Research And Markets: Study This Medical Review Criteria Guidelines For Managing Care, 4th Edition 2005 Now


The manual is actually designed for use as either any prospective utilization management reference, an educational tool, as well as with regard to retrospective claims payment review resource.

Research as well as Markets (http://www.researchandmarkets.com/reports/c12781) has announced adding medical Review Criteria Guidelines pertaining to Managing Care, 4th edition 2005 to their offering

- Allergy Screening along with Desensitization: Allergy referral, Allergy screening and also desensitization therapy; Serial Endpoint Allergy Testing; Immunotherapy pertaining to malignant disease; Leukocyte Histamine Launch Test (LHRT); Screening with regard to Hypersensitivity Reactions to foods along with Chemicals, Within Vitro Particle Dimension Measurement; Nasal Challenge Test; Rhinitis, allergic - referral criteria; Transfer factor.

Temporomandibular Joint Disorders (TMJ); Tinnitus Retraining Therapy; Tonsillectomy and/or adenoidectomy; Transcutaneous electrical stimulators with regard to severe tinnitus; Transtympanic Gentamicin Injection with regard to remedy associated with Meniere's disease; Tympanometry; Tympanostomy tubes; Ultrasonic Surgery for Meniere's; Uvulopalatopharyngoplasty (UPPP) and palatopharyngoplasty (PPP); Vestibular Perform Testing; Vestibular Rehabilitation; Vocal Cord Examination using Videostroboscopy; Vocal Cord Injections in order to Stop Recurrent Aspiration.

- Detection, Biopsy; Melanoma/Breast Cancer Staging; Scans for Infection and also Inflammation; SPECT scans; Thyroid studies; Tumor Scintigraphy (Gamma Camera).

Diagnostic radiology - general; Extremity x-rays; Knee trauma; Diagnostic Arteriography - Indications; Cervicocerebral angiography; Digital subtraction angiography (DSA); Infusion Venography; resources with regard to Angiography Indications; Abdominal along with Gastroenterological X-ray Procedures; Cholescintigraphy (HIDA); Cinedefecography; Herniography; Urological: Intravenous Pyelography (IVP); Cystography along with Urethrography; Voiding cystourethrography inside Children;

Prostate Cancer therapy; prostate Cancer Screening Assessments and Procedures; Prostate specific Antigen (PSA); Benign Prostatic Hypertrophy - treatment options; UroLume(R) endourethral prosthesis (urethral stent) with regard to BPH, stenosis, strictures; Cryosurgical ablation in the prostate; Microwave therapy pertaining to BPH; Transurethral Resection in the Prostate (TURP); Transurethral Microwave Thermotherapy (TUMT) for BPH; Transurethral Radiofrequency Thermotherapy/Needle Ablation of the Prostate (TUNA); Water-Induced Thermotherapy (WIT); Shock wave lithotripsy (Extracorporeal shock wave lithotripsy);

Immunotherapy to diminish the particular chance of spontaneous abortion; Infertility management: Coverage criteria for females, Coverage criteria regarding males, Infertility treatment, artificial insemination, Ova sticks - ovum transfer/uterine lavage - sperm donor/storage/washing; Intracytoplasmic sperm injection; In-Vitro Fertilization (IVF) as well as Gamete Intra-Fallopian Transfer (GIFT); Multifetal pregnancy reduction (MFPR); Recurrent Pregnancy Loss; Transcervical balloon tubuloplasty; Intra-uterine device (IUD) - removal, Laparoscopy - pelvic; Myomectomy; Nerve Ablation Methods with regard to Dysmenorrhea, Laparoscopic; Laparoscopic, Oophorectomy;

MRI along with CT scans - Computerized Tomography (CT) or perhaps Computerized Axial Tomography (CAT) - Overview; Computerized Tomography (CT as well as CAT) such as extracranial head, brain along with thoracic scans; High-resolution CT (HRCT) pertaining to Pulmonary Studies; CT pertaining to appendicitis; Spiral CT Scans for Lung Cancer Screening; Helical CT pertaining to Pulmonary Embolism Detection; Computerized Axial Tomography (CT) Scans: Pelvis, Abdomen, Abdomen as well as Pelvis - on the exact same day; Electron-beam CT screening regarding coronary artery disease; Ultrasound regarding peripheral websites (tibia, phalanges) for your selection of patients regarding pharmacologic remedy of osteoporosis;

- Pharmacy: Pharmacy benefits; State involving California Knox-Keene act requirements;



Canadian drugs; Formulary; MAC pricing; Generic substitution; Alpha 1-antitrypsin inhibitor therapy; Anticoagulant Therapy - Monitoring; Biologicals; Hepatitis vaccines; Growth hormone replacement (adults and also children); Botulinum toxin; Calcitriol; Cancer chemotherapy; Erythropoeitin Therapy; Experimental Drug Therapy; Chelation therapy; Diabetes management therapy/supplies; Diabetic foot ulcers - Regranex gel therapy;

- Ophthalmology: A-scans, B-scans; Blepharoplasty, ptosis correction along with eyelid reconstruction; Capsulotomy; YAG laser; Cataract surgery; Preoperative Evaluation as well as Screening regarding Cataract Extraction; Computer-assisted corneal topography; Conjunctivitis; Conjunctivodacryocystorhinostomy; Balloon Dacryocystoplasty/Dacryoplasty with regard to Nasolacrimal Duct Obstruction; contact Lenses; Corneal graft utilizing amniotic membrane transplantation (AMT); Corneal pachymetry; Corneal post-transplant wound revisions; Corneal wedge resection;

Transendoscopic gastroplasty; Stretta along with EndoCinch Procedures; Fecal Occult Blood test, screening - positive; Fiberoptic endoscopy for your evaluation regarding swallowing; Gastric freezing for your remedy regarding active peptic ulcers; Gastrostomy/PEG tubes; Capsule Imaging Endoscopy/Wireless - Medicare LMRP; Injection Sclerotherapy regarding bleeding esophageal varices; Gastric Pacing; Liver Biopsy; Liver assist or even support devices; Motility Disorders: Upper GI - Diagnosis/Evaluation; Transesophageal Endoscopic Treatments with regard to Gastroesophageal Reflux (GERD); Transjugular Intrahepatic Portosystemic Shunt; Transplantation; Urea breath screening for H. Modification associated to end up being able to nearby clinical circumstances or even regards to applicable certificates of coverage as well as provider contracts could be suitable along with necessary.

