Research And Markets: Study This Medical Review Criteria

Guidelines For Managing Care, 4th Edition 2005 Now

- Radiology Advantage Management: Web helpful details on radiology, nuclear medicine along with
radiation therapy provider manuals.
Hyperbaric Oxygen Therapy; Immunizations; Injectable Medications; Laser procedures;
Miscellaneous services - Medicare Time Frame regarding Payment Denial; Multiple Chemical
Sensitivity Syndrome or Idiopathic Environmental Intolerances (IEI); Organ and also Tissue
Transplantation - bone marrow, intestinal, solid organs; Outmoded exams along with procedures;
Pain rehabilitation programs; Outpatient Hospital Pain Rehabilitation Programs; Physician's office
within an Institution--Coverage of Solutions as well as supplies Incident to some Physician's
Services; 'Second opinions'; Sleep disorders- testing; Transportation, medical/Ambulance transports;
- Hematology/Medical Oncology: Hem-Onc Authorization Guideline Notes; Adjuvant Chemotherapy;
Adoptive immunotherapy (AIT); Bone marrow/Stem cell transplant (BMT); Umbilical cord blood
compatibility testing; Chemoresistance assays/Tumor chemosensitivity; Chemotherapy vs Endocrine
Therapy with regard to Metastatic Breast Cancer; Cryosurgical ablation hepatic lesions; Dendritic
cell immunotherapy pertaining to cancer; Donor Lymphocyte Infusions; Epithelial Cell Cytology
inside Breast Cancers risk Assessment and also High-Risk Individual Management; Extracorporeal
Immunoadsorption; Extracorporeal Photopheresis; Hematopoietic colony-stimulating
factor/Granulocyte-macrophage colony-simulating factor; Hyperalimentation pertaining to patients
receiving chemotherapy; Hyperthermia; Hypothermia (regional scalp cooling) - chemotherapyassociated head of hair loss;
Endothelial cell photography; Entropion; Ectropion; Enucleation; External Ocular Photography;
Glaucoma treatment; Optic Nerve Head Topography - Confocal Laser Scanning Tomography,
Stereophotogrammetry; Argon Laser Trabeculoplasty; Aqueous drainage/shunt implants with regard
to refractory primary open-angle glaucoma; Gold Excess Weight Upper Eye Lid Implants; Grave's
Disease Ophthalmopathy; Indocyanine Green Angiography; Intraocular Lens Implant;
Iridotomy/Iridectomy; Keratoconus; Keratoplasty; Keratoprosthesis or Synthetic Cornea;
Electrical Stimulation DME include: Dorsal Column Stimulators/Spinal Cord
- Cardiology: Acoustic Coronary Heart Scans/Recordings; Ambulatory blood pressure
- Nephrology: Nephrology Consultation/Referral with regard to ongoing care; Dialysis Therapy
Regarding Renal Failure; Laboratory tests regarding CAPD; Arteriovenous fistulae for dialysis; ESRD
coverage through Medicare vs. Modification related to be able to local clinical circumstances or
relation to applicable certificates regarding coverage or even provider contracts might always be
appropriate and necessary.
- Detection, Biopsy; Melanoma/Breast Cancer Staging; Scans pertaining to Infection and
Inflammation; SPECT scans; Thyroid studies; Tumor Scintigraphy (Gamma Camera).
Non-contact Normothermic Wound Therapy (NNWT); 'Second Look' surgical procedures;
Thyroidectomy; Post-op LOS by procedure, list; Inpatient Times Prior into a Surgical Procedure;

where should a new higher-risk procedure be performed in the certain affected person or even
population associated with patients?
Shoulder: Shoulder Arthrography; Arthroscopy, shoulder; Electrothermal arthroscopic repair with
Ladyboy Cams regard to shoulder instability; Impingement Syndromes, Shoulder Bursitis, Rotator
Cuff Tendinitis & Tears; Ultrasound therapy with regard to calcific tendinitis of the shoulder;
- Radiation Therapy/Oncology: Radiation oncology; combination Chemotherapy along with Radiation
Therapy; Brachytherapy; Brachytherapy for the Prevention associated with Restenosis inside
Peripheral Arteries following PTA with the Femoropopliteal System; Intracoronary Brachytherapy;
Breast Conservation Therapy in the Management involving Invasive Breast Cancer; Neutron Beam
Radiotherapy; Proton Beam Radiotherapy; Stereotactic radiosurgery; Transperineal Brachytherapy
for prostate cancer; Boron Neutron Capture Therapy (BNCT) With Regard To Glioblastoma
Multiforme; Intensity Modulated Radiation Therapy; Radiation Therapy web sites.
- Blood Bank: Autologous Blood-Derived Items with regard to Chronic Non-Healing Wounds; Blood
transfusions; autologous, allogeneic, donor directed; Cord blood storage; Granulocyte as well as
Platelet Transfusions; Plasmapheresis, plasma exchange, apheresis and also related procedures;
Lipid apheresis; Nonselective (random) transfusions and also living-related donor specific
transfusions throughout kidney transplantation; Therapeutic Phlebotomy
- Educational materials: General educational materials, Affected Person Training Supplies Policy Development, Approval and Review, Institutional and House Treatment Individual Education And
Learning Programs; medical 'Self Care' Educational Programs; Education And Learning lessons
regarding OB patients; Your 'Not Now!' Program; Institutional and home care patient Education And
Learning Programs; Medicare Coverage associated with Diabetes Self-management Training.
- Pulmonary: Pulmonary function tests; Quantitative pilocarpine iontophoresis sweat test; Duration
IV antibiotics pertaining to pneumonia; Electrophrenic Pacemaker; Fiberoptic bronchoscopy; Lung
volume reduction surgery; Sleep apnea studies/Polysomnography; Sleep apnea studies, portable;
BiPap; Phrenic nerve pacing/Diaphragm pacing; Positive Expiratory Strain (PEP) pertaining to Cystic
Fibrosis Therapy; Noninvasive Positive-Pressure Ventilation (NPPV) with regard to COPD; Postural
Drainage Methods and also Pulmonary Exercises; Pulmonary Rehabilitation; Outpatient Pulmonary
Rehabilitation (PR); COPD guideline sources and links; 'Virtual' Lung Scans.
Carpal Tunnel Syndrome - conservative therapy; Carpal Tunnel Release; Cranial Electrical
Stimulation; Embolization involving intracranial aneurysms; Electromyelogram (EMG)/Nerve
Conduction Velocity (NCV); Anal or perhaps Urethral Sphincter Electromyography; Sensory Evoked
Potentials; Ketogenic diet program for the charge of intractable seizures in children; Peripheral
neuropathy along with loss involving protective sensation (LOPS); H-wave stimulation for your
management regarding chronic diabetic peripheral neuropathy;
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- Vascular Laboratory: Noninvasive cerebrovascular studies of extracranial arteries; Carotid perform
- non-invasive tests: Duplex scan involving carotid arteries; vertebral arteries; Ocular
Plethysmography (OPG) along with Ophthalmodynamometry; Transcranial doppler, Penile doppler as
well as Corpora Cavernosography, Peripheral arterial non-invasive studies: Segmental Doppler
Pressures along with Pulse Volume Recording; Exercise (Stress) Doppler Test; Visceral arterial
duplex imaging; Peripheral Arterial Duplex Scan; Digital Arterial Evaluation; Peripheral venous
along with arterial non-invasive studies/ultrasonography; Peripheral Arterial Ultrasound

