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ACG

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

Automated Clinical Guidelines

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OB & Gyn

Indicates Non-covered Service
Indicates Non-covered Service
Breast Ductoscopy
Cervical Cancer Screening Visualization Technologies
Mammary Ductoscopy, Aspiration & Lavage
Selected Tests for the Evaluation & Management of Infertility

Tests for the Evaluation of Preterm Labor

& Premature Rupture of Membranes

Tumor In Vitro Chemosensitivity & Chemoresistance Assays
Vein Embolization  Treatment for Pelvic Congestion Syndrome & Varicocele
FloridaBlue
Cigna
Cigna
Anthem
Cigna
Cigna
Anthem
Cigna
Home Births

52402, 54800, 54840, 54900, 54901, 55200, 55300, 55400, 55550, 55870, 58321, 58322, 58323, 58340, 58345, 58350, 58555, 58559, 58560, 58660, 58662, 58672, 58673, 58740, 58750, 58752, 58760, 58770, 58900, 58970, 58974, 58976, 74440, 74740, 74742, 76831, 76856, 76857, 76948, 80414, 80415, 80426, 82757, 84830, 89250, 89251, 89253, 89254, 89255, 89257, 89258, 89259, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89300, 89310, 89320, 89321, 89322, 89325, 89329,89330, 89331, 89335, 89337, 89342, 89343, 89344, 89346, 89352, 89353, 89354, 89356, 89398, G0027, Q0115, S3655, S4011, S4013, S4014, S4015, S4016, S4017, S4018, S4020, S4021, S4022, S4023, S4025, S4026, S4027, S4028, S4030, S4031, S4035, S4037, S4040, S4042,

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Premenstrual Syndrome & Premenstrual Dysphoric Disorder
Aetna
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Progestins
Aetna
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Treatment of Complications of Pregnancy
Anthem
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Magnesium Sulfate Injections & Terbutaline Pump for Preterm Labor
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