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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Wrist/Hand

Aetna
Anthem
Humana
Brachial Plexus Surgery
Carpal Tunnel Syndrome (CTS) Surgical Treatments
UHC
Carpometacarpal (CMC) Joint Thumb Arthroplasty
Anthem
Collagenase Clostridium Histolyticum Xiaflex for Dupuytren's Contracture
Cigna
FloridaBlue
UHC
Anthem
 Dupuytren's Contracture- Surgical Treatment- Palmar Fasciectomy
Aetna
UHC
Aetna
Metacarpo- phalangeal (MCP) and Proximal  Interphalangeal (PIP) Joint Implants
UHC
Aetna
NeuroControl Freehand System
UHC
Nerve Decompression at the Wrist
UHC
Peripheral Nerve Surgery
UHC
Reduction and Fixation of the Distal Radius and Radial Shaft
UHC
Tendon Transfers in the Hand or Forearm
UHC
Trigger Finger (including trigger thumb) Surgery
UHC
Wrist Arthroscopy
UHC
Wrist Arthrotomy
UHC
Wrist, Total Arthroplasty
Aetna

Indicates Non-covered Service

Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions
FloridaBlue
Cooling & Heating Devices Used in the Outpatient Setting
FloridaBlue
Functional Neuromuscular  Stimulation
Aetna
Hand Transplantation
Aetna
Laser Neurolysis
Aetna
Nerve Grafting- Selected Indications
Aetna
Thumb Basal Joint Arthroscopy
FloridaBlue

Visco-

supplements

29830, 29834, 29837, 29838, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371

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