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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

ACG-Blue-Surgery

Indicates Non-covered Service

Allogeneic Pancreas Transplant
Abortion
Autologous Hematopoietic Cell Transplantation
Allogeneic Hematopoietic Cell Transplantation
Autologous Chondrocyte Implantation (ACI)
Automated Percutaneous Discectomy, Laser Discectomy, Percutaneous Endoscopic Discectomy, & DISC Nucleoplasty
Balloon Ostial Dilation (Balloon Sinuplasty) & Implantable Devices
Bone Morphogenetic Protein (BMP)
Bariatric Surgery
Bronchial Thermoplasty
Bio-Engineered Skin & Soft Tissue Substitutes; Amniotic Membrane & Amniotic Fluid
Breast Ductoscopy
Cervical Spine Surgery
Cochlear Implants
Cryoablation of Liver Tumors
Complications of Pregnancy
Deep Brain Stimulation & Responsive Neurostimulation
Computer-Assisted Navigation for Orthopedic Procedures
Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone
Dermabrasion, Chemical Peels, Salabrasion, and Acne Surgery
Diaphragmatic/ Phrenic Nerve Stimulation (Electrophrenic Pacemaker)
Endothelial Keratoplasty & Corneal Collagen Cross-Linking
Ductal Lavage & Suction Collection Systems
Endovascular Stent Grafts for Abdominal Aortic Aneurysms
Endoscopic Radiofrequency Ablation or Cryosurgical Ablation for Barrett's Esophagus
Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis & Aneurysms) & Extracranial Vertebral Artery Disease
Endovascular Stent Grafts for Disorders of the Thoracic Aorta
Epidural Injections
Facet Arthroplasty
Excimer Laser Therapy for Treatment of Dermatologic Conditions
Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)
Extracranial Carotid Angioplasty/ Stenting
Facet Joint Injections
Gender Affirmation Surgery
Heart & Lung Transplant
Hip Arthroplasty
Heart Transplant
Implantable Bone-Conduction & Bone Anchored Hearing Aids
High Resolution Anoscopy
Hip Arthroscopy & Open, Non-Arthroplasty Hip Repair
Implantable Cardioverter Defibrillators, Cardiac Contractility Modulation (CCM) Therapy
In Utero (Intrauterine) Fetal Surgery
Interstitial Laser Therapy for Breast Tumors
Infertility
Irreversible Electroporation (IRE)
Interspinous & Interlaminar Stabilization/ Distraction (Spacers) & Fixation (Fusion) Devices
Invasive Electrical Bone Growth Stimulator (EBGS)
Islet Transplantation
Isolated Small Bowel Transplant
Knee Arthroscopy & Open, Non-Arthroplasty Knee Repair
Kidney Transplant
Laser Vitreolysis
Knee Arthroplasty
Laparoscopic & Percutaneous Techniques for the Treatment of Uterine Fibroids
Liver Transplant & Combined Liver-Kidney Transplant
Lumbar Spine Surgery
Manipulation Under Anesthesia
Lung & Lobar Lung Transplant
Medical and Surgical Management of Sleep Apnea, Snoring, & Other Conditions of the Soft Palate & Nasal Passages
Lysis of Epidural Adhesions
Mastectomy for Gynecomastia
Microwave Tumor Ablation Other Than Liver Tumors
Minimally Invasive Fusion Techniques
Neurolysis - Ablation
Mohs Micrographic Surgery
Occlusion of Uterine Arteries Using Transcatheter Embolization
Nerve Block Injections
Ooccipital Nerve Stimulation
Orthognathic Surgery
Panniculectomy
&
Abdominoplasty
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Partial Left Ventriculectomy & Surgical Ventricular Restoration
Photocoagulation of Macular Drusen
Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, & Biacuplasty & Intraosseous Basivertebral Nerve Ablation
Percutaneous Vertebroplasty, Kyphoplasty, & Sacroplasty
Platelet-Derived Growth Factors & Platelet-Rich Plasma
Plugs for Fistula Repair
Radiofrequency & Microwave Ablation of Liver Tumors
Prophylactic Mastectomy
Reduction Mammaplasty
Radiofrequency Ablation of Solid Tumors Other Than Liver Tumors
Reconstructive Surgery/ Cosmetic Surgery
Sacroiliac Joint Injections
Small Bowel, Liver & Multivisceral Transplant
Transcatheter Aortic Valve Replacement
Total Ankle Replacement
Transcatheter Pulmonary Valve Implantation
Total Artificial Hearts  & Implantable Ventricular Assist Device
Transcatheter Mitral Valve Repair (TMVR)
Transmyocardial Revascularization (TMR)
Transurethral Waterjet Ablation of the Prostate
Unicondylar Interpositional Spacer Devices
Treatments for Varicose Veins/ Venous Insufficiency
Viscocanalostomy & Canaloplasty
Trigger Point Injections
Vagus Nerve Stimulation
Whole Gland Cryoablation of Prostate Cancer
Subtalar Arthroereisis
Stereotactic Body Radiotherapy
Surgical Treatments for Lymphedema & Lipedema
Stereotactic Radiosurgery (Intracranial)
Surgical Treatment of Occipital Neuralgia & Headache
Temporary Prostatic Urethral Stents (Including Implantable Nitinol Devices) & Prostatic Urethral Lift
Thumb Basal Joint Arthroscopy
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