Clinical Policies
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-
A
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B
- Bariatric Surgery
- Behavioral Health Crisis Care
- Blood Pressure Devices
- Breast Reduction and Removal of Breast Implants
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C
- Chiropractic Services
- Chronic Pain Management
- Cochlear Implants
- Continuous Positive Airway Pressure
- Crisis stabilization for adults
- Crisis stabilization for youth
- ccp4019-non-covered-benefits.pdf
- ccp4022-orthopedic-shoes-corrections.pdf
- ccp4042-hospital-services-prior-authorization.pdf
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D
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E
- Early and Periodic Screening, Diagnostic and Treatment - Personal care services
- Electrical muscle stimulation
- Enteral Nutrition
- External Insulin Pumps
-
G
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H
- Home Health Services
- Hospice Prior Authorization
- Hyperbaric Oxygen Therapy
- Hypoglossal nerve stimulation
- Hysterectomy
-
I
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L
- Level 3.7 medically monitored high intensity inpatient treatment – adolescent
- Lung transplants
- Lynch Syndrome Testing
-
M
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N
- Non-Invasive Prenatal Testing
- Non-spinal non-invasive ultrasonic stimulators
- Nonpharmacologic treatments for chronic vertigo
-
O
- Opioid Treatment
- Oral nutritional supplements
- Orthotic Devices
- Outpatient Therapy by Licensed Practitioners
- Oxygen Concentrators
-
P
- Pancreas transplantation
- Patient lifts
- Pediatric Day Health Care
- Peer Support Services
- Personal care services
- Phototherapy and photochemotherapy for skin conditions
- Plastic reconstructive surgery
- Prostatic urethral lift/UroLift for benign prostatic hypertrophy
- Prosthetic Devices
- Psychiatric residential treatment facilities
- Psychosocial rehabilitation services for children, adolescents, and adults
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R
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S
- Sacral nerve modulation/stimulation
- Site of Care Medical Pharmacy
- Speech therapy
- Spinal Non-invasive Electrical Stimulators
- Standing Frame
- Support Hose
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T
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V
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W
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