Examination using Pulsed Doppler; AcuTect/Scintigraphic Imaging Pertaining To

Detection/Localization of Lower Limb Deep Vein Thrombosis;-- Hemorheograph.
- Nuclear Medicine: Bone scan; CEA scans; Cardiac Scans - Introduction/Overview, Medicare LMRP;
Cardiac scans - thallium as well as gated pool scans; Cerebral Scintigraphy pertaining to brain
Death; Cholecystokinin Cholescintigraphy/Hepato-biliary scintigraphy; Gastrointestinal scintigraphy;
Gated Pool Scan; Indium-III Oxine labeled white blood cells scan; Liver spleen scan; Monoclonal
Antibody (Mab) Imaging/Radioimmunoscintigraphy including Scintimammography; Parathyroid
scintigraphy;
Temporomandibular Joint Disorders (TMJ); Tinnitus Retraining Therapy; Tonsillectomy and/or
adenoidectomy; Transcutaneous electrical stimulators with regard to severe tinnitus; Transtympanic
Gentamicin Injection with regard to treatment method of Meniere's disease; Tympanometry;
Tympanostomy tubes; Ultrasonic Surgery regarding Meniere's; Uvulopalatopharyngoplasty (UPPP)
and also palatopharyngoplasty (PPP); Vestibular Operate Testing; Vestibular Rehabilitation; Vocal
Cord Examination Utilizing Videostroboscopy; Vocal Cord Injections in order to Stop Recurrent
Aspiration.

- Radiology: Documentation requirements; Imaging guidance throughout surgical procedures; Bone

Mass Measurement/Bone mineral density (BMD) testing; Skeletal surveys inside children; Cardiac
scans with regard to CAD; Cerebral angiography; Chest x-rays, routine; Distinction media; Spine diagnostic radiology in grown-ups and children; Imaging studies inside acute lower back pain;
Myelography and also Cisternography; Discography; Scoliosis in youngsters - indications with regard
to radiography; Epidurogram/Epiduroscopy;
- Plastic Surgery: Abdominoplasty/Panniculectomy Breast surgery - Implant removal and/or
replacement; Gynecomastia reconstruction within the male patient; Augmentation mammoplasty;
Reduction mammoplasty as well as breast reduction surgery; Liposuction: Lipectomy, Suctionassisted; Beauty surgery; Chemical exfoliation or perhaps peel; Plastic laser surgery; Cutaneous
Ulcer, Chronic - Electrical Stimulation; Ear lobe deformities; Curly Hair transplantation;
Mentoplasty (Chin Augmentation, Genioplasty); Plastic Surgery in order to Right "Moon Face";
Porcine Skin and Gradient Strain Dressings; Reconstructive surgery - general criteria; Scar
revisions; Skin redundancy following massive excess weight loss.
Canadian drugs; Formulary; MAC pricing; Generic substitution; Alpha 1-antitrypsin inhibitor
therapy; Anticoagulant Therapy - Monitoring; Biologicals; Hepatitis vaccines; Growth hormone
replacement (adults along with children); Botulinum toxin; Calcitriol; Cancer chemotherapy;
Erythropoeitin Therapy; Experimental Drug Therapy; Chelation therapy; Diabetes management
therapy/supplies; Diabetic foot ulcers - Regranex gel therapy;
Electroencephalographic biofeedback with regard to intractable seizures; Epiduroscopy; Fetal
Tissue Transplantation for the Treatment Method involving Parkinson's disease; Pallidotomy for that
remedy of Parkinson's disease; Fetal Tissue Transplantation for that Treatment Method associated
with Parkinson's disease; Surgical evaluation pertaining to intractable seizure disorders - Grid
monitoring; Deep Mind electrical Stimulation with regard to intractable tremors; Mind mapping
(quantitative EEG) with regard to diagnosis regarding psychiatric disorders;
Papanicolaou tests/'Pap smears' along with HPV DNA testing with regard to Cervical Cancer;
Perineorrhaphy, Preimplantation Genetic Diagnosis; Pregnancy; Recurrent pregnancy loss; Presacral

