Medical and Payment Policies

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Medical
Salivary Estriol as Risk Predictor for Preterm Labor and Management of Menopause and/or Aging
Saturation Biopsy for Diagnosis, Staging and Management of Prostate Cancer
Scanning Computerized Ophthalmic Diagnostic Imaging
Scintimammography and Gamma Imaging of the Breast and Axilla
Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
Sensory Integration Therapy and Auditory Integration Therapy
Serologic Genetic and Molecular Screening for Colorectal Cancer
Serum Biomarker Human Epididymis Protein 4
Serum Tumor Markers for Breast and Gastrointestinal Malignancies
Signal-Averaged Electrocardiography (SAECG)
Skin Contact Monochromatic Infrared Energy as a Technique to Treat Cutaneous Ulcers, Diabetic Neuropathy, and Miscellaneous Musculoskeletal Conditions
Speech Therapy
Sphenopalatine Ganglion Block for Headache
Stationary Ultrasonic Diathermy Devices
Steroid-Eluting Sinus Stents and Implants
Subtalar Arthroereisis
Surgery for Groin Pain in Athletes
Surgical Deactivation of Migraine Headache Trigger Sites
Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation
Surgical Ventricular Restoration
Suture Button Suspensionplasty Fixation System for Thumb Carpometacarpal Osteoarthritis
Sympathetic Therapy for the Treatment of Pain
Synthetic Cartilage Implants for Joint Pain
Payment
Self-Treatment or Treatment of Immediate Family Members
Smoking Cessation Mandate
Specialty Interdisciplinary Care Team Participation
Specimen Provenance Error Testing
Spravato (esketamine) Payment Policy
Structured Screening and Brief Intervention Services
Prior Authorization
Skilled Nursing Facilities: Admission and Concurrent Review
Stereotactic Body Radiation Therapy
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome, Effective 1/1/2025
Surgical Treatments for Lymphedema and Lipedema