- Pediatric: Pediatric authorization guidelines regarding Lengths of stay; Apnea monitor; Circumcision in the newborn male; Cord blood testing; Cystic fibrosis screening throughout newborns; Diabetes mellitus - Assessment involving Require pertaining to Hospitalization for that Stabilization of Freshly Diagnosed children using Diabetes; Diabetes Management Utilizing 'Hepatic Activation' or perhaps 'PIVIT' Therapy; Comprehensive pediatric case management services; Early Intervention Programs; Extracorporeal membrane oxygenation (ECMO); Hearing Screening, Newborn; Immunizations, Lead screening - blood - children; Newborn LOS - when infant healthy, Mother requires continued hospital care; Phototherapy; Physician Attendance from Delivery for Evaluation and Management associated with Newborn; Port Wine Stains.

- ENT, Oral Surgery along with Dental Services: Acoustic neuroma; Audiological Testing; Aural Rehabilitation Therapy; Mind stem auditory evoked response (BER, BAER); Carbogen Inhalation Therapy for that Treatment Method involving Sudden Hearing Loss; Cleft lip/Cleft Palate Repairs; Cochlear Implantation; CPAP pertaining to obstructive sleep apnea; Noninvasive Positive Pressure/Bi- PAP; Dental services; Dental hospitalization; Damage for you to Audio and All-natural Teeth; Intra-oral appliances for that management of migraine headache syndromes; Dynamic Posturography;

monitoring; Ambulatory electrocardiography (Holter monitor); Brachytherapy, Coronary; Cardiology consultation or referral; Chest pain - admission criteria, Cardiac catheterization, correct heart; Central venous pressure monitoring, Cardiac Catheterization, proper heart, Central venous pressure monitoring; Cardiac Catheterization, left heart; Coronary Arteriography; Angiography and also Ventriculography; Cardiac Event Monitors; Implanted Loop Recorders; Catheter ablation pertaining to atrial fibrillation with HF; Cardiac Output Monitoring by simply Electrical Bioimpedance ;

Shoulder: Shoulder Arthrography; Arthroscopy, shoulder; Electrothermal arthroscopic repair regarding shoulder instability; Impingement Syndromes, Shoulder Bursitis, Rotator Cuff Tendinitis & Tears; Ultrasound therapy with regard to calcific tendinitis in the shoulder;

Impotence evaluation along with treatments: Viagra; Noninvasive suction devices; Papaverine injections; Penile prosthesis implantation; Electroejaculation; Internal Pudendal Arteriography (Angiography) regarding Erectile Dysfunction; Percutaneous Nephrostomy;

- Educational materials: General educational materials, Affected Person Education And Learning materials Policy - Development, Approval and also Review, Institutional as well as House care patient Training Programs; medical 'Self Care' Educational Programs; education courses pertaining to OB patients; The Actual 'Not Now!' Program; Institutional and House care Individual Education And Learning Programs; Medicare Coverage regarding Diabetes Self-management Training.

Stimulators: Chronic pain, Angina pectoris; treatment of Motor function Disorders using Electric Nerve Stimulation; Neuromuscular electrical stimulation (NMES) for disuse atrophy; Neuromuscular or Therapeutic Electrical Stimulation (TES); Transcutaneous electrical nerve stimulation (TENS); 'Sympathetic Therapy'; Inferential present stimulation; Non-implantable Pelvic Ground Electrical Stimulator; Percutaneous electrical nerve stimulation (PENS); ReliefBand; Implanted Peripheral Electrical Nerve Stimulation; Pulsed electrical stimulation pertaining to osteoarthritis in the knee; Electrical Stimulation for the Remedy associated with Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations; Surface electrical muscle stimulation; Bone stimulators: electrical and low-intensity ultrasound; Electrogalvanic Stimulators regarding Levator Syndrome; H-wave stimulation for your therapy of diabetic neuropathy;

- Pulmonary: Pulmonary function tests; Quantitative pilocarpine iontophoresis sweat test; Duration IV antibiotics regarding pneumonia; Electrophrenic Pacemaker; Fiberoptic bronchoscopy; Lung volume reduction surgery; Sleep apnea studies/Polysomnography; Sleep apnea studies, portable; BiPap; Phrenic nerve pacing/Diaphragm pacing; Positive Expiratory pressure (PEP) regarding Cystic Fibrosis Therapy; Noninvasive Positive-Pressure Ventilation (NPPV) with regard to COPD; Postural Drainage Methods and also Pulmonary Exercises; Pulmonary Rehabilitation; Outpatient Pulmonary Rehabilitation (PR); COPD guideline sources along with links; 'Virtual' Lung Scans.

- Radiation Therapy/Oncology: Radiation oncology; combination Chemotherapy and also Radiation Therapy; Brachytherapy; Brachytherapy for that Prevention of Restenosis inside Peripheral Arteries Next PTA of the Femoropopliteal System; Intracoronary Brachytherapy; Breast Conservation Therapy inside the Management involving Invasive Breast Cancer; Neutron Beam Radiotherapy; Proton Beam Radiotherapy; Stereotactic radiosurgery; Transperineal Brachytherapy regarding prostate cancer; Boron Neutron Capture Therapy (BNCT) for Glioblastoma Multiforme; Intensity Modulated Radiation Therapy; Radiation Therapy web sites.

