BlueCross BlueShield of Tennessee Medical Policy Manual

Neurology

• Ablation Procedure for Peripheral Neuromas

• Acupuncture

• Angioplasty or Stenting for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

• Auricular Electrostimulation

• Autonomic Nervous System Testing

• Baroreflex Stimulation Devices

• Biofeedback and Neurofeedback

• Cranial Electrotherapy Stimulation

• Diagnosis and Treatment of Sacroiliac Joint Pain

• Electrical and Electromagnetic Stimulation for the Treatment of Arthritis

• Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds

• Electromyography and Nerve Conduction Studies (Electrodiagnostic Assessment)

• Epidural Steroid Injections for Treatment of  Back Pain

• Facet Joint Injections

• Facet Joint Neurotomy

• Functional Neuromuscular Electrical Stimulation

• Genetic Testing for Epilepsy

• Hand and/or Face Transplantation (Composite Tissue Allotransplantation)

• High-Frequency Electrical Stimulation Pulses With or Without a Low Dose Local Anesthetic for the Treatment of Pain

• Implantable Hypoglossal Nerve Stimulation

• Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

• Interferential Current Stimulation

• Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders

• Lysis of Epidural Adhesions

• MRI-guided Laser-induced Thermotherapy for Neurological Indications

• Navigated Transcranial Magnetic Stimulation

• Nerve Graft with Radical Prostatectomy

• Neuromuscular Electrical Stimulation

• Pelvic Floor Stimulation

• Percutaneous Electrical Nerve Stimulation (PENS), Percutaneous Neuromodulation Therapy (PNT) and Percutaneous Electrical Nerve Field Stimulation (PENFS)

• Peripheral Subcutaneous Field Stimulation for the Treatment of Pain

• Pharmacogenetic Testing for Pain Management

• Quantitative Sensory Testing

• Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy

• Spinal Cord Stimulation for the Treatment of Pain

• Surface Electromyography (sEMG)

• Surgical Deactivation of Headache Trigger Sites

• Thermography

• Transcranial Magnetic Stimulation (TMS)

• Transcutaneous Electrical Nerve Stimulation (TENS) and Transcutaneous Afferent Patterned Stimulation (TAPS)

This document has been classified as public information.