neurectomy (PSN) for your treatment of chronic pelvic pain; Salivary estriol test pertaining to
preterm labor, Salpingectomy/salpingostomy, VABRA aspirator; Ultrasonography within pregnancy,
Ultrasonongraphy screen pertaining to Down Syndrome, Uterine activity Monitoring (UAM), Uterine
Fibroid (Leiomyomata) Therapy; Uterine artery embolization for that treatment method of fibroids;
VABRA aspirator; Zinc blood amounts throughout pregnancy.
Orthotic/prosthetic devices; Breast prosthesis, specialized bras for females post-mastectomy; Corset
used as Hernia Support; Dynamic Splinting Devices; Foot orthotics/therapeutic shoes; Magnetic
insoles regarding plantar heel pain; Myoelectric prosthesis, upper extremity;
Diagnostic radiology - general; Extremity x-rays; Knee trauma; Diagnostic Arteriography Indications; Cervicocerebral angiography; Digital Self Suck Shemale Webcams subtraction
angiography (DSA); Infusion Venography; Sources pertaining to Angiography Indications; Abdominal
as well as Gastroenterological X-ray Procedures; Cholescintigraphy (HIDA); Cinedefecography;
Herniography; Urological: Intravenous Pyelography (IVP); Cystography and also Urethrography;
Voiding cystourethrography in Children;
Oxygen coverage guidelines; Peak expiratory flow meter; Pneumatic Compression Therapy - Enddiastolic with regard to non-healing extremity ulcers; Strain reducing support Surfaces, group one
as well as 2; Computerized lower limb prostheses; Prothrombin Occasion home testing Systems;
monitoring; Ambulatory electrocardiography (Holter monitor); Brachytherapy, Coronary; Cardiology
consultation or referral; Chest pain - admission criteria, Cardiac catheterization, proper heart;
Central venous stress monitoring, Cardiac Catheterization, correct heart, Central venous strain
monitoring; Cardiac Catheterization, left heart; Coronary Arteriography; Angiography along with
Ventriculography; Cardiac Event Monitors; Implanted Loop Recorders; Catheter ablation for atrial
fibrillation using HF; Cardiac Output Monitoring through Electrical Bioimpedance ;
Other Skeletal-muscular: Extracorporeal Shock Wave Therapy (ESWT) for musculo-skeletal
conditions; Apligraft (R) (Graftskin) Medicare LMRP; Carpal tunnel release; Trigger Point Injections;
Total Hip Replacement (THR) - Primary, excluding hip fracture, indications, LOS; Bone stimulators,
electrical and low-intensity ultrasound; Gait analysis or the electrodynogram; Injection, tendon
sheath, ligament, as well as trigger points or perhaps ganglion cyst; Injection associated with joints;
Osteogenic protein-1 for the treatment involving nonunion fractures;
- Pediatric: Pediatric authorization guidelines with regard to Lengths associated with stay; Apnea
monitor; Circumcision with the newborn male; Cord blood testing; Cystic fibrosis screening inside
newborns; Diabetes mellitus - Assessment associated with need with regard to Hospitalization for
your Stabilization involving newly Diagnosed Kids with Diabetes; Diabetes Management using
'Hepatic Activation' as well as 'PIVIT' Therapy; Comprehensive pediatric case management services;
Early Intervention Programs; Extracorporeal membrane oxygenation (ECMO); Hearing Screening,
Newborn; Immunizations, Lead screening - blood - children; Newborn LOS - when infant healthy,
Mother demands continued hospital care; Phototherapy; Physician Attendance at Delivery pertaining
to Evaluation and also Management involving Newborn; Port Wine Stains.
- Neurology/Neurosurgical: Autism and Various Other Pervasive Developmental Disorders; Sensory
Stimulation for Coma; Facial Nerve Paralysis (Bell's Palsy) - Electrotherapy; Electroencephalogram
(EEG) - standard, ambulatory, sleep-deprived, surgical, video; Electrocorticography (ECoG); brain
mapping as well as Quantitive EEG for your diagnosis involving psychiatric disorders;
Electromyelogram (EMG)/Nerve Conduction Velocity (NCV); Spinal Cord Injury Neuropsychological
Screening (NPT); Stroke and other CNS Disorders; Somatosensory Evoked Responses, Vision Evoked

Reaction test (VER), Deep brain electrical Stimulation regarding intractable tremors; Vision Evoked
response test (VER); Multiple Sclerosis (MS) - Therapy, Net Sites; Multiple Sleep Latency Test
(MSLT); Neuropsychological testing (NPT);
DUBLIN, Ireland--(BUSINESS WIRE)--Feb. Well Being Plan; Darbepoetin Alfa (Aranesp); Intravenous
Iron Therapy; Medicare ESRD Coverage - algorithm; Hemodialysis for your therapy associated with
hepatorenal syndrome; Hemodialysis for your remedy involving schizophrenia; L-carnitine
supplementation; Nephrology web sites.
Breast imaging studies: Diaphanography with the breast; Mammography, screening as well as
diagnostic/Digital/CAD mammography; Magnetic Resonance Imaging in the Breast: Differential
Diagnosis; Breast Ultrasound as well as Echography; Stereotactic Breast Biopsy;
Back and Neck: Acute cervical pain; artificial Intervertebral Disc; Laminectomy ; low again pain;
Machines for you to test along with treat low again pain; Chymopapain Chemonucleolysis;
Endoscopic Anterior Spinal Surgery; Epidural injection regarding steroids pertaining to back pain;
Facet Joint Injections; Facet Denervation, Facet Neurotomy, Facet Rhizotomy, as well as Articular
Rhizolysis; Hypertonic saline for the treatment method involving epidural adhesions, adhesive
arachnoiditis, or perhaps failed back syndrome; Implantable Infusion Pumps regarding Remedy
regarding Chronic Severe Back Again Pain; Intradiscal Electrothermal Therapy (IDET);
Laminectomy; Meniscectomy; Microdiscectomy; Percutaneous Lumbar Discectomy, including laser
procedures; Percutaneous vertebroplasty and kyphoplasty; Prolotherapy; Spinal instability - Pedicle
screw fixation; Spinal stenosis; Sacro-iliac Joint Injections; Chiropractic Medicine; Distraction
osteosynthesis, Ilizarov method; Spinal manipulation below anesthesia;
Lifts - seat and also patient; Mild Emitting Diode (LED) or even Infrared Therapy; Lymphedema
'Pump'/Manual lymph drainage; Magnetic Pelvic Flooring Stimulation (MPFS); Nebulizers; Wound
Care; Negative stress wound therapy (NPWT) Pumps; Radiant Heat Wound Therapy Systems;
Neuromuscular electrical stimulation (NMES);
Incontinence - defined; Synthetic Urinary Sphincter; Anxiety incontinence - Electrical stimulation of
the pelvic floor; Sacral nerve stimulation pertaining to urge incontinence; Transurethral/Periurethral
collagen implantation regarding anxiety urinary incontinence; Marshall-Marchetti Kranz, Burch,
Stamey along with comparable procedures; References - Urinary Incontinence; Transrectal
ultrasound regarding prostate type regarding cancer - biopsy/staging; Renal Cryoablation;
Transrectal ultrasound for prostate cancer; Transsexual surgery; Urethral Dilation - female;
Urodynamic Testing;
Environmental Manage Systems; Vaporizers; Workout Equipment; Hearing aids; Bone-anchored
Hearing Aid; Hospital beds, Infusion pumps, external as well as implantable; Intrapulmonary
Percussive Ventilator (IPV); Jobst burn Garments;
- Disposable Healthcare Supplies/Durable Health-related Equipment: Medicare Coverage Criteria
pertaining to DME; Disposable Health-related supplies (DMS): Incontinence supplies; Urinary
Drainage Systems; Porcine Skin along with Gradient Stress Dressings; Ostomy supplies; Unna boot;
- multiple gestation reduction; Amniocentesis; Cervical cerclage; Cervicography (cervigram);
Cesarean section - elective; Chorionic villus sampling; Colposcopy direct access regarding OB/GYN
services, Dilation and also Curettage (D & C), D & C as well as hysteroscopy, D & C, Hysteroscopy in
addition pelvic laparoscopy - same day; Loved Ones Planning services - birth control devices and also
genetic counseling, Norplant, Oral contraceptives - sterilization - tubal ligation/vasectomy,

