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ACG

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

Automated Clinical Guidelines

Orthopaedic-All Other

Indicates Non-covered Service

Indicates Non-covered Service

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

Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions &

Soft Tissue Wounds

Humana
UHC
Humana

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

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