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Printed copies of specific medical policies may be requested by contacting the Geisinger Health Plan Health Services Dept. at (800) 544-3907 option #2, or by contacting your regional provider relations representative.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Pharmaceutical Policies
A
- Ablation Therapies for the treatment of Benign Prostatic Hypertrophy
- Acupuncture
- Adult Cardiac Magnetic Resonance Imaging
- Advanced Molecular Topographic genotyping (RedPath)
- Alpha 1-Antitrypsin Inhibitor Therapy-M
- Alternative or Complementary Medicine
- Ambulance Transport Services
- Anodyne Infrared Therapy aka Monochromatic Inrared Energy (MIRE)
- Aquatic Therapy
- Artificial Intervertebral Disc
- Autism Spectrum Disorder Evaluation and Management
- Autologous Chondrocyte Implantation
- Autologous Platelet- Derived Growth Factor
- Automated Ambulatory Blood Pressure Monitoring
- Automatic External Defibrillator
- Automatic Implantable Defibrillator
- Biofeedback
- Biventricular Pacemaker
- Blepharoplasty
- Body Surface Mapping
- Bone Growth Stimulator
-
Breast Implants Removal
Effective 03/01/2010
- Breast MRI
- Breast Reconstruction Surgery Following Mastectomy
- Breath Testing for Heart Transplant Rejection
- Computerized Cognitive Health Assessments
- Cardiac CT Angiography
- Cardiac Output Measurement by Electrical Bioimpedance
- Cardiac Rehabilitation
- Carotid Artery Stent
- Chelation Therapy
- Chemosensitivity and Chemoresistance Assays
- Chest Percussion Vest
- Childbirth Classes
- Circulating Tumor cells
- Clinical Criteria for Rehab Utilization Management Decisions
- Clinical Guideline Development, Implementation and Review
- Cochlear Implant
- Colonoscopy
- Computer Aided Detection Technology
- Continuous Passive Motion
- Continuous Positive Airway Pressure Devices (CPAP)
- Continuous Subcutaneous Glucose Monitor
- Continuous Subcutaneous Insulin Infusion Pump
- Convection-Enhanced Delivery
- Cooling Devices
- Corneal Hysteresis
- Corneal Pachymetry
- Corneal Topography
- Cranial Electrotherapy Stimulation
- Cranial Remodeling Orthotic
- Craniosacral Therapy
- Criteria for DME MM Determinations
- Criteria for Home Health Services
- Criteria for Inpatient Rehabilitation Decisions
- Cryoablation
- Cystourethroscopy With Insertion of Urethral Stent
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Deep Brain Stimulation
Effective 03/01/2010
- Dorsal Column Stimulation
- Dry Hydrotherapy
- Electrical Stimulation to Promote Wound Healing
- Endometrial Ablation
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Endovascular Repair of Intracranial Aneurysms
Effective 03/01/2010
- Epiretinal Radiation Therapy
- Evaluation of Breast Ductal Fluid
- Exhaled Nitric Oxide for Asthma Management
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Experimental, Investigational or Unproven Service or Treatment
Effective 03/01/2010
- External Counterpulsation
- Extracorporeal Shock Wave Treatment-Musculoskeletal Indications
- Fetal Surgery
- Foot Orthotics
- Functional Anesthetic Discography
- Functional Magnetic Resonance Imaging
- Gamma Knife Stereotactic Radiosurgery
- Gastric Electrical Stimulation
- Gene Expression Profiling for Breast Cancer Treatment
- Genetic Testing for BRCA1 or BRCA2
- Genetic Testing for Cystic Fibrosis
- Genetic Testing Related to Colorectal Cancer
- GliaSite Radiation Therapy
- HDR Temporary Brachytherapy
- Hippotherapy
- Home Health Related to Hyperbilirubinemia
- Home Phlebotomy Program
- Home Uterine Activity Monitor
- Human Leukocyte Antigen Typing (HLA)
- Human Papillomavirus DNA Testing
- Hydrophilic Contact Lense (Corneal Bandage)
- Hyperbaric Oxygen Therapy
- Hysteroscopic Microinsert Tubal Occlusion
-
Immune Cell Function Assay for Transplant Rejection
Effective 04/01/2010
- Implantable and Semi-implantable Hearing Aids
- Implantable Cardiac Loop Recorder
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Injectable Bulking Agents for Treatment of Urinary Incontinence
Effective 03/01/2010
- Injection Therapies for Back Pain
- Intensity Modulated Radiation Therapy
- Interactive Metronome Training
- Interferential Stimulation
- Interspinous Distraction Technology
- Intracavitary Balloon Brachytherapy for Breast Cancer
-
Intracranial Artery angioplasty
Effective 03/01/2010
- Intradiscal Biacuplasty
- Intradiscal Electrothermal Therapy (IDET)
- Iontophoresis
- Laser Assisted Uvulopalatoplasty (LAUP)
- Laser Treatment for Cutaneous Vascular Lesions
- Long Term Acute Care
- Low Level Laser Therapy
- Lung Volume Reduction Surgery
- Lysis of Epidural Adhesions
- Magnetic Resonance Guided Focused Ultrasound Surgery of Uterine Fibroids
- Management of Excessive Skin and Subcutaneous Tissue
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Management of Excessive Skin and Subcutaneous Tissue