MRI Scientific studies - Overview; 'Standing' along with 'Sitting' MRI Scans; MRI Brain; MRI Orbit, Face, as well as Neck; MRI Spine; MRI/MRA - Cardiovascular studies; MRI Abdomen as well as Pelvis; Tumor staging; Table citing optimal imaging studies by region; CT Angiogram; MRI along with CT-guided biopsies; Magnetic Resonance Angiography (MRA) which includes Venography; Magnetic resonance spectroscopy/Nuclear magnetic resonance; Magnetic Supply Imaging (MSI)/Magnetoencephalography (MEG);

Other Skeletal-muscular: Extracorporeal Shock Wave Therapy (ESWT) regarding musculo-skeletal conditions; Apligraft (R) (Graftskin) Medicare LMRP; Carpal tunnel release; Trigger Point Injections; Total Hip Replacement (THR) - Primary, excluding hip fracture, indications, LOS; Bone stimulators, electrical and low-intensity ultrasound; Gait analysis or possibly the electrodynogram; Injection, tendon sheath, ligament, or perhaps trigger factors or even ganglion cyst; Injection involving joints; Osteogenic protein-1 for the treatment involving nonunion fractures;

Orthotic/prosthetic devices; Breast prosthesis, specialized bras for women post-mastectomy; Corset used as Hernia Support; Dynamic Splinting Devices; Foot orthotics/therapeutic shoes; Magnetic insoles with regard to plantar heel pain; Myoelectric prosthesis, upper extremity;

- Blood Bank: Autologous Blood-Derived Goods for Chronic Non-Healing Wounds; Blood transfusions; autologous, allogeneic, donor directed; Cord blood storage; Granulocyte and Platelet Transfusions; Plasmapheresis, plasma exchange, apheresis and related procedures; Lipid apheresis; Nonselective (random) transfusions along with living-related donor specific transfusions inside kidney transplantation; Therapeutic Phlebotomy

Gonadotropin-releasing hormone therapy; HIV Drug susceptibility and resistance testing; Hyaluronidase, intra-articular injections; Intravenous immunoglobulins (IVIG); IVIG to always be able to stop RSV; Cytomegalovirus Immune Globulin Intravenous, Human (CMV-IVIG); Interferon therapy; Intrathecal Baclofen for spasticity; Intravenous Histamine Therapy; Iontophoresis - software within transdermal medication delivery;

- Radiology Advantage Management: Internet helpful details on radiology, nuclear medicine and also radiation therapy provider manuals.

- Skeletal-muscular system: Knee region: Arthroscopy - knee; Arthroscopic lavage or even debridement, knee; Total Knee Replacement; Autologous chondrocyte transplantation surgery in the knee; Hyaluronidase, intra-articular injections for osteoarthritis;

- Neurology/Neurosurgical: Autism and Some Other Pervasive Developmental Disorders; Sensory Stimulation for Coma; Facial Nerve Paralysis (Bell's Palsy) - Electrotherapy; Electroencephalogram (EEG) - standard, ambulatory, sleep-deprived, surgical, video; Electrocorticography (ECoG); brain mapping as well as Quantitive EEG for the diagnosis associated with psychiatric disorders; Electromyelogram (EMG)/Nerve Conduction Velocity (NCV); Spinal Cord Injury Neuropsychological testing (NPT); Stroke along along with other CNS Disorders; Somatosensory Evoked Responses, Vision Evoked response test (VER), Deep Mind electrical Stimulation with regard to intractable tremors; Vision Evoked Reaction test (VER); Multiple Sclerosis (MS) - Therapy, Web Sites; Multiple Sleep Latency Test (MSLT); Neuropsychological Screening (NPT);

Pediculosis ('lice'); Photochemotherapy for that treatment method of scleroderma, extracorporeal; Pityriasis rosea; Psoriasis; PUVA Therapy; Rosacea; Scabies; Sclerotherapy regarding varicose veins, Seborrheic dermatitis/'Dandruff'; Seborrheic keratosis; Squamous cell carcinoma; Tattoos; Verruca Vulgaris/ Warts; Vitiligo; Ultraviolet Any light Therapy; Ultraviolet B light Therapy.

Intrahepatic Chemotherapy with regard to Liver metastasis - Chemoembolization; Isolated limb perfusion (ILP); Mitoxantrone hydrochloride (Novantrone (R)); Monoclonal Antibody (Mab) Imaging or even Radioimmunoscintigraphy - colorectal cancer staging; Photodynamic Therapy; Radiofrequency tumor ablation; Therapeutic phlebotomy; Vaccines for you to treat various cancers; Cancer-related web sites; Photodynamic Therapy; Vaccines to treat various cancers; Vitamin B12 Injections.

Incontinence - defined; Synthetic Urinary Sphincter; Strain incontinence - Electrical stimulation of the pelvic floor; Sacral nerve stimulation regarding urge incontinence; Transurethral/Periurethral collagen implantation regarding tension urinary incontinence; Marshall-Marchetti Kranz, Burch, Stamey and comparable procedures; References - Urinary Incontinence; Transrectal ultrasound regarding prostate cancer - biopsy/staging; Renal Cryoablation; Transrectal ultrasound pertaining to prostate cancer; Transsexual surgery; Urethral Dilation - female; Urodynamic Testing;

Breast imaging studies: Diaphanography in the breast; Mammography, screening or perhaps diagnostic/Digital/CAD mammography; Magnetic Resonance Imaging of the Breast: Differential Diagnosis; Breast Ultrasound as well as Echography; Stereotactic Breast Biopsy;

