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WebHorizon NJ Health : Physicians : Members : Clinical and Preventive Guidelines : Medical Policies

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BCBSNJ Medical Policy for

Web3. Semi-electric hospital bed (head and foot adjustment) (E0260, E0261, E0294, E0295, and E0329) is considered medically necessary when the member meets the criteria for a …

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BCBSNJ Medical Policy for

WebThis can include intra-coronal restorations such as amalgam, gold, or composite, full or partial coverage crowns and tooth strengthening and retention enhancement for …

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BCBSNJ Medical Policy for

WebMenopause most commonly occurs in women between the ages of 45 and 55. Some women who reach menopause are asymptomatic. However, some women experience a variety …

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BCBSNJ Medical Policy for

WebPreimplantation Genetic Testing (Policy #005 in the Obstetrics Section) Policy: ( NOTE: In 2001, a law - P.L.2001, c.236 - became effective in New Jersey requiring coverage for …

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BCBSNJ Medical Policy for

WebWith a prevalence of ADHD of 61% based on clinical diagnosis, the theta/beta ratio had a sensitivity of 87%, a specificity of 94%, a positive predictive value of 95%, and negative …

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BCBSNJ Medical Policy for

WebIn this policy, procedures are considered reconstructive when intended to address a significant variation from normal related to accidental injury, disease, trauma, treatment …

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BCBSNJ Medical Policy for

WebCPAP use for <4 hours per night for ≥5 nights per week, or refusal to use CPAP. CPAP intolerance may be observed in patients with mild, moderate, or severe OSA. Due to …

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BCBSNJ Medical Policy for

WebCMM 203.4 Non-Indications. † Ultrasound guidance for a sacroiliac joint injection, for any indication, is considered investigational. † Sacral lateral nerve branch blocks and/or …

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BCBSNJ Medical Policy for

WebThis Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, …

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BCBSNJ Medical Policy for

WebI. Contract exclusions and/or limitations for gender affirming surgery, including related services such as medical counseling, psychological clearance for surgery in the absence …

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