditions (12/15/09) (PDF, 210KB)

Lung and Heart-Lung Transplantation (09/15/08) (PDF, 237KB)

Lung Volume Reduction Surgery (11/15/07) (PDF, 184KB)

Lyme Disease Treatment (08/15/08) (PDF, 173KB)

Lymphedema Pumps and Sleeves (05/15/10) (PDF, 173KB)

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M

Magnetic Resonance (MR) Spectroscopy (MRS) (01/15/09) (PDF, 163KB)

Magnetic Resonance Angiography (MRA) (09/15/09) (PDF, 219KB)

Magnetic Resonance Cholangiopancreatography (MRCP) (02/15/10) (PDF, 81KB)

Magnetic Resonance Imaging (MRI) of the Breast (10/15/09) (PDF, 176KB)

Magnetic Resonance Imaging (MRI), Low-Field (05/15/10) (PDF, 212KB)

Magnetic Resonance Neurography (03/15/10) (PDF, 33KB)

Malignant Melanoma Surveillance Technologies (11/15/09) (PDF, 121KB)

Manipulation Under Anesthesia (MUA) (10/15/09) (PDF, 113KB)

Mammary duct Aspiration and Lavage (02/15/10) (PDF, 223KB)

Maze Procedure (05/15/10) (PDF, 113KB)

Mechanical Devices for the Treatment of Back Pain (08/15/08) (PDF, 162KB)

Meniett™ Device)(11/15/09) (PDF, 52KB)

Minimally Invasive Total Hip Arthroplasty (11/15/09) (PDF, 179KB)

Minimally Invasive Treatment of Back Pain (07/15/10) (PDF, 175KB)

Myoelectric Protheses (11/15/09) (PDF, 134KB)

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N

Negative-Pressure Wound Therapy/Vacuum-Assisted Closure (VAC) for Non-Healing Wounds (03/15/09) (PDF, 151KB)

Nerve Conduction Velocity Studies Including Late Response (H-reflex and F-wave) (07/15/10 (PDF, 142KB)

Neuropsychological Testing (07/15/10) (PDF, 158KB)

Never Events (02/15/09) (PDF, 50KB)

Nuclear Imaging Including Single-Photon Emission Computed Tomography (SPECT)(10/15/09) (PDF, 387KB)

Nutritional Support (08/15/08) (PDF, 154KB)

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O

Obstructive Sleep Apnea Diagnosis and Treatment Services (10/15/09) (PDF, 365KB)

Occupational Therapy (11/15/09) (PDF, 195KB)

Organ Transplant Donation (11/15/09) (PDF, 209KB)

Orthognathic Surgery (10/15/09) (PDF, 209KB)

Osteochondral Autograft Transplant (Mosaicplasty/OATS®) (10/15/09 (PDF, 179KB)

Oxygen for Home Use (10/15/09) (PDF, 143KB)

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P

Pancreas-Kidney Transplantation and Pancreas Transplantation Alone< (09/15/09) /a> (PDF, 255KB)

Pancreatic Islet Cell Transplantation (06/15/10) (PDF, 144KB)

Parenteral Tocolytic Therapy (10/15/09) (PDF, 124KB)

Pelvic Denervation Procedures (06/15/10) (PDF, 67KB)

Penile for Erectile Dysfunction (05/15/10) (PDF, 67KB)

Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty (04/15/10) (PDF, 167KB)

Photopheresis (Extracorporeal Photochemotherapy) (04/15/10) (PDF, 167KB)

Phototherapy, Photochemotherapy, ad Excimer Laser Therapy for dermatologic Conditions (04/15/10) (PDF, 128KB)

Physical Therapy (12/15/08) (PDF, 128KB)

Plantar Fasciitis Treatments (02/15/09) (PDF, 144KB)

Plasmapheresis (10/15/09) (PDF, 320KB)

Pneumatic Compression Devices for Vascular Diseases of the Lower Extremities (05/15/10) (PDF, 144KB)

Positron Emission Tomography (PET) (07/15/10) (PDF, 145KB)

Postoperative Continuous Local Delivery of Analgesia (02/15/10) (PDF, 180KB)

Preoperative Inpatient Admissions (08/15/07) (PDF, 131KB)

Pressure Reducing Surfaces (02/15/09) (PDF, 68KB)

Prophylactic Mastectomy (02/15/08) (PDF, 145KB)

Prophylactic Oophorectomy With or Without Hysterectomy (02/15/10) (PDF, 145KB)