- Radiology: Documentation requirements; Imaging guidance during surgical procedures; Bone Mass Measurement/Bone mineral density (BMD) testing; Skeletal surveys throughout children; Cardiac scans for CAD; Cerebral angiography; Chest x-rays, routine; contrast media; Spine - diagnostic radiology in adults and children; Imaging studies in acute low back again pain; Myelography as well as Cisternography; Discography; Scoliosis in youngsters - indications for radiography; Epidurogram/Epiduroscopy;

Oral surgery; Oral biopsy for malignancy; Orthodontia; Orthognathic surgery; Distraction osteogenesis with regard to craniofacial abnormalities; Otitis media, recurrent; Otoplasty; Positional vertigo; Rhinomanometry and also acoustic rhinometry/Nasal Operate Studies; Septoplasty; Septorhinoplasty; Sialorrhea (drooling) - Surgical Treatment; Sinusitis, acute; Sinus endoscopy, using or perhaps with out computer-augmentation; Smell as well as Taste - Evaluation coverage;

DUBLIN, Ireland--(BUSINESS WIRE)--Feb. These People needs to end up being able to be dispersed in order to relevant physicians as well as other providers with regard to review, input and then with regard to any necessary adjust prior to implementation. Most needs in order to be reviewed and approved with a Healthcare Policy Committee in the purchasing organization prior to use. pylori infection.

- Complementary as well as Alternative Medicine: Alternative medicine criteria; Acupuncture/Acupressure; Ayurvedic medicine; Biofeedback; Biofeedback pertaining to Urinary Incontinence; Magnetic as well as Bioelectromagnetic Therapy; Diet Plan and also Nutrition; Guided imagery; Homeopathy; Hypnotherapy; Manual/massage therapy; Naturopathy; Relaxation therapy; Transcendental meditation; Alternative medicine resources; references; web sites; useful resource organizations;.

- Nutritional: Nutrition Counseling/Educational Programs; Specialty foods, Liquid nutrition products; Ketogenic diet counseling regarding refractory seizure control; Reduced protein food products; Really low excess fat diets to become able to treat or prevent coronary heart disease; Supplemental Fasting Regimens; Enteral Nutrition/Tube feeding; Parenteral nutrition/Total Parenteral Nutrition (TPN); World wide web resources for meals along with nutrition;

Cardiovascular Nuclear Medicine studies; Congestive heart Failure - admission, discharge criteria guidelines; CT scans in order to screen with regard to coronary artery disease; Congestive heart Failure - Hospital admission criteria; Defibrillator devices, automatic implantable cardioverter; direct existing cardioversion, elective; Directional coronary atherectomy (DCA);

Non-contact Normothermic Wound Therapy (NNWT); 'Second Look' surgical procedures; Thyroidectomy; Post-op LOS by procedure, list; Inpatient Times Prior to a Surgical Procedure; Exactly Where ought to a higher-risk procedure be performed in a specific patient or even population involving patients?

- Nuclear Medicine: Bone scan; CEA scans; Cardiac Scans - Introduction/Overview, Medicare LMRP; Cardiac scans - thallium as well as gated pool scans; Cerebral Scintigraphy pertaining to Mind Death; Cholecystokinin Cholescintigraphy/Hepato-biliary scintigraphy; Gastrointestinal scintigraphy; Gated Pool Scan; Indium-III Oxine labeled white blood cells scan; Liver spleen scan; Monoclonal Antibody (Mab) Imaging/Radioimmunoscintigraphy which includes Scintimammography; Parathyroid scintigraphy;

- Disposable medical Supplies/Durable medical Equipment: Medicare Coverage Criteria regarding DME; Disposable Health-related Provides (DMS): Incontinence supplies; Urinary Drainage Systems; Porcine Skin and also Gradient pressure Dressings; Ostomy supplies; Unna boot;

- General Surgery: Clinical Guidelines regarding Office-based Surgery; Anal fissure, chronic; Appendectomy; Breast surgery - biopsy; Mastectomy; Cholecystectomy, open or perhaps laparoscopic; Colon resection - Colectomy, Debridement, Wound; Gastroesophageal Reflux Device Implantation, Gastroesophageal Reflux (GERD) Surgery; Hemorrhoidectomy - internal along with external, Hiatal Hernia repair, Incisional Hernia Repair, Inguinal Hernia Repair, Umbilical Hernia Repair, Incision as well as Drainage (I & D) Procedures; Laparoscopy as well as Peritoneoscopy;. The Actual manual is accompanied by the entire contents on a CD. referrals; Guidelines; 'Evaluate and Treat' orders and also authorization requests; medical Necessity - Exactly what can be it?; Case law citations related to healthcare necessity; AHRQ Prevention High Quality Indicators; Speed up the particular review procedure by ...; Hospital Inpatient Admission Criteria, general principles; 'Automatic' approval of authorization requests;

- Obstetrics/Gynecology: Ablation - cervical lesion; Abortion/pregnancy termination



Lifts - seat and also patient; light Emitting Diode (LED) or perhaps Infrared Therapy; Lymphedema 'Pump'/Manual lymph drainage; Magnetic Pelvic floor Stimulation (MPFS); Nebulizers; Wound Care; Negative pressure wound therapy (NPWT) Pumps; Radiant Heat Wound Therapy Systems; Neuromuscular electrical stimulation (NMES);

- Plastic Surgery: Abdominoplasty/Panniculectomy Breast surgery - Implant removal and/or replacement; Gynecomastia reconstruction within the male patient; Augmentation mammoplasty; Reduction mammoplasty or even breast reduction surgery; Liposuction: Lipectomy, Suction-assisted; Beauty surgery; Chemical exfoliation or even peel; cosmetic laser surgery; Cutaneous Ulcer, Chronic - Electrical Stimulation; Ear lobe deformities; Head Of Hair transplantation; Mentoplasty (Chin Augmentation, Genioplasty); Plastic Surgery for you to correct "Moon Face"; Porcine Skin along with Gradient Strain Dressings; Reconstructive surgery - general criteria; Scar revisions; Skin redundancy subsequent enormous excess weight loss.

