Review ConnectiCare's policies on various medical treatments and emerging medical technologies.
For other Medical Policies, see:
- CMS Local and National Coverage Determinations
- EmblemHealth’s Medical Policies
- Enterprise Pharmacy Medical Policies
- Genetic Testing
- Dental Policies
- MCG*
- New Century Health – Medical Oncology Policies
- NIA Magellan – Advanced Imaging, Cardiac, and Musculoskeletal Surgery
- Optum Behavioral Health
- Services That Require Preauthorization
*See instructions for finding specific MCG guidelines shared in determination letters
| Policy Name | Download (PDF) |
|---|---|
| Abdominoplasty-Panniculectomy | Download (PDF) |
| Autologous Chondrocyte Implantation | Download (PDF) |
| Automatic External Defibrillators | Download (PDF) |
| Balloon Sinuplasty | Download (PDF) |
| Bariatric Surgery | Download (PDF) |
| Biomagnetic Therapy | Download (PDF) |
| Blepharoplasty | Download (PDF) |
| Breast Implants and Reconstruction | Download (PDF) |
| Cardiac Event Monitoring | Download (PDF) |
| Chemical Peels | Download (PDF) |
| Clinical Trial | Download (PDF) |
| Cochlear and Other Auditory Implants | Download (PDF) |
| Continuous Passive Motion Devices | Download (PDF) |
| Cortical Stimulation for Epilepsy (NeuroPace®) | Download (PDF) |
| Cosmetic and Reconstructive Surgery Procedures | Download (PDF) |
| Dermabrasion | Download (PDF) |
| Experimental Investigational or Unproved Services Policy | Download (PDF) |
| Fecal Incontinence Treatment | Download (PDF) |
| Fetal Surgery | Download (PDF) |
| Gastric Electrical Stimulation | Download (PDF) |
| Gender Affirming Surgery | Download (PDF) |
| Glaucoma Surgery | Download (PDF) |
| High Frequency Chest Wall Oscillation Devices and Intrapulmonary Percussive Ventilators | Download (PDF) |
| Home Birth Midwifery Services | Download (PDF) |
| Home Care Services | Download (PDF) |
| Hyperbaric Oxygen Therapy | Download (PDF) |
| Implantable Cardioverter Defibrillators | Download (PDF) |
| Infertility | Download (PDF) |
| Insulin Delivery Devices and Continuous Glucose Monitoring Systems | Download (PDF) |
| Lyme Disease Intravenous Treatment | Download (PDF) |
| Mechanical Stretching Devices | Download (PDF) |
| Neuropsychological Testing | Download (PDF) |
| Non-Emergent Ambulance Services | Download (PDF) |
| Obstructive Sleep Apnea Diagnosis and Treatment | Download (PDF) |
| Ocular Photoscreening Policy | Download (PDF) |
Omnibus Policy
|
Download (PDF) |
| Oral Surgery | Download (PDF) |
| Orthognathic Surgery | Download (PDF) |
| Osteochondral Grafting |
Download (PDF) |
| Otoacoustic Emissions Testing Policy | Download (PDF) |
| Penile Implants | Download (PDF) |
| Peripheral Nerve Block | Download (PDF) |
| Phototherapy Photochemotherapy Photodynamic Therapy | Download (PDF) |
| Posterior Tibial Nerve Stimulation for Voiding Dysfunction | Download (PDF) |
| Pulsed Dye Laser Therapy for Cutaneous Vascular Lesions | Download (PDF) |
| Radiofrequency Ablation for Spinal Pain | Download (PDF) |
| Radiofrequency Ablation for Tumors | Download (PDF) |
| Reduction Mammoplasty | Download (PDF) |
| Rhinoplasty | Download (PDF) |
| Septoplasty | Download (PDF) |
| Surgical Correction Chest Wall Deformities | Download (PDF) |
| Transcatheter Aortic Valve Replacement | Download (PDF) |
| Vacuum-Assisted Wound Closure | Download (PDF) |
| Varicose Vein Treatment | Download (PDF) |
| Vertical Expandable Prosthetic Titanium Rib (VEPTR) | Download (PDF) |