Pulmonary Rehabilitation (05/15/10)(PDF, 152KB)

Pulse Oximetry for Home Use (06/15/09) (PDF, 128KB)

Pulsed Electromagnetic Therapy (11/15/09) (PDF, 128KB)

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Q

Quantitative Sensory Testing (QST) (12/15/09) (PDF, 128KB)

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R

Radioembolization with Yttrium-90 (90Y) Microspheres (04/15/10) (PDF, 163KB)

Radiofrequency Ablation (RFA) of Renal Masses (11/15/09) (PDF, 145KB)

Radiofrequency Ablation for Primary and Metastatic Cancers of the Liver (PDF, 105KB)

Reduction Mammoplasty (PDF, 133KB)

Redundant Skin Surgery (10/15/09) (PDF, 124KB)

Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome Treatment (02/15/10) (PDF, 150KB)

Rhinoplasty/Septoplasty (07/15/10) (PDF, 135KB)

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S

Sacral Nerve Stimulation For Urinary Voiding Dysfunction (08/15/08) (PDF, 137KB)

Scar Revision (04/15/10) (PDF, 144KB)

Scoliosis Treatments, Idiopathic (07/15/10) (PDF, 173KB)

Seat Lift Mechanisms and Patient Lifts (06/15/10) (PDF, 122KB)

Sensory Stimulation for Individuals in Coma or Persistent Vegetative State (12/15/09) (PDF, 144KB)

Sensory and Auditory Integration-Facilitated Communication (02/15/10) (PDF, 74KB)

Somatosensory Evoked Potentials (07/15/10)(PDF, 137KB)

Somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Nutropin AQ, Saizen, Serostim, Tev-Tropin, Zorbtive) (PDF, 245KB) (11/15/09)

Speech Generating Devices (03/15/10) (PDF, 166KB)

Speech Therapy for Swallowing and Feeding Disorders (12/15/08) (PDF, 175KB)

Speech/Language Therapy (06/15/08) (PDF, 278KB)

Spinal Cord Stimulation (07/15/10) (PDF, 149KB)

Spinal Orthoses (07/15/10) (PDF, 125KB)

Spinal Ultrasound (PDF, 128KB)

Spiral Computed Tomography for Lung Cancer Screening (12/15/09) (PDF, 127KB)

Stem-Cell Transplant for Acute Lymphocytic/Lymphoblastic Leukemia: Adult (09/15/09) (PDF, 236KB)

Stem-Cell Transplant for Acute Myelogenous Leukemia (02/15/10)(PDF, 286KB)

Stem-Cell Transplantation for Adult Solid Tumors (01/15/10) (PDF, 225KB)

Stem-Cell Transplantation for Amyloidosis (11/15/09) (PDF, 178KB)

Stem-Cell Transplantation for Aplastic Anemia (05/15/10) (PDF, 209KB)

Stem-Cell Transplantation for Autoimmune Diseases (06/15/10) (PDF, 96KB)

Stem-Cell Transplantation for Breast Cancer (PDF, 142KB) (06/15/10)

Stem-Cell Transplantation for Central Nervous System Tumors (PDF, 142KB) (07/15/10)

Stem-Cell Transplant for Chronic Lymphocytic Leukemia (12/15/09) (PDF, 189KB)

Stem-Cell Transplantation for Chronic Myelogenous Leukemia (11/15/09) (PDF, 132KB)

Stem-Cell Transplantation for Chronic Myelomonocytic Leukemia (CMML) and Juvenile Myelomonocytic Leukemia (JMML) (11/15/09) (PDF, 132KB)

Stem-Cell Transplantation for Epithelial Ovarian Cancer (04/15/10)(PDF, 89KB)

Stem-Cell Transplantation Fanconi Anemia (05/15/10) (PDF, 99KB)

Stem-Cell Transplantation for Hodgkin Disease (10/15/09) (PDF, 188KB)

Stem-Cell Transplantation for Inherited Metabolic Disorders (07/15/10) (PDF, 218KB)

Stem-Cell Transplantation for Myelodysplastic Syndrome (10/15/09) (PDF, 188KB)

Stem-Cell Transplant for Myelofibrosis (03/15/10) (PDF, 204KB)

Stem-Cell Transplantation for Multiple Myeloma and POEMS Syndrome (04/15/10) (PDF, 266KB)

Stem-Cell Transplantation for Neuroblastoma (10/15/09) (PDF, 179KB)