Laser with regard to actinic lesions; Malignant melanoma; Mohs Micrographic Surgery;

- Cardiology: Acoustic heart Scans/Recordings; Ambulatory blood pressure

Durable Healthcare Equipment (DME): Definitions; Strain Lowering Assistance Surfaces, groups 1, 2, and 3; Air Fluidized Beds; Bathroom as well as Toilet Equipment along with Supplies; Beds as well as Mattress Accessories/Trapeze Bars; Mattress and also Pillow covers pertaining to Asthmatics; Bed-wetting Alarm; Breast Pumps; Catheters, urinary; --Cervical traction; Chairs, therapeutic; Communication devices/aides; Compression Garments inside the Remedy associated with Venous Stasis Ulcers; Steady Passive Motion device; Cranial Remodeling Band/Helmet for infants; Dorsal Column Stimulators - with regard to chronic intractable pain control; Diabetes mellitus-related DME - Glucose monitors, blood; GlucoWatch(R) Biographer - automatic glucose values without having a new needle-stick; Jet Injectors with regard to insulin administration; Insulin pens; Sleep sentry to be able to detect hypoglycemia; Steady Glucose Monitoring;

Positron Emission Tomography (PET scans); Pulmonary Scintigraphy; Prostate cancer staging scan; Renal Scintigraphy; Scrotal scintigraphy; Sentinel Lymph Node

- Urology - review criteria: Referral guidelines; BCG therapy with regard to bladder cancer; Urinary FISH Test regarding Recurrent Bladder Cancer; Valrubicin for carcinoma in-situ with the bladder; Bladder stimulator/Pacemaker implantation; Bladder pacemakers; Bladder Capacity Ultrasound (Post-void Residual Measurements); Circumcision with the adult male; Cystoscopy; Bladder biopsy, transurethral;

Morbid Obesity/Bariatric Surgery; Variety regarding surgery according to comorbid diabetes and also hypertension furthermore to BMI;

Low molecular excess weight heparin; Lyme disease vaccine; Meningococcal vaccine; Mifepristone (Mifeprex(TM), RU 486); Nicotine patch, gum or nasal apply therapy regarding smoking cessation; Off-label drug therapy; Oral contraceptives; Phonophoresis; Prior authorization record w/indications; Platelet-derived Growth Aspect regarding Wound Healing (Regranex, Procuren); Prophylactic antibiotics; Prostacyclin infusion therapy; Sexual perform therapy; Smallpox Vaccination; Topical steroids; Transfer Factor; Tumor Necrosis factor Inhibitors - Ankylosing Spondylitis, Ulcerative Colitis, Psoriasis; Injectable drugs; Pharmacy web sites.

Hyperbaric Oxygen Therapy; Immunizations; Injectable Medications; Laser procedures; Miscellaneous Solutions - Medicare Time Frame with regard to Payment Denial; Multiple Chemical Sensitivity Syndrome or even Idiopathic Environmental Intolerances (IEI); Organ along with Tissue Transplantation - bone marrow, intestinal, solid organs; Outmoded exams along with procedures; Pain rehabilitation programs; Outpatient Hospital Pain Rehabilitation Programs; Physician's Workplace inside an Institution--Coverage associated with services and supplies Incident to some Physician's Services; 'Second opinions'; Sleep disorders- testing; Transportation, medical/Ambulance transports;

Environmental Manage Systems; Vaporizers; Workout Equipment; Hearing aids; Bone-anchored Hearing Aid; Hospital beds, Infusion pumps, external or perhaps implantable; Intrapulmonary Percussive Ventilator (IPV); Jobst Burn Up Garments;

Papanicolaou tests/'Pap smears' together with HPV DNA testing with regard to Cervical Cancer; Perineorrhaphy, Preimplantation Genetic Diagnosis; Pregnancy; Recurrent pregnancy loss; Presacral neurectomy (PSN) for that therapy of chronic pelvic pain; Salivary estriol test with regard to preterm labor, Salpingectomy/salpingostomy, VABRA aspirator; Ultrasonography within pregnancy, Ultrasonongraphy screen pertaining to Down Syndrome, Uterine Exercise Monitoring (UAM), Uterine Fibroid (Leiomyomata) Therapy; Uterine artery embolization for your treatment regarding fibroids; VABRA aspirator; Zinc blood amounts within pregnancy.

Back along with Neck: Acute cervical pain; Synthetic Intervertebral Disc; Laminectomy ; Reduced back again pain; Machines to test and also treat lower back again pain; Chymopapain Chemonucleolysis; Endoscopic Anterior Spinal Surgery; Epidural injection regarding steroids for back again pain; Facet Joint Injections; Facet Denervation, Facet Neurotomy, Facet Rhizotomy, or perhaps Articular Rhizolysis; Hypertonic saline for your treatment method of epidural adhesions, adhesive arachnoiditis, or perhaps failed back syndrome; Implantable Infusion Pumps regarding treatment involving Chronic Severe Back Again Pain; Intradiscal Electrothermal Therapy (IDET); Laminectomy; Meniscectomy; Microdiscectomy; Percutaneous Lumbar Discectomy, which includes laser procedures; Percutaneous vertebroplasty and kyphoplasty; Prolotherapy; Spinal instability - Pedicle screw fixation; Spinal stenosis; Sacro-iliac Joint Injections; Chiropractic Medicine; Distraction osteosynthesis, Ilizarov method; Spinal manipulation under anesthesia;

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Cognitive Rehabilitation Therapy; Constraint-induced movement therapy (CIMT); Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy; Hypothermia next acute brain injury; Induced Lesions of Nerve Tracts; Intra-operative Electromyographic Monitoring regarding Cranial Nerves; Invasive Intracranial Strain Monitoring; Ulnar Nerve Transposition, Decompression or Release; Monitoring; Ulnar Nerve Transposition, Decompression or Release; Vagus Nerve Stimulation for that remedy regarding refractory seizures; Vagus Nerve Stimulation for that therapy regarding depression; Videopupillography/Tropicamide Drop Test for your Diagnosis involving Alzheimer's Disease; Perception Threshold/Sensory Nerve Conduction Threshold (SNCT);

Electrical Stimulation DME include: Dorsal Column Stimulators/Spinal Cord

- References and also Resources: situated throughout the actual manual - conveniently following each and also every criteria or perhaps topic.

