BlueCross BlueShield of Tennessee Medical Policy Manual

Obstetrics and Gynecology

• Bioidentical Compounded Hormone Therapy

• Chromosomal Microarray Analysis for Evaluation of Pregnancy Loss

• Endometrial Ablation

• Fetal Surgery for Prenatally Diagnosed Malformations

• First-Trimester Detection of Down Syndrome Using Fetal Ultrasound Markers Combined with Maternal Serum Assessment

• Fractional Laser Treatment of Vulvovaginal Atrophy

• Gender Reassignment Surgery

• Laparoscopic, Percutaneous and Transcervical Techniques for the Myolysis of Uterine Fibroids

• Non-invasive Prenatal Testing Using Cell-free Fetal DNA (cffDNA)

• Vulvectomy

This document has been classified as public information.