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ACG

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

Automated Clinical Guidelines

Point             Health

Harvard Pilgrim Health Care

Mass Health

Point32Health

Hereditary Cancer Testing 
Hematopoietic Stem-Cell Transplantation (HSCT)
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Pharmaco-genomic Testing
Polygenic Risk Scores
Transcervical Radiofrequency Ablation of Uterine Fibroids
Tumor Treating Fields
Assisted Reproductive Technology Services
Bariatric Surgery
Behavioral Health Inpatient & 24 Hour Level of Care Determinations
Behavioral Health Level of Care for Non- 24 Hour/Intermediate/Diversionary Services
Cardiac Diagnostic Tests/
Interventional Procedures
Cholecystectomy, Laparoscopic
Clinical Review of Dental Services
Clinical Trials: Routine Costs
Fertility Services
Home Health Care Services
Hysterectomy, Certain Electives
Implantable Neurostimulators
Lower Limb Prostheses
Medical Transportation
Mobile Cardiac Outpatient Telemetry (MCOT)
Mobile Crisis Intervention (MCI) for Youths
Molecular Diagnostic Management
Neuropsycho-logical Testing & Assessment
Noncovered Investigational Services
Orthognathic Surgery for Severe Oral- Maxillofacial Functional Disorders
Osteogenesis Stimulators
Out-of-Network Coverage at the In-Network Level of Benefits
Private Duty Nursing in the Home
Outpatient Psychotherapy
Outpatient Pulmonary Rehabilitation
Procedures for the Treatment of Benign Prostatic Hypertrophy (BPH) 
Procedures for the Treatment of Symptomatic Varicose Veins 
Positive Airway Pressure Devices for Sleep Apnea
Power Operated Vehicles (POVs)
Power Wheelchairs
Psychological Testing and Assessment 
Reconstructive & Cosmetic Surgery 
Removal of Benign Skin Lesions
Shoulder Surgery 
Sleep Studies
Speech, Hearing, & Language Services
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Stereotactic Radiosurgery
& Stereotactic Body Radiotherapy
Surgical Procedures for the Treatment of Obstructive Sleep Apnea
Targeted Case Management Services
Temporoman-dibular Joint (TMJ) Disorder Treatment 
Therapeutic Mentoring (TM)
Transcranial Magnetic Stimulation (rTMS)
Video Capsule Endoscopy 
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