Procedure Criteria

PROCEDURE GUIDELINES

Autologous Platelet-Rich Plasma (PRP) (03/26/21) 

Continuous Glucose Monitor

Corneal Collagen Cross-Linking (08/07/20)

Gender Affirmation Surgery (11/23/2020)

Medical Nutrition Therapy Registered Dietician Services (7/1/2021)

Nipple Tattooing (11/20/20)

Out-of-Network Services- office visits, elective inpatient hospital admissions and procedures- (10/16/20)

Photodynamic Therapy (01/08/21)

Proton Beam Therapy (02/18/20)

Pulmonary Rehabilitation (02/18/20)

Sacroiliac (SI) Joint Fusion (08/07/20)

Sleep Study: Facility Based AND Unattended/Home Sleep Test (10/06/21)

Vibration-Controlled Fibroscan (10/06/21)