Effective 04/01/2010
- Massage Therapy
- Mastectomy for Gynecomastia
- Med Dir Auth for Home Infusion Service
- Medical Error Never Events
- Medical Policy Assessment Group
- Medical Policy Development
- Meniett Device
- Meniscal Allograft
- MicroVas Vascular Treatment System
- Microvolt T-wave Alternans
- Mobile Cardiac Outpatient Telemetry
- Morphometric Tumor Analysis
- Nasal and Sinus Surgery
- Negative Pressure Wound Therapy
- Neuromuscular Electrical Stimulation
- Nocturnal Enuresis Alarm
- Non-contact, Low Frequency Ultrasound for Wound Management
- Non-invasive Treatments for Low Back Pain
- Obesity Surgery
- Obstructive Sleep Apnea
- Occipital Nerve Stimulation
- Oral Health
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Oral Health
Effective 04/01/2010
- Osteochondral Autograft Transplant
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Outpatient Pulmonary Rehabilitation
Effective 04/01/2010
- Pectus eformity Surgical Correction
- Percutaneous Disc Decompression - Nucleoplasty
- Percutaneous Laser Lumbar Disc
- Percutaneous Neuromodulation Therapy
- PET Scan
- Photodynamic Therapy
- Photodynamic therapy for the treatment of head and neck cancer
- Phototherapy for Seasonal Affective Disorder
- Polysomnography and Sleep Studies
- Progressive Stretch Devices
- Prolotherapy
- Prolozone Therapy
- Prometheus IBD Serology Testing
- Prophylactic Mastectomy
- Prophylactic Oophorectomy
- Prothrombin Time Home Testing
- Proton Beam Radiation
- Pulse Oximetry for Home Use
- Pulsed Dye Laser Treatment for Acne Vulgaris
- Pulsed Electrical Stimulation for Osteoarthritis
- Radiofrequency Ablation Therapy for Barrett's Esophagus
-
Radiofrequency Facet Joint Denervation
Effective 04/01/2010
- Reduction Mammaplasty
- Retinal Prosthesis
- Rhinophototherapy
- Robotically Assisted Prostatectomy
- Sacral Nerve Stimulation
- Salivary Hormone Testing for Menopause and Aging
- Selective Internal Radiation Therapy
- Sensory Integration Therapy
- Sexual Dysfunction Therapies
- Somnoplasty
- Spaced Retrieval Training
- Stretta Procedure for GERD
- Suit Therapy
- Suprachoroidal Delivery of Pharmacologic Agents
- Sympathetic Therapy
- Therapeutic Listening
- Thermal Capsulorraphy
- Thermography
- Tissue Engineered Skin Substitutes
- Topical Oxygenation
-
Total Body CAT Screening
Effective 03/01/2010
-
Total Facet Arthroplasty
Effective 04/01/2010
- Total Hip Resurfacing
- Total Parenteral Nutrition
- Transanal Radiofrequency Therapy
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Transcatheter Closure Devices for Cardiac Defects
Effective 03/01/2010
- Transcranial Magnetic Stimulation
- Transmyocardial Laser Revascularization
- Transplant Services
-
Transpupillary Thermotherapy
Effective 03/01/2010
- Treatment of Vestibular Disorders
- Trigger Point Injections
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Ultrafiltration
Effective 03/01/2010
- Ultrasound in Uncomplicated Pregnancy
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Unilateral Pallidotomy
Effective 03/01/2010
- Uterine Artery Embolization
- Vagus Nerve Stimulation
- Varicose Vein Treatments
- Vertebroplasty
- Vibroacoustic Therapy
- Virtual Colonoscopy
- Visual Field Testing
- VitalStim
- Vitamin B-12 Injection Therapy
- Voice Therapy
- Abraxane™ (paclitaxel protein bound particles)
- Aldurazyme (laronidase)
- Alefacept (Amevive®)
- Alemtuzumab (Campath®)
- Arranon®
- Avastin™ (bevacizumab)
- Botulinum Toxin (Botox)(Myobloc)
- Cerezyme®
- Clolar™ (clofarabine)
- Coordination of Medical Benefit And Pharmaceutical Use
- Cubicin® (daptomycin)
- Dacogen®
- Degarelix®
- Elaprase®
- Elitek™ (rasburicase)
- Eraxis™
- Erbitux®(cetuximab)
- Erythropoietin Stimulating Agents
- Fabrazyme (agalsidase beta)
- FASLODEX™ (Fulvestrant Injection)
- Flolan®
- Herceptin®
- Ibritumomab tiuxetan [(IDEC Y2B8) Zevalin]
- Implanon™
- Infliximab (Remicade)
- Intravenous Immune Globulin (IVIG)
- IV Boniva®
- IV Ketamine
- Ixempra®
- Kepivance® (palifermin)
- Meningococcal vaccine
- Mozibil® (plerixafor)
- Myozyme
- Naglazyme® (galsulfase)
- Natrecor®
- Nplate™
- Ontak® (denileukin diftitox)
- Orencia® (abatacept)
- Oxaliplatin (Eloxatin®)
- Palivizumab (Synagis®)
- Prialt®
- Reclast®(zoledronic acid)
- Remodulin®
- Retisert™
- Rituxin for the Treatment of RA
Effective 03/01/2010
- Soliris®
- Suprelin®LA (histerlin acetate)
- Torisel®
- Tositumomab and Iodine 131-tositumomab (Bexxar®)
- Treanda (bendamustine)
Effective 04/01/2010
- Tysabri®
- Vectibix®
- Velcade
- Viscosupplementation Synvisc ® Hyalgan ® Orthovisc®, Supartz™ and Euflexxa™
- Vitrasert® (ganciclovir intravitreal implant)
- Vivitrol® Injection
- Voriconazole (Vfend)
- White Blood Cell Stimulating Factor
- Xolair® (Omalizumab)
- Zoledronic Acid (Zometa®)
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Pharmaceutical Policies
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