ACG
h.o.l.M.E.S.
Automated Clinical Guidelines
ΨΥΧΗΣ ΙΑΤΡΕΙΟΝ
Transplant Services
Indicates Non-covered Service
Transplantation (Mesencephalic, Adrenal-Brain and Fetal Xenograft)
Vascularized Composite Allograft (VCA) Transplantation
Anthem
Cigna
32850, 32851, 32852, 32853, 32854, 33927, 33928, 33929, 33935, 33945, 38230, 38232, 38240, 38241, 38243, 47135, 48160, 48550, 48554, 48556, 50360, 50365, 50370, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81595, 0494T, 0495T,0496T, 0584T, 0585T, 0586T, L8698, S9975,
Thymus Tissue Transplantation
Isolated Small Bowel Transplant
Allogeneic Pancreas Transplant
ENT
Indicates Non-covered Service
FEP
Surface Electrical Stimulation Devices for Headache & Migraine
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,
