mcgs.bcbsfl.comMedical Coverage Guideline

Home s Open the calendar popup. << < January 2020 > >> S M T W T F S 53 29 30 31 1 2 3 4 2 5 6 7 8 9 10 11 3 12 13 14 15 16 17 18 4 19 20 21 22 23 24 25 5 26 27 28 29 30 31 1 6 2 3 4 5 6 7 8 Search What's New Current Guidelines By Category Ambulance Ambulance Services Durable Medical Equipment Blood Glucose Monitors and Supplies Continuous Passive Motion Device Cooling and Heating Devices Used in the Outpatient Setting (e.g., Ice Man Therapy Unit) Durable Medical Equipment (DME) Electric and Electromagnetic Stimulation and Ultrasound for Wound Healing End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema External Infusion Pumps (non-insulin) External Insulin Infusion Pumps and Continuous Glucose Monitors Functional Neuromuscular Stimulation Home Cardiorespiratory Monitoring, Infant Home Pulse Oximetry Home Spirometry Hospital Beds and Accessories Infrared Energy Therapy and Low Level Laser Therapy Mechanical Stretching Devices Negative Pressure Wound Therapy (NPWT) Pumps Neuromuscular Electrical Stimulation (NMES) Non-Invasive Electrical Bone Growth Stimulators (EBGS) Noncontact Normothermic Wound Therapy Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Disorders Oxygen Percutaneous Electrical Nerve Stimulation (PENS) Pneumatic Compression Devices Positive Airway Pressure Devices Positive Pressure Ventilation in Adults Sacral Nerve Modulation Stimulation Speech Generating Devices Spinal Cord and Dorsal Root Ganglion Stimulation Transcutaneous Electric Nerve Stimulation (TENS) Transtympanic Micropressure Applications as a Treatment of Meniere’s Disease Ultrasound Osteogenesis Stimulators, Non-invasive Wheelchairs and Wheelchair Accessories Medicine Adoptive Immunotherapy Advanced Imaging of the Heart-Echocardiography Allergy Testing and Immunotherapy Ambulatory Blood Pressure Monitoring (ABPM) Apheresis, Plasmapheresis and Plasma Exchange Arterial Ultrasound (Duplex Ultrasounds and Physiologic Testing) Autonomic Nervous System Testing Balloon Dilation of the Eustachian Tube Bioimpedance Devices for Detection and Management of Lymphedema Cardiac Monitoring Devices Chelation Therapy Cognitive Rehabilitation Diabetic Self-Management Training and Educational Supplies Diagnosis and Treatment of Temporomandibular Joint Disorder Diagnostic Coronary Angiography Elective Percutaneous Coronary Intervention Electroretinography Esophageal pH Monitoring Evoked Potentials, Intraoperative Neurophysiologic Monitoring, and Quantitative Electroencephalography (QEEG) External Counterpulsation (ECP) Extracorporeal Membrane Oxygenation (ECMO) for Adult Conditions Extracorporeal Photopheresis (ECP) Extracorporeal Shock Wave (ESW) Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions Extracorporeal Shock Wave Therapy in the Treatment of Peyronie’s Disease Fecal Microbiota Transplantation Gastric Electrical Stimulation Home Prothrombin Time Monitoring Hyperbaric Oxygen Therapy (Systemic, Topical) Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Ingestible pH and Pressure Capsule Inhaled Nitric Oxide Magnetoencephalography/Magnetic Source Imaging Minimally Invasive Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD) and Dysphagia Nerve Conduction Studies, F-wave Studies, H-reflex Studies Neuropsychological Testing Orthopedic Applications of Stem-Cell Therapy Outpatient Pulmonary Rehabilitation Pelvic Floor Stimulation as a Treatment of Incontinence Percutaneous Tibial Nerve Stimulation Physical Therapy (PT) and Occupational Therapy (OT) Preventive Services Psoralens with Ultraviolet A (PUVA) Therapy Quantitative Sensory Testing Signal Averaged Electrocardiography (SAECG) Sleep Testing Speech Therapy Services Thoracic Electrical Bioimpedance (TEB) Total Body Plethysmography Transanal Radiofrequency Therapy as a Treatment of Fecal Incontinence Transcranial Doppler Studies Transcranial Magnetic Stimulation Treatment of Autism