Sterilization - Tubal ligation or perhaps vasectomy, OTC products; Fetal fibronectin screening with
regard to preterm labor and delivery risk; Genetic Counseling as well as Testing; home births;
Hysterectomy; Outpatient hysterectomy; Hysteroscopy/Hysterosonography;
MRI Research - Overview; 'Standing' along with 'Sitting' MRI Scans; MRI Brain; MRI Orbit, Face,
along with Neck; MRI Spine; MRI/MRA - Cardiovascular studies; MRI Abdomen and also Pelvis;
Tumor staging; Table citing optimal imaging studies through region; CT Angiogram; MRI along with
CT-guided biopsies; Magnetic Resonance Angiography (MRA) which includes Venography; Magnetic
resonance spectroscopy/Nuclear magnetic resonance; Magnetic Supply Imaging
(MSI)/Magnetoencephalography (MEG);
- Complementary and also Alternative Medicine: Alternative medicine criteria;
Acupuncture/Acupressure; Ayurvedic medicine; Biofeedback; Biofeedback pertaining to Urinary
Incontinence; Magnetic and also Bioelectromagnetic Therapy; diet along with Nutrition; Guided
imagery; Homeopathy; Hypnotherapy; Manual/massage therapy; Naturopathy; Relaxation therapy;
Transcendental meditation; Alternative medicine resources; references; web sites; source
organizations;.
Neuroimaging Scientific studies with regard to Headaches; Metastatic bone disease - radiologic
evaluation; Percutaneous Drainage/Aspiration associated with Abscesses and also Fluid Collection;
Percutaneous Permanent Inferior Vena Cava Placement; Percutaneous Transcatheter Embolization;
Percutaneous Transluminal Angioplasty (PTA); Peripheral Vascular Disease Evaluation; Renal Artery
Stenosis - Angiography as well as Stent Placement; Spiral CT regarding Lung Cancer Screening;
Thermography;
- Urology - review criteria: Referral guidelines; BCG therapy regarding bladder cancer; Urinary
FISH Test pertaining to Recurrent Bladder Cancer; Valrubicin regarding carcinoma in-situ with the
bladder; Bladder stimulator/Pacemaker implantation; Bladder pacemakers; Bladder Capacity
Ultrasound (Post-void Residual Measurements); Circumcision in the adult male; Cystoscopy; Bladder
biopsy, transurethral;
Age-related Macular Degeneration (AMD); Macular degeneration: Laser Therapy; Radiation
Treatment; Macular Fovea Translocation with regard to AMD; Ocular Photodynamic Therapy (OPT) Visudyne (Verteporfin) Therapy with regard to Age-related Macular Degeneration; Opthalmoscopy,
extended with retinal drawing Orbitotomy; Photocoagulation; Pterygium; Ptosis; Punctal
dilation/snipping; Punctal Plugs as well as Punctoplasty pertaining to 'Dry Eyes' Syndrome; Corneal
remodeling procedures - Refractive Keratoplasty/Radial Keratotomy/Phototherapeutic Keratectomy;
Refractive Keratoplasty/Radial keratotomy; Prosthesis, eye; Eye Examinations - Medicare; Routine
vision exam; Scleral buckle; Strabismus correction; Tarsorrhaphy; Transpupillary Thermal Therapy;
Viscocanalostomy; Visual Area Testing; Visual coaching (Orthoptics); Visual Rehabilitation Program;
Vitrectomy; Referral criteria summary sheet/grid for typical complaints.
Morbid Obesity/Bariatric Surgery; selection pertaining to surgery depending on comorbid diabetes
along with hypertension additionally in order to BMI;
Selective peripheral denervation (Bertrand procedure) pertaining to spastic torticollis; Spinal tap,
diagnostic, Stereotactic Cingulotomy, pertaining to severe and intractable pain credited in order to
terminal cancer; Sympathetic therapy with regard to chronic pain management; Sympathetic
therapy with regard to chronic pain management; Sympathectomy, Thoracoscopic; Thalamic
Electrical Stimulation, for your treatment method associated with intractable tremors; Transcranial
Doppler Ultrasonography; Transient Ischemic Attack (TIA) - Hospitalization Indications; Trigeminal

