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ACG

h.o.l.M.E.S.

Automated Clinical Guidelines

Anthem
Aetna
Cigna
Elder

Indicates Non-covered Service

Commercial
Pediatric
FloridaBlue
Humana
Medicare
MA
Sleep Testing
FloridaBlue
UHC
Medicaid
Aetna
Anthem
FloridaBlue
Cigna
Medicare
UHC
Humana

0200T, 0201T, 0202T, 0219T, 0220T, 0221T, 0222T, 0274T, 0275T, 20930, 20931, 22100, 22101, 22102, 22103, 22110, 22112, 22114, 22116, 22206, 22207, 22208, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22510, 22511, 22512, 22513, 22514, 22515, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22586, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22850, 22852, 22853, 22854, 22855, 22859, 22867, 22868, 22869, 22870, 22899, 27279, 27280, 62380, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63275, 63277, 63280, 63282, 63285, 63286, 63287, 63290, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63275, 63277, 63280, 63282, 63285, 63286, 63287, 63290, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 63650, 63655, 63663, 63664, 63685, 63688, 64999, C1816, C1820, C1822, L8679, L8680, L8682, L8685, L8686, L8687, L8688

Sleep Testing
Coagulation Modifiers
caprelsa4.jpg

Vandetanib (INN, trade name Caprelsa) is an anti-cancer drug that is used for the treatment of certain tumours of the thyroid gland...Wikipedia

 

Manufacturer's Website: Caprelsa                                                                                                                   Average retail cost: $7,524/month

Caprelsa (vandetanib)
VEGF/VEGFR Inhibitors
vegf-vegfr.jpg
* Prices reflect U.S. average retail price
FEP
FEP
BCBSIL
BCBSMT
BCBSNM
BCBSOK
BCBSTX
HCSC
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