- multiple gestation reduction; Amniocentesis; Cervical cerclage; Cervicography (cervigram); Cesarean section - elective; Chorionic villus sampling; Colposcopy direct access for OB/GYN services, Dilation as well as Curettage (D & C), D & C additionally hysteroscopy, D & C, Hysteroscopy additionally pelvic laparoscopy - exact same day; Loved Ones Planning Solutions - birth control devices as well as genetic counseling, Norplant, Oral contraceptives - sterilization - tubal ligation/vasectomy, Sterilization - Tubal ligation or vasectomy, OTC products; Fetal fibronectin screening for preterm labor and delivery risk; Genetic Counseling and Testing; House births; Hysterectomy; Outpatient hysterectomy; Hysteroscopy/Hysterosonography;

Transrectal ultrasound regarding prostate as well as rectal cancer - biopsy/staging; Pelvic Ultrasound in Females; Sonohysterosalpingraphy; Obstetrical Ultrasonography; Scrotal Ultrasonography; Retroperitoneal Ultrasonography; Developmental Hip Dysplasia Detection by Ultrasonography; Ultrasound associated with peripheral sites (tibia, phalanges) for your selection of patients with regard to pharmacologic therapy associated with osteoporosis; Radiology guideline resources/web links.

Age-related Macular Degeneration (AMD); Macular degeneration: Laser Therapy; Radiation Treatment; Macular Fovea Translocation regarding AMD; Ocular Photodynamic Therapy (OPT) - Visudyne (Verteporfin) Therapy pertaining to Age-related Macular Degeneration; Opthalmoscopy, extended along with retinal drawing Orbitotomy; Photocoagulation; Pterygium; Ptosis; Punctal dilation/snipping; Punctal Plugs and Punctoplasty for 'Dry Eyes' Syndrome; Corneal remodeling processes - Refractive Keratoplasty/Radial Keratotomy/Phototherapeutic Keratectomy; Refractive Keratoplasty/Radial keratotomy; Prosthesis, eye; Eye Examinations - Medicare; Routine vision exam; Scleral buckle; Strabismus correction; Tarsorrhaphy; Transpupillary Thermal Therapy; Viscocanalostomy; Visual field Testing; Visual coaching (Orthoptics); Visual Rehabilitation Program; Vitrectomy; Referral criteria summary sheet/grid for widespread complaints.



Electroencephalographic biofeedback regarding intractable seizures; Epiduroscopy; Fetal Tissue Transplantation for the treatment involving Parkinson's disease; Pallidotomy for the hot tranny cams treatment method of Parkinson's disease; Fetal Tissue Transplantation for the treatment regarding Parkinson's disease; Surgical evaluation pertaining to intractable seizure disorders - Grid monitoring; Deep brain electrical Stimulation pertaining to intractable tremors; Mind mapping (quantitative tranny cams EEG) regarding diagnosis involving psychiatric disorders;

Foot along with ankle: Bunionectomy; Foot treatment - routine; Mycotic nails; other covered services for the foot and also ankle; Ingrown toe nails; Olecranon bursa aspiration; Plantar Keratosis; Interdigital Neuroma; Plantar fasciitis as well as heel spurs; Consultation solutions with a podiatrist - skilled nursing facility; Hammertoe surgery; Fractures of the toe; Maxwell-Brancheau Arthroereisis (MBA) Implant - for flat-foot;

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- Emergency healthcare services: Emergency services/authorization system, Emergency room authorization/claims processing matrix, Emergency treatment criteria; Relationship regarding ER admissions to insurance status; Ambulance along together with other medical transportation;

- Hematology/Medical Oncology: Hem-Onc Authorization Guideline Notes; Adjuvant Chemotherapy; Adoptive immunotherapy (AIT); Bone marrow/Stem cell transplant (BMT); Umbilical cord blood compatibility testing; Chemoresistance assays/Tumor chemosensitivity; Chemotherapy vs Endocrine Therapy regarding Metastatic Breast Cancer; Cryosurgical ablation hepatic lesions; Dendritic cell immunotherapy regarding cancer; Donor Lymphocyte Infusions; Epithelial Cell Cytology within Cancer In The Breast risk Assessment and High-Risk Individual Management; Extracorporeal Immunoadsorption; Extracorporeal Photopheresis; Hematopoietic colony-stimulating factor/Granulocyte-macrophage colony-simulating factor; Hyperalimentation pertaining to patients receiving chemotherapy; Hyperthermia; Hypothermia (regional scalp cooling) - chemotherapy-associated curly hair loss;



Selective peripheral denervation (Bertrand procedure) with regard to spastic torticollis; Spinal tap, diagnostic, Stereotactic Cingulotomy, regarding severe along with intractable pain thanks to become able to terminal cancer; Sympathetic therapy pertaining to chronic pain management; Sympathetic therapy for chronic pain management; Sympathectomy, Thoracoscopic; Thalamic Electrical Stimulation, for that therapy of intractable tremors; Transcranial Doppler Ultrasonography; Transient Ischemic Attack (TIA) - Hospitalization Indications; Trigeminal Neuralgia, Cryosurgery;

Impedance plethysmography; Intermittent claudication; Intraoperative Ventricular Mapping; Left Ventricular Assist Devices; Maze Procedure regarding atrial fibrillation/flutter; Microsurgical lymphaticovenous anastomosis operation with regard to lymphedema; Pectus excavatum as well as Pectus carinatum - Surgical Correction; Photophoresis, extracorporeal - Therapy regarding Coronary Heart Transplant Rejection; Post-thoracotomy Pain - Intraoperative, Intercostal Nerves, Cryoanalgesia; Pulmonary vein isolation regarding atrial fibrillation; Renal Artery Stenosis - Angioplasty, Stent Placement; Transcoronary ablation regarding septal hypertrophy (TASH); Transjugular Intrahepatic Portosystemic Shunt; Transmyocardial laser revascularization; Varicose vein methods such as Endovenous Ablation Therapy; Ventricular Assist Devices; Ventricular Reduction/Remodeling as well as Partial Ventriculectomy; Vertebral artery surgery; Peripheral vascular rehabilitation programs.