Neuralgia, Cryosurgery;
- Dermatology: Dermatology referral management; Acne vulgaris; Actinic keratosis; Alopecia areata;
Atopic dermatitis; Basal cell carcinoma; Biopsy/excision regarding benign skin along with
subcutaneous lesions, Cysts involving the skin along with subcutaneous structures; Decubitus
Ulcers, treatment; Digital Epiluminescence Microscopy (DELM)/Total body Photography; Fungus
infections, skin and nails; Dermatophytosis; Grenz Ray Therapy; Herpes Simplex; Herpes Zoster;
Impetigo as well as pyoderma; Inflammatory dermatosis/'Rashes'; hair Loss/Alopecia; Keloids;
Prostate Cancer therapy; Cancer of The Prostate Screening Exams along with Procedures; Prostate
specific Antigen (PSA); Benign Prostatic Hypertrophy - Remedy options; UroLume(R) endourethral
prosthesis (urethral stent) regarding BPH, stenosis, strictures; Cryosurgical ablation with the
prostate; Microwave therapy with regard to BPH; Transurethral Resection of the Prostate (TURP);
Transurethral Microwave Thermotherapy (TUMT) pertaining to BPH; Transurethral Radiofrequency
Thermotherapy/Needle Ablation of the Prostate (TUNA); Water-Induced Thermotherapy (WIT);
Shock wave lithotripsy (Extracorporeal shock wave lithotripsy);
- Note: Review criteria guidelines or 'benefit interps' are useful practical information on claims
payment decisions in order to base healthcare necessity decisions, particularly if minimum
preauthorization function or even information exists as well as utilization management, educational
along with precertification tools. they ought to be distributed in order to relevant physicians along
together with other providers with regard to review, input and then pertaining to any needed change
prior to implementation. pylori infection.
Stimulators: Chronic pain, Angina pectoris; treatment involving Motor Operate Disorders with
Electric Nerve Stimulation; Neuromuscular electrical stimulation (NMES) for disuse atrophy;
Neuromuscular or perhaps Therapeutic Electrical Stimulation (TES); Transcutaneous electrical
nerve stimulation (TENS); 'Sympathetic Therapy'; Inferential existing stimulation; Non-implantable
Pelvic Ground Electrical Stimulator; Percutaneous electrical nerve stimulation (PENS); ReliefBand;
Implanted Peripheral Electrical Nerve Stimulation; Pulsed electrical stimulation with regard to
osteoarthritis with the knee; Electrical Stimulation for your Therapy of Wounds: Chronic Stage III &
IV Musculo-Cutaneous Ulcerations; Surface electrical muscle mass stimulation; Bone stimulators:
electrical and also low-intensity ultrasound; Electrogalvanic Stimulators pertaining to Levator
Syndrome; H-wave stimulation for your remedy regarding diabetic neuropathy;
Gonadotropin-releasing hormone therapy; HIV Drug susceptibility as well as resistance testing;
Hyaluronidase, intra-articular injections; Intravenous immunoglobulins (IVIG); IVIG for you to avoid
RSV; Cytomegalovirus Immune Globulin Intravenous, Human (CMV-IVIG); Interferon therapy;
Intrathecal Baclofen regarding spasticity; Intravenous Histamine Therapy; Iontophoresis - apps
within transdermal medication delivery;
Foot as well as ankle: Bunionectomy; Foot care - routine; Mycotic nails; Additional covered solutions
for that foot as well as ankle; Ingrown toe nails; Olecranon bursa aspiration; Plantar Keratosis;
Interdigital Neuroma; Plantar fasciitis as TS Cams well as heel spurs; Consultation services with a
podiatrist - skilled nursing facility; Hammertoe surgery; Fractures with the toe; Maxwell-Brancheau
Arthroereisis (MBA) Implant - for flat-foot;
Cognitive Rehabilitation Therapy; Constraint-induced movement therapy (CIMT);
Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy; Hypothermia next acute brain
injury; Induced Lesions of Nerve Tracts; Intra-operative Electromyographic Monitoring involving
Cranial Nerves; Invasive Intracranial Strain Monitoring; Ulnar Nerve Transposition, Decompression

or Release; Monitoring; Ulnar Nerve Transposition, Decompression or perhaps Release; Vagus