Stem-Cell Transplantation for Non-Hodgkin's Lymphoma (12/15/09) (PDF, 268KB)

Stem-Cell Transplant for Polycythemia Vera (03/15/10) (PDF, 106KB)

Stem-Cell Transplantation for Primary Immunodeficiency Disorders (07/15/10) (PDF, 106KB)

Stem-Cell Transplantation for Renal Cell Carcinoma (05/15/10) (PDF, 141KB)

Stem-Cell Transplantation for Sickle Cell Disease and Thalassemia Major (07/15/10) (PDF, 268KB)

Stem-Cell Transplant for Solid Tumors in Children (08/15/08) (PDF, 138KB)

Stem-Cell Transplant for Testicular Cancer (03/15/10) (PDF, 216KB)

Stereotactic Radiosurgery (04/15/10) (PDF, 215KB)

Stretch Devices for Joint Stiffness and Contractures( 09/15/08 ) (PDF, 135KB)

Stuttering Treatment Devices (06/15/10) (PDF, 67KB)

Subtalar Arthroereisis (11/15/09) (PDF, 47KB)

Suit Therapy (05/15/10) (PDF, 132KB)

Surgery for Male Sexual Dysfunction (08/18/08) (PDF, 167KB)

Surgical Interventions for Urinary Incontinence (12/15/09) (PDF, 293KB)

Surgical Treatment for Chest Wall Deformities (Pectus Excavatum/Carinatum and Poland Syndrome) (03/15/10) (PDF, 134KB)

Surgical Treatment of Gynecomastia (10/15/09) (PDF, 104KB)

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T

Temporomandibular Joint (TMJ) Disorder Surgery (08/15/08) (PDF, 151KB)

Therabite Jaw Motion Rehabilitation System™ (07/15/10) (PDF, 151KB)

Thermography/Temperature Gradient Studies (3/15/10) (PDF, 180KB)

Tilt Table Testing (3/15/10) (PDF, 62KB)

Tinnitus Treatment Services and Devices (11/15/09) (PDF, 125KB)

Tissue-Engineered Skin Substitutes and Platelet-derived Growth Factors (05/15/10)(PDF, 367KB)

Total Ankle Arthroplasty (02/15/10) (PDF, 145KB)

Total Artificial Heart (11/15/09) (PDF, 136KB)

Transcatheter ArterialChemoembolization (TACE) (02/15/10) (PDF, 151KB)

Transcatheter Closure of Septal Defects (11/15/09) (PDF, 166KB)

Transcranial Doppler Ultrasonography (11/15/09) (PDF, 194KB)

Transcutaneous Electrical Joint Stimulation Devices (12/15/09) (PDF, 103KB)

Transmyocardial Revascularization (TMR) and Percutaneous Myocrdial Revascularization (PMR) (12/15/09) (PDF, 154KB)

Treatment of Cutaneous Congenital Hemangiomas (04/15/10) (PDF, 143KB)

Transcutaneous Electrical Joint Stimulation Devices (12/15/08) (PDF, 103KB)

Tumor In Vitro Chemosensitivity and Chemoresistance Assays (02/15/10) (PDF, 72KB)

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U

Ultrasound In Pregnancy (08/15/08) (PDF, 160KB)

Umbilical Cord Blood Banking (06/15/10) (PDF, 61KB)

Uterine Artery Embolization (01/15/09) (PDF, 110KB)

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V

Vagus Nerve Stimulation (VNS) (10/15/09) (PDF, 156KB)

Varicose Vein Treatments (11/15/09) (PDF, 330KB)

Vestibular Rehabilitation and Particle Repositioning Maneuvers (01/15/09) (PDF, 81KB)

Video Electroencephalographic (V-EEG) Monitoring (11/15/09) (PDF, 145KB)

Vision Therapy/Orthoptics (12/15/08)(PDF, 145KB)

Visual Perceptual Training (08/15/08) (PDF, 118KB)

Vitrectomy Chair/Vitrectomy Support System/Face-Down Positioning (02/15/08) (PDF, 114KB)

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W

Wearable Cardioverter Defibrillator and Automatic External Defibrillator (01/15/10) (PDF, 129KB)

Wheelchairs/Power Operated Vehicles (PDF, 234KB)

Whole Body Dual X-Ray Absorptiometry (DXA) (03/15/10) (PDF, 53KB)

Wireless Esophageal pH Monitoring System (Bravo™) (04/15/10) (PDF, 161KB)

Work Hardening Programs (04/15/09) (PDF, 94KB)

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