- Laboratory: Medicare Coverage of Laboratory Testing; Diagnostic testing, indications, coverage (HIV, PSA, Thyroid examples); Tau, BA-42 and also Apolipoprotein E tests with regard to Alzheimer's disease; Substantial Sensitivity C-Reactive Protein (hsCRP); Anti-MAG as well as Anti-GM1 Antibody Exams with regard to Neurologic Disease; Cytogenetic studies; Human tumor cell assays (Fluorescent Cytoprint assay, extreme Drug Resistance assay); Genetic/Molecular Susceptibility Screening/Testing; Genetic screen with regard to thyroid carcinoma and also MEN; Genetic screen pertaining to breast as well as ovarian cancer (BRCA1, 2); Genetic testing regarding cystic fibrosis; Genetic testing for hereditary nonpolyposis colorectal cancer; Head Of Hair analysis; heavy metals as well as other minerals, test indications; Histocompatibility (HLA) testing; Iron/Ferritin Studies, Serum; Tumor markers; Lipid Profiles/Testing; Lyme Disease Testing; Laboratory References, general.

Carpal Tunnel Syndrome - conservative therapy; Carpal Tunnel Release; Cranial Electrical Stimulation; Embolization of intracranial aneurysms; Electromyelogram (EMG)/Nerve Conduction Velocity (NCV); Anal as well as Urethral Sphincter Electromyography; Sensory Evoked Potentials; Ketogenic diet plan for your power over intractable seizures in children; Peripheral neuropathy along with loss of protective sensation (LOPS); H-wave stimulation for the management associated with chronic diabetic peripheral neuropathy;

- Miscellaneous: Assisted Suicide; Autopsies; Cryoanalgesia as well as Cold Laser (low-energy) Therapy regarding wound healing, pain therapy, as well as other disorders; Complications subsequent Non-covered Solutions - Coverage; Hospital Costs pertaining to Noncovered Services; Death-related Services; Electrosleep Therapy; Experimental/Investigative Services; Histamine desensitization therapy for intractable headache; Hospital Admission Guidelines pertaining to Diabetic Adults;

- Cardiovascular/Peripheral Vascular Surgery: Alcohol Septal Ablation trannycams with regard to Hypertrophic Obstructive Cardiomyopathy; Aortic Aneurysm Repair - Criteria along with Options; Aortic and/or valve replacement; Atherectomy, peripheral; Atrial septal defect, repair; Carotid physique tumor resection (Glomectomy); Carotid endarterectomy - Indications, LOS; Carotid/Vertebral Artery Angioplasty along with Stenting Procedures; Coronary artery bypass graft(s) surgery (CABG) - Indications, LOS; Extracranial-Intracranial arterial bypass surgery; heart volume reduction surgery;

- Note: Review criteria guidelines or even 'benefit interps' are useful resources for claims payment decisions to end up being able to base healthcare necessity decisions, particularly when little or perhaps no preauthorization perform or perhaps info exists also as utilization management, educational and precertification tools. Wellness Plan; Darbepoetin Alfa (Aranesp); Intravenous Iron Therapy; Medicare ESRD Coverage - algorithm; Hemodialysis for that remedy involving hepatorenal syndrome; Hemodialysis for your therapy involving schizophrenia; L-carnitine supplementation; Nephrology web sites.

- Gastroenterology: Balloon Dilation involving Gastrointestinal Tract Strictures; Colonoscopy, Immediate & Virtual: screening, diagnostic; Dysphagia - Evaluation involving swallowing mechanism; Electrogastrography (EGG); Endoscopic Retrograde Cholangiopancreatography (ERCP); Magnetic resonance cholangiopancreatography (MRCP); Endoscopic Ultrasonography; Upper, Lower; Esophagogastroduodenoscopy (EGD); flexible sigmoidoscopy; Gastroesophageal reflux disease (GERD); Intestinal Rehabilitation Programs; Implanted Capsule pH Monitoring regarding GERD;

Echocardiograms, adult as well as pediatric; Doppler Echocardiography; Electrocardiograms; Electrophysiology screening (ET); Endocardial electrical recording along with stimulation (EES), diagnostic; Enhanced external counterpulsation (ECP) - remedy regarding severe angina; Exercise Treadmill Test (ETT), routine screening; Workout Treadmill Test (ETT) - routine, screening; ETT together with Thallium imaging; Pacemakers - permanent cardiac/Resynchronization Therapy; Pacemaker monitors; Pacemakers/External manually activated devices in order to terminate tachyarrhythmias; Percutaneous Transluminal Coronary Angioplasty (PTCA); Radiofrequency Catheter Ablation; Stents, coronary artery; Thoracic electrical bioimpedance; Thrombolysis with regard to acute myocardial infarction; Tilt Table Testing; T-Wave Alternans (TWA) testing; Cardiac Rehabilitation Programs; Phonocardiography along with Vectorcardiography; LOS benchmarks/targets pertaining to cardiology diagnoses; References re: AMI LOS; Screening regarding cardiac disease; Cardiology guideline resources, web links.

