Medical Protocol Introduction


Our Corporate Medical Protocols provide a concise overview of the criteria used for clinical determinations for a member’s coverage.

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Medical Protocols


A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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Cardiac Rehabilitation in the Outpatient Setting
Protocol
Cardiovascular Risk Panels
Protocol
Carrier Testing for Genetic Diseases
Protocol
Catheter Ablation as Treatment for Atrial Fibrillation
Protocol
Catheter Ablation for Cardiac Arrhythmias
Protocol
Charged-Particle (Proton or Helium Ion) Radiation Therapy
Protocol
Chelation Therapy for Off-Label Uses
Protocol
Chromosomal Microarray Testing for the Evaluation of Early Pregnancy Loss and Intrauterine Fetal Demise
Protocol
Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
Protocol
Cochlear Implant
Protocol
Cognitive Rehabilitation
Protocol
Computed Tomography Perfusion Imaging of the Brain
Protocol
Computer-Aided Evaluation of Malignancy With Magnetic Resonance Imaging of the Breast
Protocol
Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Protocol
Confocal Laser Endomicroscopy
Protocol
Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
Continuous Passive Motion in the Home Setting
Protocol
Cooling Devices Used in the Outpatient Setting
Protocol
Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy
Protocol
Cosmetic vs. Reconstructive Surgery or Services
Protocol
Cryoablation of Prostate Cancer
Protocol
Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
Protocol
Cryosurgical Ablation of Primary or Metastatic Liver Tumors
Protocol
Cytochrome p450 Genotyping
Protocol
Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

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Gastric Electrical Stimulation
Protocol
Gender Reassignment Surgery
Protocol
Gene Expression Testing to Predict Coronary Artery Disease
Protocol
Gene Expression-Based Assays for Cancers of Unknown Primary
Protocol
General Approach to Evaluating the Utility of Genetic Panels
Protocol
General Approach to Genetic Testing
Protocol
Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
Protocol
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
Protocol
Genetic Testing for Alpha-1 Antitrypsin Deficiency
Protocol
Genetic Testing for Cardiac Ion Channelopathies
Protocol
Genetic Testing for Duchenne and Becker Muscular Dystrophy
Protocol
Genetic Testing for Familial Alzheimer Disease
Protocol
Genetic Testing for Familial Cutaneous Malignant Melanoma
Protocol
Genetic Testing for FMR1 Mutations (Including Fragile X Syndrome)
Protocol
Genetic Testing for Hereditary Breast and/or Ovarian Cancer Syndrome (BRCA1/BRCA2)
Genetic Testing for Hereditary Hearing Loss
Protocol
Genetic Testing for Hereditary Hemochromatosis
Protocol
Genetic Testing for Inherited Thrombophilia
Protocol
Genetic Testing for Lactase Insufficiency
Protocol
Genetic Testing for Li-Fraumeni Syndrome
Protocol
Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
Protocol
Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
Protocol
Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
Protocol
Genetic Testing for Mental Health Conditions
Protocol
Genetic Testing for PALB2 Mutations
Protocol
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
Protocol
Genetic Testing for PTEN Hamartoma Tumor Syndrome
Protocol
Genetic Testing for Rett Syndrome
Protocol
Genetic Testing for Statin-Induced Myopathy
Protocol
Genetic Testing for Tamoxifen Treatment
Protocol
Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
Protocol
Genetic Testing for Warfarin Dose
Protocol
Genetic Testing of CADASIL Syndrome
Protocol
Genetic Testing of Mitochondrial Disorders
Protocol
Genetic Testing, Including Chromosomal Microarray Analysis and Next-Generation Sequencing Panels, for the Evaluation of Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and/or Congenital Anomalies
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Genotyping for 9p21 Single Nucleotide Polymorphisms to Predict Risk of Cardiovascular Disease or Aneurysm
Protocol

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Heart Transplant
Protocol
Heart/Lung Transplant
Protocol
Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia
Protocol
Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia
Protocol
Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases
Protocol
Hematopoietic Stem Cell Transplantation for Breast Cancer
Protocol
Hematopoietic Stem-Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
Protocol
Hematopoietic Stem Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Protocol
Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia
Protocol
Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer
Protocol
Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma
Protocol
Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults
Protocol
Hematopoietic Stem Cell Transplantation for Non-Hodgkin Lymphomas
Protocol
Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
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Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis
Protocol
Hematopoietic Stem Cell Transplantation for Solid Tumors of Childhood
Protocol
Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia
Protocol
Hematopoietic Stem Cell Transplantation in the Treatment of Germ-Cell Tumors
Protocol
Hip Resurfacing
Protocol
Hippotherapy
Protocol
Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease
Protocol
Human Leukocyte Antigen Testing for Celiac Disease
Protocol
Hyperbaric Oxygen Therapy

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