Nerve Stimulation for that treatment method associated with refractory seizures; Vagus Nerve
Stimulation for the remedy involving depression; Videopupillography/Tropicamide Drop Test for your
Diagnosis regarding Alzheimer's Disease; Perception Threshold/Sensory Nerve Conduction
Threshold (SNCT);
- Obstetrics/Gynecology: Ablation - cervical lesion; Abortion/pregnancy termination
- Introduction: Introduction to always be able to referral authorization management guidelines and
criteria; CMS national policies; levels of risk within capitation; Fundamental elements of your
utilization management plan; Consultants vs. Almost All should be reviewed as well as approved by
method of a Health-related Policy Committee of the purchasing organization just before use. The
Particular manual will be designed for use as both a prospective utilization management reference,
an educational tool, or for retrospective claims payment review resource.
Research and Markets (http://www.researchandmarkets.com/reports/c12781) has announced the
inclusion of Healthcare Review Criteria Guidelines regarding Managing Care, 4th edition 2005 to
their offering
Positron Emission Tomography (PET scans); Pulmonary Scintigraphy; Prostate cancer staging scan;
Renal Scintigraphy; Scrotal scintigraphy; Sentinel Lymph Node
- Ophthalmology: A-scans, B-scans; Blepharoplasty, ptosis correction and also eyelid reconstruction;
Capsulotomy; YAG laser; Cataract surgery; Preoperative Evaluation and Screening with regard to
Cataract Extraction; Computer-assisted corneal topography; Conjunctivitis;
Conjunctivodacryocystorhinostomy; Balloon Dacryocystoplasty/Dacryoplasty for Nasolacrimal Duct
Obstruction; contact Lenses; Corneal graft utilizing amniotic membrane transplantation (AMT);
Corneal pachymetry; Corneal post-transplant wound revisions; Corneal wedge resection;
Intrahepatic Chemotherapy with regard to Liver metastasis - Chemoembolization; Isolated limb
perfusion (ILP); Mitoxantrone hydrochloride (Novantrone (R)); Monoclonal Antibody (Mab) Imaging
or perhaps Radioimmunoscintigraphy - colorectal cancer staging; Photodynamic Therapy;
Radiofrequency tumor ablation; Therapeutic phlebotomy; Vaccines to become able to treat a variety
of cancers; Cancer-related web sites; Photodynamic Therapy; Vaccines in order to treat numerous
cancers; Vitamin B12 Injections.
Impotence evaluation and treatments: Viagra; Noninvasive suction devices; Papaverine injections;
Penile prosthesis implantation; Electroejaculation; Internal Pudendal Arteriography (Angiography)
pertaining to Erectile Dysfunction; Percutaneous Nephrostomy;
- ENT, Oral Surgery and Dental Services: Acoustic neuroma; Audiological Testing; Aural
Rehabilitation Therapy; Mind stem auditory evoked response (BER, BAER); Carbogen Inhalation
Therapy for that treatment of Sudden Hearing Loss; Cleft lip/Cleft Palate Repairs; Cochlear
Implantation; CPAP pertaining to obstructive sleep apnea; Noninvasive Positive Pressure/Bi- PAP;
Dental services; Dental hospitalization; Damage in order to sound as well as natural Teeth; Intra-oral
appliances for the management regarding migraine headache syndromes; Dynamic Posturography;
- References along with Resources: located throughout the manual - conveniently following each
criteria or perhaps topic.
Echocardiograms, adult as well as pediatric; Doppler Echocardiography; Electrocardiograms;

Electrophysiology screening (ET); Endocardial electrical recording as well as stimulation (EES),

diagnostic; Enhanced external counterpulsation (ECP) - treatment regarding severe angina; Workout
Treadmill Test (ETT), routine screening; Physical exercise Treadmill Test (ETT) - routine, screening;
ETT using Thallium imaging; Pacemakers - permanent cardiac/Resynchronization Therapy;
Pacemaker monitors; Pacemakers/External manually activated devices to become able to terminate
tachyarrhythmias; Percutaneous Transluminal Coronary Angioplasty (PTCA); Radiofrequency
Catheter Ablation; Stents, coronary artery; Thoracic electrical bioimpedance; Thrombolysis
regarding acute myocardial infarction; Tilt Table Testing; T-Wave Alternans (TWA) testing; Cardiac
Rehabilitation Programs; Phonocardiography and also Vectorcardiography; LOS benchmarks/targets
with regard to cardiology diagnoses; References re: AMI LOS; Screening pertaining to cardiac
disease; Cardiology guideline resources, web links.
- Miscellaneous: Assisted Suicide; Autopsies; Cryoanalgesia along with Cold Laser (low-energy)
Therapy for wound healing, pain therapy, along with other disorders; Complications subsequent
Non-covered services - Coverage; Hospital Costs regarding Noncovered Services; Death-related
Services; Electrosleep Therapy; Experimental/Investigative Services; Histamine desensitization
therapy for intractable headache; Hospital Admission Guidelines for Diabetic Adults;
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iew-Criteria-Guidelines
- Pharmacy: Pharmacy benefits; State involving California Knox-Keene act requirements;
Transendoscopic gastroplasty; Stretta as well as EndoCinch Procedures; Fecal Occult Blood test,
screening - positive; Fiberoptic endoscopy for the evaluation associated with swallowing; Gastric
freezing for the remedy involving active peptic ulcers; Gastrostomy/PEG tubes; Capsule Imaging
Endoscopy/Wireless - Medicare LMRP; Injection Sclerotherapy with regard to bleeding esophageal
varices; Gastric Pacing; Liver Biopsy; Liver assist or even support devices; Motility Disorders: Upper
GI - Diagnosis/Evaluation; Transesophageal Endoscopic Methods for Gastroesophageal Reflux
(GERD); Transjugular Intrahepatic Portosystemic Shunt; Transplantation; Urea breath screening for
H. 10, 2005--949 pages contain greater than 1,200 clinical 'benefit interps'/ review criteria clinical
guidelines. referrals; Guidelines; 'Evaluate and also Treat' orders as well as authorization requests;
Healthcare Necessity - Exactly what is actually it?; Case law citations related to become able to
health-related necessity; AHRQ Prevention Top Quality Indicators; Speed up the review procedure
by ...; Hospital Inpatient Admission Criteria, general principles; 'Automatic' approval associated with
authorization requests;
- Skeletal-muscular system: Knee region: Arthroscopy - knee; Arthroscopic lavage or even
debridement, knee; Total Knee Replacement; Autologous chondrocyte transplantation surgery in the
knee; Hyaluronidase, intra-articular injections regarding osteoarthritis;
- Cardiovascular/Peripheral Vascular Surgery: Alcohol Septal Ablation regarding Hypertrophic
Obstructive Cardiomyopathy; Aortic Aneurysm Repair - Criteria as well as Options; Aortic and/or
valve replacement; Atherectomy, peripheral; Atrial septal defect, repair; Carotid body tumor
resection (Glomectomy); Carotid endarterectomy - Indications, LOS; Carotid/Vertebral Artery
Angioplasty and also Stenting Procedures; Coronary artery bypass graft(s) surgery (CABG) Indications, LOS; Extracranial-Intracranial arterial bypass surgery; Coronary Heart volume
reduction surgery;
Impedance plethysmography; Intermittent claudication; Intraoperative Ventricular Mapping; Left
Ventricular Assist Devices; Maze Procedure regarding atrial fibrillation/flutter; Microsurgical

