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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 >>>

Medical Policies

8.0 Therapy


8.01 Therapy Introduction 

Medically

Necessary

and

Investigational

 For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here. 
8.01.01 Adoptive Immunotherapy 
8.01.02 Chelation Therapy 
8.01.03 Interferon Therapy 
8.01.04 Oncologic Applications of Interleukin-2 (Aldesleukin) When Used as Monotherapy 
8.01.05 Intravenous Immune Globulin Therapy 
8.01.06 Oncologic Applications of Photodynamic Therapy, Including Barrett’s Esophagus 
8.01.07 Paclitaxel Chemotherapy 
8.01.08 Intraoperative Radiation Therapy 
8.01.09 Neutron Beam Radiotherapy 
8.01.10 Charged-Particle (Proton or Helium Ion) Radiation Therapy 
8.01.11 Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies 
8.01.12 Rabies Vaccine 
8.01.13 Breast Brachytherapy after Breast-Conserving Surgery, as Boost with Whole Breast Irradiation, or alone as Partial Breast Irradiation 
8.01.14  Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds 
8.01.15 Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma 
8.01.16 Chemical Peels 
8.01.17 Single or Tandem Courses of High-Dose Chemotherapy plus Hematopoietic Stem-Cell Support for Multiple Myeloma 
8.01.18 Lysis of Epidural Adhesions 
8.01.19 Treatment of Hyperhidrosis 
8.01.20 High-Dose Chemotherapy and Hematopoietic Stem-Cell Support for Non-Hodgkin's Lymphomas 
8.01.21 Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
8.01.22 Hematopoietic Stem Cell Transplantation for Genetic Diseases and Acquired Anemias 
8.01.23 Hematopoietic Stem-cell Transplantation for Epithelial Ovarian Cancer 
8.01.24 Hematopoietic Stem Cell Transplantation for Miscellaneous Solid Tumors in Adults 
8.01.25 Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases 
8.01.26 Hematopoietic Stem-cell Transplantation for Acute Myelogenous Leukemia 
8.01.27 Hematopoietic Stem-Cell Transplantation for Breast Cancer 
8.01.28 High-dose Chemotherapy with Hematopoietic Stem-cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma 
8.01.29 Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma 
8.01.30 Hematopoietic Stem-cell Transplantation for Chronic Myelogenous Leukemia 
8.01.31 Hematopoietic Stem-cell Transplantation for Malignant Astrocytomas and Gliomas 
8.01.32 Hematopoietic Stem-cell Transplantation for Acute Lymphoblastic Leukemia 
8.01.33 High-Dose Rate Temporary Prostate Brachytherapy 
8.01.34 High-dose Chemotherapy with Hematopoietic Stem-cell Support for Solid Tumors of Childhood
8.01.35 Hematopoietic Stem-Cell Transplantation as a Treatment of Germ-Cell Tumors
8.01.36 Extracorporeal Photopheresis as a Treatment of Graft-versus-Host Disease, Autoimmune Disease and Cutaneous T-Cell Lymphoma 
8.01.37 Inhaled Nitric Oxide as a Treatment of Hypoxic Respiratory Failure
8.01.38 Nonmyeloablative Allogeneic Transplants of Hematopoietic Stem Cells for Treatment of Malignancy
8.01.39 Treatment of Tinnitus
8.01.40 Manipulation Under Anesthesia for Treatment of Chronic Spinal or Pelvic Pain 
8.01.41 Interleukin-2 as a Treatment of HIV Infection
8.01.42 Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis or Waldenstrom’s Macroglobulinemia
8.01.43 Selective Internal Radiation Therapy for Primary and Metastatic Tumors of the Liver
8.01.44 Intradialytic Parenteral Nutrition
8.01.45 Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain
8.01.46 Intensity Modulated Radiation Therapy of the Breast and Lung
8.01.47 Intensity Modulated Radiation Therapy (IMRT) of the Prostate
8.01.48 Intensity Modulated Radiation Therapy (IMRT) - Head and Neck
8.01.49 Intensity Modulated Radiation Therapy (IMRT) - Abdomen and Pelvis
8.01.50 Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
8.02 Dialysis Introduction
8.02.01 Continuous Renal Replacement Therapies
8.02.02 Plasma Exchange (Plasmapheresis)
8.02.03 Extracorporeal Immunoadsorption Using Protein A Column
8.02.04 Low-Density Lipid Apheresis
8.02.05 Daily Hemodialysis in the Home
8.03 Rehabilitation Therapy Introduction
8.03.01 Functional Neuromuscular Electrical Stimulation
8.03.02 Physical Therapy
8.03.03 Occupational Therapy
8.03.04 Speech Therapy
8.03.05 Pulmonary Rehabilitation
8.03.06 Work Hardening Programs
8.03.07 Back School
8.03.08 Cardiac Rehabilitation
8.03.09 Vertebral Axial Decompression
8.03.10 Cognitive Rehabilitation
8.03.11 Endobronchial Brachytherapy
8.03.12 Hippotherapy
8.03.13 Sensory Integration Therapy
8.03.14 Iontophoresis as a Technique for Drug Delivery

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