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ACG

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

Automated Clinical Guidelines

Shoulder

Indicates Non-covered Service

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Indicates Non-covered Service

Articular Cartilage Repair of the Shoulder
Cooling & Heating Devices Used in the Outpatient Settings
Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions
Intramedullary Lengthening Devices – Humerus
Subacromial Balloon Spacer
Thermal Shrinkage
Cigna
UHC
Humana
Cigna
Cigna
FloridaBlue

23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828

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