Medical
Prior Authorization Guidelines
Allergy Testing/Immunotherapy
Bariatric Surgery
Doula Services
High Risk OB (HROB)
In-Home Nursing Services
Pain Management-Chiropractic and Physical Therapy Services for Adults
- Chiropractic Services Guideline (Updated 3/15/25)
- Physical Therapy Adult Pain Management Guideline (Updated 3/15/25)
Procedure/Surgery Information
- Actinotherapy Guidelines (Updated 6/10/24)
- Cosmetic vs Recontructive Guideline (Updated 3/25/25)
- Dermatologic Laser Treatment
- Doppler-Middle Cerebral Artery
- EEG - Digital Analysis Guideline (Updated 3/1/25)
- EEG - Long Term Electoencephalographic Monitoring
- Express Shunt Guidelines
- Eye Surgery PA Overview
- Eye Surgery Guidelines
- Hyperbaric Oxygen Therapy Guideline
- Hysteroscopy PA Overview
- Micra Transcatheter Pacing System
- Negative Pressure Wound Therapy Guideline
- Ocular Amniotic Membrane without Sutures
- Panniculectomy Guidelines (Updated 3/7/25)
- Proton Beam Therapy Guideline (Updated 8/10/23)
- Routine Coverage in Clinical Trials (Updated 3/26/25)
- SI Joint Fusion Guidelines (Updated 3/27/24)
- TBI Guidelines (Updated 3/25/25)
- Transplant Guideline
- Viscosupplementation Guidelines
- Vulvectomy Labiaplasty Guidelines (Updated 3/25/25)
Psychological/Neuropsychological Testing for Medical Providers
Stimulators
- Diaphragmatic Phrenic Nerve Stimulator Guidelines
- Gastric Electrical Stimulation Guidelines (Updated 3/27/24)
- Non-invasive Osteogenic Stimulators Guidelines (updated 1/15/25)
- Peripheral Nerve Stimulator Guidelines (Updated 3/27/24)
- Sacral Nerve Simulator Guidelines (Updated 3/27/24)
- Vagal Nerve Stimulation Guidelines
Urine Drug Screens
Wound Care
- Wound Care and Skin Substitutes (Updated 3/25/25)
Ventricular Assist
Last Modified on
Apr 18, 2025
