BlueCross BlueShield of Tennessee Medical Policy Manual

Women's Health

• Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast

• Breast Augmentation / Mammaplasty (Non-Cancerous)

• Breast Cancer Gene Expression Assays

• Breast Implant Removal

• Breast Reconstructive and Symmetry Surgery Following Mastectomy

• Cryosurgical Ablation of Solid Tumors

• Digital Breast Tomosynthesis

• Electrical Impedance Scanning of the Breast

• Endometrial Ablation

• Fractional Laser Treatment of Vulvovaginal Atrophy

• Genetic Testing for CHEK2 Mutations for Breast Cancer

• Intensity-Modulated Radiotherapy (IMRT) of the Breast and Lung

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

• Mammography

• Nonfamilial Genetic Testing for Breast Cancer Risk Assessment

• Ovarian Cancer Tumor Markers

• Reduction Mammaplasty (Non-Cancerous)

• Vulvectomy

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