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ACG

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

Automated Clinical Guidelines

ENT

Indicates Non-covered Service
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Surface Electrical Stimulation Devices for Headache & Migraine 
Anthem
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Balloon Ostial Dilation (Balloon Sinuplasty) & Implantable Devices
Computerized Dynamic Posturograpjhy (CDP)

Drug-Eluting Devices for

Use Following Endoscopic Sinus Surgery

Ernest or Eagle's Syndrome (Stylomandibular Ligament Pain): Treatment with Radiofrequency Thermoneurolysis
Oral Cancer Screening Systems
ProThelial for the Treatment of Oral Mucositis

Meniere's

Disease

Surgery

FloridaBlue
FloridaBlue
Cigna
Cigna
FloridaBlue
FloridaBlue
Aetna
Self-Expanding Absorptive Sinus Ostial Dilation
Anthem

15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 69930, L8614, L8615, L8616, L8617, L8619, L8625, L8627, L8628, S2235, 21010, 21050, 21060, 21070, 21085, 21100, 21110, 21116, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21210, 21215, 21240, 21242, 21243, 21244, 21247, 29800, 29804, 69300, 69320,21685, 41512, 41530, 41599, 42140, 42145, 42299, 42950, 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 0466T, 0467T, 0468T, C9727, S2080,  31295, 31296, 31297, 31298, 69705, 69706, 60210, 60212, 60220, 60225, 60240, 60252, 60254, 60260, 60270, 60271,

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