AmeriHealth Medical Policies

	Policy #	Policy Bulletin Title
	11.08.06f	Abdominoplasty and/or Panniculectomy
	11.08.05f	Application and Removal of Tattoos
	11.14.11e	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
	11.03.02m	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
	11.08.03h	Lipectomy and 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
	11.08.23f	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)
	11.08.19j	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
	11.05.10b	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)
	11.00.09c	Solid Organ Transplants
	11.15.01i	Spinal Cord Stimulation (Dorsal Column Stimulation)
	11.08.12g	Surgery for Gynecomastia
	11.17.06h	Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
	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)
[Replication or Save Conflict]
	11.02.16j	Ventricular Assist Devices (VADs)
	11.08.20i	Wound Care: Bioengineered Skin Substitutes