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Health Care Service Corporation (HCSC) Medical Policy Updates – February 2023
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February 2023 Health Care Service Corporation (HCSC) Medical Policy Updates:
- Ablation of Peripheral Nerves to Treat Pain
- Airway Clearance Devices
- Allogeneic Processed Thymus Tissue-agdc (Rethymic)
- Amniotic Membrane and Amniotic Fluid
- Applied Behavior Analysis (ABA) for Autism Spectrum Disorder (ASD) Diagnosis
- Bamlanivimab and Etesevimab Antibody Therapy
- Biofeedback as a Treatment of Chronic Pain
- Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
- Botulinum Toxin
- Brain Tissue Transplantation and Neurotransplantation
- Brexanolone for Postpartum Depression
- Bronchial Thermoplasty
- Cervical Spinal Fusion
- Computed Tomography to Detect Coronary Artery Calcification
- Cosmetic and Reconstructive Procedures
- Diagnosis of Obstructive Sleep Apnea Syndrome
- Elastography and Associated Imaging Techniques
- Electrical Bone Growth Stimulation of the Appendicular Skeleton
- Electromagnetic Navigation Bronchoscopy (ENB)
- Electroretinography (ERG), Multi-Focal Electroretinography (mfERG) And Pattern Electroretinography (PERG)
- Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
- Esketamine Nasal Spray
- Experimental, Investigational and/or Unproven Procedures/Services
- Extracranial Carotid Angioplasty or Stenting
- Facet Joint Injections
- FDA-Approved Drugs and Biologicals
- Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
- Genetic Testing for Mitochondrial Disorders
- Givosiran
- Hematopoietic Cell Transplantation (HCT) or Additional Infusion Following Preparative Regimens (General Donor and Recipient Information)
- High-Intensity Focused Ultrasound (HIFU) With or Without Magnetic Resonance Imaging (MRgFUS)
- Human Growth Hormone (GH)
- Inhaled Nitric Oxide
- Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)
- In-Vivo Analysis of Colorectal Polyps
- Laser Treatment of Vulvovaginal Atrophy (VVA)
- Long-Term Ambulatory Cardiac Monitoring (Outpatient Cardiac Telemetry, Implantable Cardiac Rhythm Event Monitors, and Intracardiac Ischemia Detection Systems)
- Low-Level and High-Power Laser Therapy
- Management of Hereditary Angioedema (HAE) with C1 Esterase Inhibitor, Human and Ecallantide
- Medical Management of Sleep Related Breathing Disorders
- Molecular Testing For Chronic Heart Failure and Heart Transplant
- Myocardial Sympathetic Innervation Imaging in Patients With Heart Failure
- Oncology Medications
- Orthognathic Surgery
- Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers
- Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers
- Polysomnography for Non-Respiratory Sleep Disorders
- Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia
- Progesterone Therapy as a Technique to Reduce Preterm Delivery in High-Risk Pregnancies
- Radiofrequency Ablation (RFA) of Solid Tumors, Excluding Liver
- Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant or Uncontrolled Hypertension
- Reconstructive Breast Surgery
- Refractive and Therapeutic Keratoplasty
- Reslizumab
- Risk Stratification Tests for Determining Arrhythmias (Signal-Averaged Electrocardiography [SAECG] and Microvolt T-Wave Alternans [MTWA])
- Sacroiliac Joint Fixation/Fusion
- Services for Infertility and Recurrent Fetal Loss
- Sleep Related Breathing Disorders: Surgical Management
- Specialty Medication Administration Site of Care
- Staphylococcal Vaccines
- Surgery for Lipedema and Lymphedema
- Tocilizumab
- Transcatheter Arterial Chemoembolization (TACE) of the Liver
- Ustekinumab
- Vertebral Axial Decompression
- Viscocanalostomy and Canaloplasty
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