Spectrum Disorders Treatment of Hyperhidrosis Treatment of Tinnitus Vestibular Rehabilitation Wearable and Non-Wearable Cardioverter-Defibrillators Wireless Capsule Endoscopy Orthotics and Prosthetics Cranial Orthosis for Craniosynostoses and Plagiocephaly Knee Braces Lower Limb Microprocessor-Controlled Prosthetics Myoelectric Prosthetic Components for the Upper Limb Orthotics Prosthetics Other Enteral Formulas Home Health Care Hospice Care Hyperalimentation Injectable Bulking Agents for Treatment of Fecal Incontinence Investigational Services Non-Covered Services Private Duty Nursing Care in the Home ProThelial for the Treatment of Oral Mucositis Technologies for the Evaluation of Malignant Melanoma Pathology and Laboratory Analysis of Human DNA as a Technique for Colorectal Cancer Screening Assays of Genetic Expression in Tumor Tissue - Breast Cancer Chemoresistance and Chemosensitivity Assays Drug Testing in Pain Management and Substance Use Disorder Treatment Fecal Analysis in the Diagnosis of Intestinal Dysbiosis Genetic Testing Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast Ovarian Cancer Syndrome and Other High-Risk Cancers Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes Human Papillomavirus (HPV) Testing Intracellular Micronutrient Analysis KRAS, NRAS, and BRAF Variant Analysis (Including Liquid Biopsy) in Metastatic Colorectal Cancer Laboratory Tests for Heart Transplant Rejection Measurement of Apolipoprotein B (apo B) and Apolipoprotein E (apo E) in Risk Assessment and Management of Cardiovascular Disease Multigene Expression Assay for Predicting Recurrence in Colon Cancer Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA Topographic Genotyping Tumor Genetic Markers Pharmacy Abaloparatide (Tymlos) Abatacept (Orencia) Abemaciclib (Verzenio) Abiraterone Acetate (Yonsa, Zytiga) Tablet Acalabrutinib (Calquence) Oral Adalimumab (Humira) Injection Ado-trastuzumab emtansine (Kadcyla) Afatinib (Gilotrif TM) Tablets Agalsidase Beta (Fabrazyme) IV Alectinib (Alecensa) Alemtuzumab (Lemtrada) IV Alpelisib (Piqray) Tablet Alpha1-Proteinase Inhibitors (Human) Altretamine (Hexalen) Capsules Amifampridine Phosphate (Firdapse, Ruzurgi) Anakinra (Kineret) Injection Apalutamide (Erleada) Apremilast (Otezla) Tablet Asfotase alfa (StrensiqTM) Asparaginase (Elspar, Erwinaze) Injection Avatrombopag (Doptelet) Axicabtagene Ciloleucel (Yescarta) Axitinib (Inlyta) Tablets Azacitidine (Vidaza®) Injection Baricitinib (Olumiant) Belimumab (Benlysta) Injection Belinostat (Beleodaq) Injection Bendamustine Injection Benralizumab (Fasenra) Betaine, anhydrous (Cystadane) Oral Solution Bevacizumab (Avastin) and bevacizumab-awwb (Mvasi) Injection Bexarotene (Targretin®) Capsules Bezlotoxumab (Zinplava) Injection Binimetinib (Mektovi) Tablet Blinatumomab (Blincyto) IV Bortezomib (Velcade) Injection Bosutinib (Bosulif™) Tablets Botulinum Toxins Brentuximab (Adcetris) Injection Brexanolone (Zulresso) IV Infusion Brigatinib (Alunbrig) Brodalumab (Siliq) Injection Buprenorphine Hydrochloride (Probuphine) and Buprenorphine (Sublocade) Burosumab (Crysvita) Cabazitaxel (Jevtana) Injection Cabozantinib Capsules and Tablets (Cometriq, Cabometyx) Canakinumab (Ilaris®) Injection Cannabidiol (Epidiolex) Capecitabine (Xeloda®) Tablets Caplacizumab-yhdp (Cablivi) Carboplatin (Paraplatin®) IV Carfilzomib (Kyprolis) Injection Cenegermin-bkbj (Oxervate) Ceritinib (Zykadia) Capsules Certolizumab Pegol (Cimzia) Cholic Acid (Cholbam®) Capsule Cladribine (Mavenclad) tablets Clotting Factors and Coagulant Blood Products Cobimetinib (Cotellic) Tablet Contraceptive Drugs Corticosteroid Intravitreal Implant Crizotinib (Xalkori) Capsules Cysteamine Bitartrate (Procysbi) Capsules Dabrafenib (Tafinlar) Capsules Dacomitinib (Vizimpro) Dalfampridine (Ampyra) Oral Daratumumab (Darzalex) Darolutamide (Nubeqa) Tablet Dasatinib (Sprycel) Tablets Deflazacort (Emflaza) Denosumab (Prolia, Xgeva) Injec...