AmeriHealth Medical Policies

		Policy #			Policy Bulletin Title
		11.08.06f			Abdominoplasty and/or Panniculectomy
		11.08.05f			Application and Removal of Tattoos
		11.14.11d			Arthroscopic Electrothermal Joint Repair
		11.14.19e			Artificial Intervertebral Disc Insertion
		11.01.04c			Auditory Brainstem Implant
		11.14.06e			Autologous Chondrocyte Implantation (ACI)/Carticel� and Other Cell-based Treatments of Focal Articular Cartilage Lesions
		11.16.06d			Balloon Sinuplasty for the Treatment of Chronic Sinusitis
		11.03.02l			Bariatric Surgery
		11.05.02f			Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
		11.01.06			Bone-Anchored (Osseointegrated) Hearing Aids, Implantable Bone-Conduction Hearing Aids, and Semi-Implantable Hearing Aids
		11.17.01e			Bulking Agents for the Treatment of Stress Urinary Incontinence (SUI) due to Intrinsic Sphincter Deficiency (ISD) and for the Treatment of Vesicoureteral Reflux (VUR)
		11.01.07			Cataract Surgery
		11.02.06g			Catheter Ablation of Cardiac Arrhythmias
		11.08.08e			Chemical Peels
		11.11.05d			Circumcision
		11.01.02i			Cochlear Implant
		11.03.12j			Colorectal Cancer Screening
		11.14.17b			Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
		11.11.03c			Cryosurgical Ablation of the Prostate Gland
		11.08.17b			Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Nails
		11.15.20g			Deep Brain Stimulation (DBS)
		11.06.02e			Elective Abortion
		11.06.05a			Endometrial Ablation
		11.02.10g			Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
		11.02.17c			Endovascular Stent-Graft Repair of the Thoracic Aortic Aneurysm and Dissection
		11.11.01c			Evaluation and Treatment of Erectile Dysfunction
		11.08.10e			Excision of Redundant Skin
		11.14.13e			Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
		11.00.03g			Fetal Surgery
		11.03.15e			Gastric Electrical Stimulation (Enterra™), Gastric Pacing
		11.08.01d			Hair Transplants and Cranial Prostheses (Wigs)
		11.07.01i			Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)
		11.14.20d			Hip Resurfacing
		11.00.13d			Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
		11.15.22b			Image-Guided Minimally Invasive Lumbar Decompression for Spinal Stenosis
		11.05.11a			Implantation of Intrastromal Corneal Ring Segments (INTACS)
		11.15.03e			Insertion of Implantable Infusion Pumps
		11.14.07h			Intra-articular Injection of Hyaluronan for the Treatment of Osteoarthritis
		11.04.01b			Islet Cell Transplantation
		11.06.09			Labiaplasty
		11.08.03g			Lipectomy and/or Liposuction
		11.14.22a			Lumbar Interspinous Process Decompression
		11.16.03e			Lung Volume Reduction Surgery
		11.15.13b			Lysis of Epidural Adhesions
		11.02.20d			Maze Procedure
		11.14.03d			Meniscal Allograft Transplantation
		11.14.01e			Mentoplasty or Genioplasty
		11.14.21b			Microprocessor-Controlled Prosthetic Knees and Ankle-foot Systems for Lower-Extremity Amputees
		11.17.06g			Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
		11.08.23f			Mohs' Micrographic Surgery
		11.00.10k			Multiple Surgical Reduction Guidelines
		11.15.19d			Nucleoplasty
		11.14.08b			Orthognathic Surgery
		11.14.12b			Osteochondral Allograft Transplantation
		11.14.09d			Osteochondral Autograft Transplantation (OAT) Procedure
		11.01.01f			Otoplasty
		11.06.07			Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
		11.15.17d			Paravertebral Facet Joint Nerve Block
		11.15.15d			Percutaneous Discectomy
		11.02.12d			Percutaneous Extracranial and Intracranial Cerebrovascular Artery Angioplasty and Stenting
		11.14.14d			Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
		11.14.10j			Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
		11.05.08c			Photocoagulation of Macular Drusen
		11.08.29c			Procedures for the Treatment of Acne
		11.03.11g			Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
		11.08.19i			Prophylactic Mastectomy
		11.00.16b			Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
		11.15.09c			Radiofrequency Lesioning of the Spinal Nerves for Chronic Pain
		11.17.07e			Radiofrequency Micro-remodeling (by transurethral, transvaginal, or paraurethral approach) for Urinary Stress Incontinence
		11.08.15n			Reconstructive Breast Surgery
		11.08.02e			Reduction Mammoplasty
		11.05.01c			Refractive Keratoplasty
		11.05.10a			Reimbursement for a Presbyopia- or Astigmatism-Correcting Intraocular Lens
		11.08.14f			Removal of Breast Implants
		11.03.01b			Repair of Cleft Lip and/or Cleft Palate
		11.00.01d			Revision of a Previous Cosmetic Procedure
		11.08.13e			Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty
		11.17.04i			Sacral Nerve Stimulation (SNS) for the Control of Urinary and Fecal Incontinence
		11.11.06c			Saturation Needle Biopsy of the Prostate
		11.08.25f			Scar Revision
		11.08.04f			Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
		11.07.02f			Sentinel Lymph Node Biopsy
		11.16.01f			Septoplasty, Rhinoplasty, and Septorhinoplasty
		11.09.02			Sex Reassignment Surgery (SRS) for Gender Identity Disorder (GID)
		11.00.09b			Solid Organ Transplants
		11.15.01i			Spinal Cord Stimulation (Dorsal Column Stimulation)
		11.08.12f			Surgery for Gynecomastia
		11.14.23b			Surgical Treatment of Femoroacetabular Impingement
		11.05.07b			Surgical Treatment of Strabismus
		11.14.25			Total Ankle Arthroplasty/Replacement
		11.02.19b			Total Artificial Hearts (TAHs)
		11.02.11d			Transcatheter Occlusion for the Treatment of Cardiac Septal Defects
		11.02.13d			Transcoronary Ablation of Septal Hypertrophy (TASH)
		11.15.23a			Transforaminal Epidural Nerve Block Injections
		11.15.11b			Treatment for Hyperhidrosis (Nonpharmacologic)
		11.00.02e			Treatment of Medical and Surgical Complications
		11.00.06c			Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
		11.00.14b			Treatment of Twin-Twin Transfusion Syndrome (TTTS)
		11.02.01h			Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
		11.14.02i			Trigger Point Injections
		11.00.11f			Use of an Operating Microscope During a Surgical Procedure
		11.06.04f			Uterine Artery Embolization for the Treatment of Fibroids
		11.15.16h			Vagus Nerve Stimulation (VNS)
		11.02.16j			Ventricular Assist Devices (VADs)
		11.08.20i			Wound Care: Bioengineered Skin Substitutes