Neuroimaging Research with regard to Headaches; Metastatic bone disease - radiologic evaluation; Percutaneous Drainage/Aspiration associated with Abscesses and Fluid Collection; Percutaneous Permanent Inferior Vena Cava Placement; Percutaneous Transcatheter Embolization; Percutaneous Transluminal Angioplasty (PTA); Peripheral Vascular Disease Evaluation; Renal Artery Stenosis - Angiography and also Stent Placement; Spiral CT with regard to Lung Cancer Screening; Thermography;

- Dermatology: Dermatology referral management; Acne vulgaris; Actinic keratosis; Alopecia areata; Atopic dermatitis; Basal cell carcinoma; Biopsy/excision regarding benign skin as well as subcutaneous lesions, Cysts involving the skin and also subcutaneous structures; Decubitus Ulcers, treatment; Digital Epiluminescence Microscopy (DELM)/Total Entire Body Photography; Fungus infections, skin along with nails; Dermatophytosis; Grenz Ray Therapy; Herpes Simplex; Herpes Zoster; Impetigo and also pyoderma; Inflammatory dermatosis/'Rashes'; Head Of Hair Loss/Alopecia; Keloids;

- Addenda: Operational Standards; Delegation to always be able to PCPs; Delegation to SCPs; New Health-related technology Assessment - Policy/Procedure, Performance standards: QI/UM/Provider relations/Customer service; Critical Treatment - Medicare LMRP; Worker's Compensation; Hospital treatment 'length regarding stay' targets, through age group range; Frequency through Diagnostic/Procedural Group, Size of stay targets simply by DRG; NY State Medicaid ALOS by simply DRG 2004; Surgical Procedures, LOS benchmarks; Outpatient processes or 'Same-day discharge' authorization list;

- Vascular Laboratory: Noninvasive cerebrovascular studies of extracranial arteries; Carotid operate - non-invasive tests: Duplex scan regarding carotid arteries; vertebral arteries; Ocular Plethysmography (OPG) as well as Ophthalmodynamometry; Transcranial doppler, Penile doppler as well as Corpora Cavernosography, Peripheral arterial non-invasive studies: Segmental Doppler Pressures along with Pulse Volume Recording; Physical exercise (Stress) Doppler Test; Visceral arterial duplex imaging; Peripheral Arterial Duplex Scan; Digital Arterial Evaluation; Peripheral venous and arterial non-invasive studies/ultrasonography; Peripheral Arterial Ultrasound Examination Making Use Of Pulsed Doppler; AcuTect/Scintigraphic Imaging Regarding Detection/Localization regarding Lower Limb Deep Vein Thrombosis;-- Hemorheograph.

Endothelial cell photography; Entropion; Ectropion; Enucleation; External Ocular Photography; Glaucoma treatment; Optic Nerve Head Topography - Confocal Laser Scanning Tomography, Stereophotogrammetry; Argon Laser Trabeculoplasty; Aqueous drainage/shunt implants with regard to refractory primary open-angle glaucoma; Gold weight Upper Eye Lid Implants; Grave's Disease Ophthalmopathy; Indocyanine Green Angiography; Intraocular Lens Implant; Iridotomy/Iridectomy; Keratoconus; Keratoplasty; Keratoprosthesis as well as artificial Cornea;

Ultrasonography: Overview; Noninvasive cerebrovascular studies regarding extracranial arteries; Paranasal sinus ultrasonography; Spinal canal and contents ultrasonography; Peripheral Arterial Ultrasound Examination using Pulsed Doppler; Peripheral Venous Ultrasound Examination; Thyroid and also Parathyroid Ultrasonography;

Electronystagmogram (ENG); Ernest or perhaps Eagle's Syndrome/Stylomandibular Ligament Pain - Remedy along with Radiofrequency Thermoneurolysis; Frenulectomy; Hearing Tests,; Impacted teeth - extraction; Intra-operative Electromyographic Monitoring involving Cranial Nerves; Laser assisted Uvulopharyngoplasty (LAUP); Myringotomy with Tympanostomy Tubes/Laser Myringotomy; Meniett 20 for overpressure treatment method of Meniere's Disease;

Speech aids, electronic; Thairapy O vest pertaining to cystic fibrosis; Thairapy Bronchial Drainage System; Therabite Jaw Motion Rehabilitation System; Therapeutic Electrical Stimulation/TES; Transcutaneous Electrical Nerve Stimulation/TENS; Inferential existing stimulation; Non-Implantable Pelvic floor Electrical Stimulator; Implanted Peripheral Electrical Nerve Stimulation; Percutaneous Electrical Nerve Stimulation/PENS; Electrical Stimulation with regard to Chronic Musculo-cutaneous Ulceration; Respiratory Assist Devices; Standers, Boards and also Tables; Vitrectomy Deal With Support; Wheelchairs, Power-type along with Power-operated vehicles (POVs); Wigs; DME Screening Checklist - a grid listing 290 further DME/DMS review guidelines; Reuse information Notice.

Oxygen coverage guidelines; Peak expiratory flow meter; Pneumatic Compression Therapy - End-diastolic regarding non-healing extremity ulcers; Stress Decreasing support Surfaces, Team 1 and also 2; Computerized lower limb prostheses; Prothrombin Period House Screening Systems;

- Introduction: Introduction to referral authorization management guidelines and criteria; CMS national policies; Ranges of risk inside capitation; basic elements of a utilization management plan; Consultants vs. 10, 2005--949 pages contain more than 1,200 clinical 'benefit interps'/ review criteria clinical guidelines.

- Nephrology: Nephrology Consultation/Referral pertaining to ongoing care; Dialysis Therapy With Regard To Renal Failure; Laboratory exams with regard to CAPD; Arteriovenous fistulae with regard to dialysis; ESRD coverage by Medicare vs

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