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Behavioral Health Management

Our Behaviorial Health Management Department focuses on improving the quality of life for people suffering from mental health or substance abuse issues (MHSA) and is a key aspect of a person’s overall health and wellbeing. Learn More >>>

Mental Health Parity

The Mental Health Parity Act is effective October 3, 2009. Click here to learn more about the Act and how it affects you. Learn More >>>

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Oral Contraceptives May Help Treat Asthma

Treatment with oral contraceptives may benefit premenopausal women with asthma, even if their asthma symptoms are not strongly linked to their monthly menstrual cycles, early research suggests.

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Medical Policies

2.0

Medicine

2.01	Medicine Introduction
Medically Necessary and Investigational	For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here.
2.01.01	Diagnosis and Management of Idiopathic Environmental Intolerance (i.e., Clinical Ecology)
2.01.02	Dynamic Posturography
2.01.03	Gait Analysis
2.01.04	Hyperbaric Oxygen Pressurization (HBO2)
2.01.05	Local or Whole Body Hyperthermia
2.01.06	Hypnosis
2.01.07	Psoralens with Ultraviolet A (PUVA)
2.01.08	Rhinomanometry and Acoustic Rhinometry
2.01.09	Tilt Table
2.01.10	Topographic Brain Mapping
2.01.11	Total Body and Regional Hypothermia
2.01.12	Vitamin B12 Injection
2.01.13	Human Antihemophilic Factor (AHF)
2.01.16	Recombinant and Autologous Platelet-derived Growth Factors as a Primary Treatment of Wound Healing and Other Miscellaneous Conditions
2.01.17	Sublingual Immunotherapy as a Technique of Allergen Specific Therapy
2.01.18	Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
2.01.20	Esophageal pH Monitoring
2.01.21	Temporomandibular Joint Dysfunction
2.01.22	Plasma HIV-1 RNA Quantification for HIV-1 Infection
2.01.23	Serial Endpoint Testing for the Diagnosis and Treatment of Allergic Disorders
2.01.24	Sensory Stimulation for Coma Patients
2.01.26	Prolotherapy
2.01.27	Biofeedback as a Treatment of Urinary Incontinence in Adults
2.01.28	Neurofeedback
2.01.29	Biofeedback as a Treatment of Headache
2.01.30	Biofeedback as a Treatment of Chronic Pain
2.01.31	Intra-articular Hyaluronan Injections for Osteoarthritis of the Knee
2.01.33	Home Spirometry
2.01.34	Cutaneous Electrogastrography (EGG)
2.01.35	Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
2.01.36	Laser-Assisted Myringotomy and Tympanostomy
2.01.37	Canalith Repositioning as a Treatment of Benign Paroxysmal Positional Vertigo (BPPV)
2.01.38	Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
2.01.39	Quantitative Sensory Testing
2.01.40	Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
2.01.41	Noncontact Radiant Heat Bandage for the Treatment of Wounds
2.01.42	Dermatoscopy
2.01.43	Chronic Intermittent Intravenous Insulin Therapy (CIIIT)
2.01.44	Dermatologic Applications of Photodynamic Therapy
2.01.45	Epithelial Cell Cytology in Breast Cancer Risk Assessment and High-Risk Patient Management (Ductal Lavage and Suction Collection Systems)
2.01.46	Vacuum Therapy as a Treatment for Female Sexual Dysfunction
2.01.47	Targeted Phototherapy for Psoriasis
2.01.48	Inpatient Intestinal Rehabilitation Therapy
2.01.49	Water-Induced Thermotherapy as a Treatment of Benign Prostatic Hypertrophy
2.01.50	Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric Disorders
2.01.51	Fiberoptic Analysis of Colorectal Polyps
2.01.52	Pulsed Irrigation of Fecal Impaction
2.01.53	Biofeedback for Miscellaneous Indications
2.01.54	Percutaneous Transluminal Angioplasty of Intracranial Atherosclerotic Stenoses With or Without Stenting
2.01.55	Breast Duct Endoscopy
2.01.56	Low-Level Laser Therapy as a Treatment of Carpal Tunnel Syndrome
2.01.57	Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds
2.01.58	Transanal Radiofrequency Treatment of Fecal Incontinence
2.01.59	Ultrasonographic Evaluation of Skin Lesions
2.01.60	Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence
2.01.61	Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders
2.01.62	Extracorporeal Shock Wave Therapy in the Treatment of Peyronie’s Disease