lymphaticovenous anastomosis operation pertaining to lymphedema; Pectus excavatum and Pectus

carinatum - Surgical Correction; Photophoresis, extracorporeal - Therapy regarding Coronary Heart
Transplant Rejection; Post-thoracotomy Pain - Intraoperative, Intercostal Nerves, Cryoanalgesia;
Pulmonary vein isolation with regard to atrial fibrillation; Renal Artery Stenosis - Angioplasty, Stent
Placement; Transcoronary ablation regarding septal hypertrophy (TASH); Transjugular Intrahepatic
Portosystemic Shunt; Transmyocardial laser revascularization; Varicose vein methods including
Endovenous Ablation Therapy; Ventricular Assist Devices; Ventricular Reduction/Remodeling or
even Partial Ventriculectomy; Vertebral artery surgery; Peripheral vascular rehabilitation programs.
Low molecular excess weight heparin; Lyme disease vaccine; Meningococcal vaccine; Mifepristone
(Mifeprex(TM), RU 486); Nicotine patch, gum or nasal bottle of spray therapy for smoking cessation;
Off-label drug therapy; Oral contraceptives; Phonophoresis; Prior authorization list w/indications;
Platelet-derived Growth Element regarding Wound Healing (Regranex, Procuren); Prophylactic
antibiotics; Prostacyclin infusion therapy; Sexual operate therapy; Smallpox Vaccination; Topical
steroids; Transfer Factor; Tumor Necrosis Element Inhibitors - Ankylosing Spondylitis, Ulcerative
Colitis, Psoriasis; Injectable drugs; Pharmacy web sites.
Transrectal ultrasound regarding prostate or rectal cancer - biopsy/staging; Pelvic Ultrasound within
Females; Sonohysterosalpingraphy; Obstetrical Ultrasonography; Scrotal Ultrasonography;
Retroperitoneal Ultrasonography; Developmental Hip Dysplasia Detection by Ultrasonography;
Ultrasound regarding peripheral web sites (tibia, phalanges) for your selection of patients for
pharmacologic treatment method regarding osteoporosis; Radiology guideline resources/web links.
Laser pertaining to actinic lesions; Malignant melanoma; Mohs Micrographic Surgery;
- Emergency My Shemale Cams health-related services: Emergency services/authorization system,
Emergency space authorization/claims processing matrix, Emergency treatment criteria;
Relationship of ER admissions in order to insurance status; Ambulance as well as other healthrelated transportation;
- Addenda: Operational Standards; Delegation in order to PCPs; Delegation in order to SCPs; New
Health-related Technologies Assessment - Policy/Procedure, Performance standards: QI/UM/Provider
relations/Customer service; Critical Treatment - Medicare LMRP; Worker's Compensation; Hospital
care 'length associated with stay' targets, by get older range; Frequency simply by
Diagnostic/Procedural Group, Duration involving stay targets by DRG; NY State Medicaid ALOS
simply by DRG 2004; Surgical Procedures, LOS benchmarks; Outpatient procedures or even 'Sameday discharge' authorization list;
Immunotherapy to lower your risk of spontaneous abortion; Infertility management: Coverage
criteria for females, Coverage criteria regarding males, Infertility treatment, artificial insemination,
Ova sticks - ovum transfer/uterine lavage - sperm donor/storage/washing; Intracytoplasmic sperm
injection; In-Vitro Fertilization (IVF) and Gamete Intra-Fallopian Transfer (GIFT); Multifetal
pregnancy reduction (MFPR); Recurrent Pregnancy Loss; Transcervical balloon tubuloplasty; Intrauterine device (IUD) - removal, Laparoscopy - pelvic; Myomectomy; Nerve Ablation Treatments
regarding Dysmenorrhea, Laparoscopic; Laparoscopic, Oophorectomy;
Speech aids, electronic; Thairapy O vest for cystic Shemale Cams fibrosis; Thairapy Bronchial
Drainage System; Therabite Jaw Motion Rehabilitation System; Therapeutic Electrical
Stimulation/TES; Transcutaneous Electrical Nerve Stimulation/TENS; Inferential present
stimulation; Non-Implantable Pelvic floor Electrical Stimulator; Implanted Peripheral Electrical
Nerve Stimulation; Percutaneous Electrical Nerve Stimulation/PENS; Electrical Stimulation

