top of page

ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Orthopaedic-All Other

bonestim.jpg
Ablative Therapy of Bone
Amputation of Digit or Extremity
Arthrocentesis
Bone Graft Substitutes and Bone Morphogenetic Proteins
Bone Growth Stimulators - Electrical (Invasive), Ultrasound 
Noninvasive Electrical Bone Growth Stimulation
Complex Regional Pain Syndrome (RSD)
UHC
Anthem
Humana
Cigna
Anthem
Cigna
Humana

Indicates Non-covered Service

Debridement Services
Debridement Services of bone, muscle, fascia, and subcutaneous tissue
Debridement Services of Extensive Eczematous or Infected Skin
Excision of malignant skin lesions: Trunk, arms, or legs
Internal Rib Fixation System
Implantable Infusion Pump for Pain and Spasticity
Humana
Implantable Intrathecal Drug Delivery Systems
Cigna
Incision and Drainage of abscess of skin, subcutaneous and accessory structures
Intraoperative Neurological Monitoring
Humana
Invasive Electrical Bone Growth Stimulator (EBGS)
Manipulation Under Anesthesia
Bio-Surgery Medicinal Leech Therapy and Medical Maggots
Osteopathic Manipulative Treatment
Inpatient Setting for Elective Total Joint Arthroplasty
Treatment of leg length discrepancy
Ultrasound Ablation for Oncologic Indications High Intensity Focused Ultrasound (HIFU)
FloridaBlue
Cigna
UHC
Aetna
HPT

Indicates Non-covered Service

Athletic Pubalgia Surgery
Autologous Cellular Implant Derived from Adipose Tissue
Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])
Computer-Assisted Navigation for Orthopedic Procedures

Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions &

Soft Tissue Wounds

Ablation Techniques & Extracorporeal Shock Wave Therapy for Musculoskeletal Indications & Soft Tissue Wounds

Cartilage Regeneration Membrane
Humana
Cigna
FloridaBlue
Cigna
UHC
Cigna
Humana
UHC
Humana
Anthem
 Electrothermal Intradiscal Therapies
 Electrothermal Arthroscopy
Healing Response Technique
In-Office Diagnostic Arthroscopy
Irreversible Electroporation (NanoKnife)
Surgical Treatment of Occipital Neuralgia & Headache
Orthopedic Applications of Stem-Cell Therapy
Humana
Aetna
Cigna
Cigna
FloridaBlue
Humana
FloridaBlue
FloridaBlue
Cigna
Prolotherapy for Musculo-skeletal Indications
Subchon-droplasty
Thermal Shrinkage
Xenograft Implantation into the Articular Surface
Cigna
Cigna
Cigna
Humana
UHC
Cigna

20974, 20975, 20979, E0747, E0748, E0749, E0760

bottom of page