2.01.63	Electrical Impedance Scanning of the Breast
2.01.64	Biofeedback as a Treatment of Fecal Incontinence
2.01.65	Aerosolized Antibiotics as a Treatment of Chronic Sinusitis
2.01.66	Immunochemical Fecal Occult Blood Testing
2.01.67	Monitoring of Regional Cerebral Blood Flow Using an Implanted Cerebral Thermal Perfusion Probe
2.01.68	Laboratory Tests for Heart Transplant Rejection
2.01.69	Laser Treatment of Active Acne
2.01.70	Temporary Prostatic Stent
2.01.72	Insulin Potentiation Therapy
2.01.73	Actigraphy
2.01.74	Intratympanic Injections of a Pharmacologic Agent for the Treatment of Meniere’s Disease or Sudden Hearing Loss
2.01.75	Percutaneous Treatment of Fracture Non-Unions or Bone Defects with Autologous Bone Marrow with or without Demineralized Bone Matrix (DBM)
2.01.76	Mechanical Embolectomy for Treatment of Acute Stroke
2.01.77	Automated Point-of-Care Nerve Conduction Tests
2.01.78	Anti-CCP Testing for Rheumatoid Arthritis
2.01.79	Non-Contact Ultrasound Treatment for Wounds
2.01.80	Endoscopic Radiofrequency Ablation for Barrett's Esophagus
2.01.81	Ingestible pH and Pressure Capsule
2.01.99	Rhinophototherapy
2.02	Cardiology Introduction
2.02.01	Catheter Ablation for Cardiac Arrhythmias
2.02.02	Doppler Echocardiography
2.02.04	Signal-Averaged Electrocardiography
2.02.05	Intracardiac Electrophysiologic Studies
2.02.06	Enhanced External Counterpulsation (EECP) for Chronic Stable Angina or Congestive Heart Failure
2.02.08	Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
2.02.09	Closure Devices for Patent Foramen Ovale and Atrial Septal Defects (ASD)
2.02.10	Biventricular Pacemakers for the Treatment of Congestive Heart Failure
2.02.11	Intra-arterial Brachytherapy for Prevention and Management of Restenosis after Percutaneous Transluminal Angioplasty (PTA)
2.02.12	Noninvasive Measurements of Cardiac Hemodynamics in the Ambulatory Care-Outpatient Setting
2.02.13	T-Wave Alternans
2.02.14	Transcoronary Ablation of Septal Hypertrophy (TASH)
2.02.15	Wearable Cardioverter-Defibrillators
2.02.16	Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis
2.02.17	End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema
2.02.18	Autologous Cell Therapy for the Treatment of Damaged Myocardium
2.02.19	Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Veins Isolation as a Treatment for Atrial Fibrillation
2.02.21	Non-Invasive Measurement of Left Ventricular End Diastolic Pressure (LVEDP) in the Outpatient Setting
2.02.22	Ultrafiltration in Decompensated Heart Failure
2.02.23	Electrocardiographic Body Surface Mapping
2.03	Oncology Introduction
2.03.01	In Vitro Chemoresistance and Chemosensitivity Assays
2.03.02	Serum Tumor Markers for Breast and Gastrointestinal Malignancies
2.03.03	Donor Leukocyte Infusion for Hematologic Malignancies that Relapse after Allogeneic Stem-cell Transplant
2.03.04	Melanoma Vaccines
2.03.05	Uses of Monoclonal Antibodies for the Treatment of Non-Hodgkin Lymphoma and Acute Myeloid Leukemia in the Non-stem-cell Transplant Setting
2.03.06	Microwave Thermotherapy for Primary Breast Cancer
2.03.07	Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Peritoneal Carcinomatosis of Gastrointestinal Origin
2.03.10	Real-Time Intra-Fraction Target Tracking during Radiation Therapy
2.04	Pathology/Laboratory Introduction
2.04.02	Genetic Testing for Hereditary Breast and/or Ovarian Cancer
2.04.03	Fetal Fibronectin Enzyme Immunoassay
2.04.04	Cervicography
2.04.06	Urea Breath Test for Diagnosis of Helicobactor pylori
2.04.07	Urinary Tumor Markers for Bladder Cancer
2.04.08	Genetic Testing for Inherited Susceptibility to Colon Cancer, Including Microsatellite Instability Testing
2.04.09	Monolayer Slide Preparation, Automated Slide Reading Systems, and Human Papillomavirus Testing for Cervical Cancer Screening
2.04.10	Identification of Microorganisms Using Nucleic Acid Probes
2.04.12	Measurement of Small Low-Density Lipoprotein (LDL) Particles and Concentration of LDL Particles in Cardiac Risk Assessment and Management
2.04.13	Genetic Testing for Familial Alzheimer’s Disease
2.04.14	Biochemical Markers of Alzheimer’s Disease
