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Criteria for Benefit Decisions Related to:

• Abdominal Panniculectomy
• Absorbent Products
• Autologous Chondrocyte Transplant
• BH - ABA
• BH ART
• BH CSU
• BH Day Treatment
• BH FST
• BH Medicare Neuropsych Testing
• BH Psych Testing
• BH rTMS
• Biofeedback
• Blepharoplasty
• BRCA Testing
• Cardiac Monitoring Long Term Care
• Clinical Trials
• Cochlear Implants
• Continuous Glucose Monitoring System
• Cranial Orthoses
• Dermal Injections
• Formula and Enteral Nutrition
• Gardasil Protocol-HPV Vaccine
• Gastric Electrical Stimulation
• Hearing Aids for Children
• High Frequency Chest Wall Oscillation Devices
• Home Use of Oxygen
• Hyperbaric Oxygen (HBO) Therapy
• Infertility Protocol
• IVIG
• Laser Assisted Uvulopalatoplasty or Uvulopalatopharyngoplasty (UPPP)
• Long Term Care 30-day Cardiac Monitoring
• Lower Limb Prosthesis
• Lynch Syndrome
• Lymes
• Mandibular Advancement Device (MAD) in the treatment of Obstructive Sleep Apnea
• Mastectomy for Gynecomastia
• Monitoring of Oral Anticoagulant Therapy
• Oncotype DX Assay
• Orthognathic Surgery
• Outpatient PT OT ST
• Positive Airway Pressure
• Proton Beam Therapy
• Reduction Mammoplasty
• Rhinoplasty
• Sacral Nerve and Electrical Percutaneious Tibial Nerve Stimulation
• Sacroiliac Join Fusion
• Scleral Lens
• Speech Generating Devices
• Speech Therapy
• Spinal Cord Stimulation
• Spinal Muscular Atrophy Testing
• Surgical Management of Morbid Obesity
• Therapeutic Shoes and Orthotics
• Total Ankle Replacement
• Total Hip Resurfacing
• Trisomy 21
• Upper Limb Prosthesis