regarding Chronic Musculo-cutaneous Ulceration; Respiratory Assist Devices; Standers, Boards and
Tables; Vitrectomy Deal With Support; Wheelchairs, Power-type along with Power-operated vehicles
(POVs); Wigs; DME Screening Checklist - a grid listing 290 extra DME/DMS review guidelines;
Reuse Details Notice.
- Nutritional: Nutrition Counseling/Educational Programs; Specialty foods, Liquid nutrition products;
Ketogenic diet plan counseling regarding refractory seizure control; Reduced protein meals
products; Really reduced fat diet programs to treat or even avoid heart disease; Supplemental
Fasting Regimens; Enteral Nutrition/Tube feeding; Parenteral nutrition/Total Parenteral Nutrition
(TPN); Web practical info on meals and also nutrition;
MRI as well as CT scans - Computerized Tomography (CT) or Computerized Axial Tomography (CAT)
- Overview; Computerized Tomography (CT or CAT) which includes extracranial head, mind as well
as thoracic scans; High-resolution CT (HRCT) for Pulmonary Studies; CT regarding appendicitis;
Spiral CT Scans pertaining to Lung Cancer Screening; Helical CT for Pulmonary Embolism
Detection; Computerized Axial Tomography (CT) Scans: Pelvis, Abdomen, Abdomen and Pelvis around the exact same day; Electron-beam CT screening regarding coronary artery disease;
Ultrasound of peripheral websites (tibia, phalanges) for that collection of patients regarding
pharmacologic therapy involving osteoporosis;
Oral surgery; Oral biopsy pertaining to malignancy; Orthodontia; Orthognathic surgery; Distraction
osteogenesis regarding craniofacial abnormalities; Otitis media, recurrent; Otoplasty; Positional
vertigo; Rhinomanometry and also acoustic rhinometry/Nasal Operate Studies; Septoplasty;
Septorhinoplasty; Sialorrhea (drooling) - Surgical Treatment; Sinusitis, acute; Sinus endoscopy, with
or even with out computer-augmentation; Smell along with Taste - Evaluation coverage;
Electronystagmogram (ENG); Ernest or Eagle's Syndrome/Stylomandibular Ligament Pain treatment with Radiofrequency Thermoneurolysis; Frenulectomy; Hearing Tests,; Impacted teeth extraction; Intra-operative Electromyographic Monitoring associated with Cranial Nerves; Laser
assisted Uvulopharyngoplasty (LAUP); Myringotomy along with Tympanostomy Tubes/Laser
Myringotomy; Meniett twenty for overpressure remedy regarding Meniere's Disease;
- Laboratory: Medicare Coverage regarding Laboratory Testing; Diagnostic testing, indications,
coverage (HIV, PSA, Thyroid examples); Tau, BA-42 as well as Apolipoprotein E assessments
pertaining to Alzheimer's disease; Substantial Sensitivity C-Reactive Protein (hsCRP); Anti-MAG as
well as Anti-GM1 Antibody Exams for Neurologic Disease; Cytogenetic studies; Human tumor cell
assays (Fluorescent Cytoprint assay, extreme Drug Resistance assay); Genetic/Molecular
Susceptibility Screening/Testing; Genetic screen pertaining to thyroid carcinoma along with MEN;
Genetic screen pertaining to breast as well as ovarian cancer (BRCA1, 2); Genetic screening
regarding cystic fibrosis; Genetic testing for hereditary nonpolyposis colorectal cancer; Head Of
Hair analysis; heavy metals and other minerals, test indications; Histocompatibility (HLA) testing;
Iron/Ferritin Studies, Serum; Tumor markers; Lipid Profiles/Testing; Lyme Disease Testing;
Laboratory References, general.
- Allergy testing and also Desensitization: Allergy referral, Allergy testing and desensitization
therapy; Serial Endpoint Allergy Testing; Immunotherapy for malignant disease; Leukocyte
Histamine Launch Test (LHRT); Screening pertaining to Hypersensitivity Reactions in order to Meals
along with Chemicals, Throughout Vitro Particle size Measurement; Nasal Challenge Test; Rhinitis,
allergic - referral criteria; Transfer factor.
- General Surgery: Clinical Guidelines regarding Office-based Surgery; Anal fissure, chronic;

Appendectomy; Breast surgery - biopsy; Mastectomy; Cholecystectomy, open up as well as

laparoscopic; Colon resection - Colectomy, Debridement, Wound; Gastroesophageal Reflux Device
Implantation, Gastroesophageal Reflux (GERD) Surgery; Hemorrhoidectomy - internal and external,
Hiatal Hernia repair, Incisional Hernia Repair, Inguinal Hernia Repair, Umbilical Hernia Repair,
Incision along with Drainage (I & D) Procedures; Laparoscopy as well as Peritoneoscopy;
- Gastroenterology: Balloon Dilation of Gastrointestinal Tract Strictures; Colonoscopy, Immediate &
Virtual: screening, diagnostic; Dysphagia - Evaluation regarding swallowing mechanism;
Electrogastrography (EGG); Endoscopic Retrograde Cholangiopancreatography (ERCP); Magnetic
resonance cholangiopancreatography (MRCP); Endoscopic Ultrasonography; Upper, Lower;
Esophagogastroduodenoscopy (EGD); flexible sigmoidoscopy; Gastroesophageal reflux disease
(GERD); Intestinal Rehabilitation Programs; Implanted Capsule pH Monitoring with regard to GERD;
Ultrasonography: Overview; Noninvasive cerebrovascular studies associated with extracranial
arteries; Paranasal sinus ultrasonography; Spinal canal as well as contents ultrasonography;
Peripheral Arterial Ultrasound Examination Utilizing Pulsed Doppler; Peripheral Venous Ultrasound
Examination; Thyroid along with Parathyroid Ultrasonography;
Cardiovascular Nuclear Medicine studies; Congestive Coronary Heart Failure - admission, discharge
criteria guidelines; CT scans to screen regarding coronary artery disease; Congestive Coronary
Heart Failure - Hospital admission criteria; Defibrillator devices, automatic implantable
cardioverter; direct existing cardioversion, elective; Directional coronary atherectomy (DCA);
Durable Healthcare Equipment (DME): Definitions; pressure Lowering Assistance Surfaces, Teams
1, 2, and 3; Air Fluidized Beds; Bathroom along with Toilet Equipment as well as Supplies; Beds as
well as Mattress Accessories/Trapeze Bars; Bed as well as Pillow Handles for Asthmatics; Bedwetting Alarm; Breast Pumps; Catheters, urinary; --Cervical traction; Chairs, therapeutic;
Communication devices/aides; Compression Garments in the Remedy involving Venous Stasis
Ulcers; Constant Passive Motion device; Cranial Remodeling Band/Helmet for infants; Dorsal
Column Stimulators - with regard to chronic intractable pain control; Diabetes mellitus-related DME
- Glucose monitors, blood; GlucoWatch(R) Biographer - automatic glucose values without any needlestick; Jet Injectors pertaining to insulin administration; Insulin pens; Sleep sentry in order to detect
hypoglycemia; Constant Glucose Monitoring;
Pediculosis ('lice'); Photochemotherapy for the treatment regarding scleroderma, extracorporeal;
Pityriasis rosea; Psoriasis; PUVA Therapy; Rosacea; Scabies; Sclerotherapy with regard to varicose
veins, Seborrheic dermatitis/'Dandruff'; Seborrheic keratosis; Squamous cell carcinoma; Tattoos;
Verruca Vulgaris/ Warts; Vitiligo; Ultraviolet A New light Therapy; Ultraviolet B Mild Therapy.. The
Particular manual is accompanied by the entire contents on the CD