2.04.15	Bone Turnover Markers for the Diagnosis and Management of Osteoporosis
2.04.16	Diagnosis of Vaginitis
2.04.17	Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease
2.04.18	HIV Genotyping and Phenotyping
2.04.19	Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines
2.04.20	Apolipoprotein B in the Risk Assessment and Management of Cardiovascular Disease
2.04.21	Lipoprotein(a) Enzyme Immunoassay in the Management of Cardiovascular Disease
2.04.22	High-Sensitivity C-Reactive Protein
2.04.23	Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease
2.04.24	High-Density Lipoprotein Subclass Testing in the Diagnosis and Management of Cardiovascular Disease
2.04.25	Apolipoprotein E Genotype or Phenotype in the Management of Cardiovascular Disease
2.04.27	CA-125
2.04.29	Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening
2.04.30	Serologic Diagnosis of Celiac Disease
2.04.31	Measurement of Serum Intermediate Density Lipoproteins (Remnant-like Particles)
2.04.32	Measurement of Lipoprotein-associated Phospholipase A2 (Lp-PLA2) in the Assessment of Cardiovascular Risk
2.04.33	Gene-Based Tests for Screening, Detection, and/or Management of Prostate Cancer
2.04.34	Analysis of Proteomic Patterns in Serum to Identify Cancer
2.04.36	Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis In Patients With Breast Cancer
2.04.37	Detection of Circulating Tumor Cells in the Management of Patients with Cancer
2.04.38	Cytochrome p450 Genotyping
2.04.39	Serum Holo-transcobalamin as a Marker of Vitamin B12 (i.e., Cobalamin) Status
2.04.41	Combination of Serum Markers for Liver Fibrosis in the Evaluation and Monitoring of Patients with Chronic Liver Disease
2.04.42	Leukocyte Histamine Release Test
2.04.43	Genetic Testing for the Congenital Long QT Syndrome
2.04.44	Genetic Testing for Mutations Associated with Malignant Melanoma Susceptibility
2.04.45	Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small Cell Lung Cancer (NSCLC)
2.04.46	Alpha-Fetoprotein for Detection of Hepatocellular (Liver) Cancer
2.04.47	Biomarker Genes for Detection of Lymph Node Metastases in Breast Cancer
2.04.48	Genetic Testing for Initial Warfarin Dose
2.04.49	Laboratory Testing for HIV Tropism
2.04.50	Genetic Testing for Helicobactor Pylori Treatment
2.04.51	Genetic Testing for Tamoxifen Treatment
2.04.54	Microarray-based Gene Expression Testing for Cancers of Unknown Primary
2.04.55	KRAS in Non-Small Cell Lung Cancer
2.04.56	Immune Cell Function Assay in Solid Organ Transplantation
2.04.57	Non-BRCA Breast Cancer Risk Assessment (OncoVue)
2.04.58	Intraepidermal Nerve Fiber Density
2.04.98	Genetic Testing
2.04.99	Genetic Counseling
	Genetic Testing/Counseling Introduction
2.04.02	Genetic Testing for Inherited BRCA1 or BRCA2 Mutations
2.04.05	Genetic Testing for Germline Mutations of the RET Proto-Oncogene in Medullary Carcinoma of the Thyroid
2.04.08	Genetic Testing for Inherited Susceptibility to Colon Cancer: Including Microsatellite Instability Testing
2.04.13	Genetic Testing for Familial Alzheimer’s Disease
2.04.29	Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening /providers/medical_policies/Med/mp_20448.asp
2.04.33	Gene-Based Tests for Screening, Detection, and/or Management of Prostate Cancer
2.04.36	Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients With Breast Cancer
2.04.38	Cytochrome p450 Genotyping
2.04.43	Genetic Testing for the Congenital Long QT Syndrome
2.04.44	Genetic Testing for Mutations Associated with Malignant Melanoma Susceptibility
2.04.45	Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small Cell Lung Cancer (NSCLC)
2.04.47	Biomarker Genes for Detection of Lymph Nodes Metastases in Breast Cancer
2.04.48	Genetic Testing for Initial Warfarin Dose
2.04.50	Genetic Testing for Hleicobactor Pylori Treatment
2.04.51	Genetic Testing for Tamoxifen Treatment
2.04.52	PathFinderTG® Molecular Testing
2.04.54	Microarray-based Gene Expression Testing for Cancers of Unknown Primary
2.04.55	KRAS in Non-Small Cell Lung Cancer
2.04.98	Genetic Testing
2.04.99	Genetic Counseling
4.02.05	Preimplantation Genetic Diagnosis
4.02.10	Genetic Testing for Recurrent Pregnancy Loss

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