Medical policies
Below are links to the most up-to-date policies on treatment options for FCHP members. Each policy includes an overview, policy and criteria, an explanation of when services are covered, and any exclusions that apply.
- Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy (pdf, 167 KB)
- Allogeneic Stem Cell Transplant (pdf, 123 KB)
- Allograft Transplants of the Knee (pdf, 108 KB)
- Ambulatory Blood Pressure Monitoring (pdf, 59 KB)
- Arthroscopy for Osteoarthritis of the Knee (pdf, 76 KB)
- Autologous Blood Donation, Processing and Storage (pdf, 61 KB)
- Autologous Chondrocyte Implant (formerly "Autologous chondrocyte implantation (Carticel)") (pdf, 90 KB)
- Autologous Platelet Derived Products (pdf, 53 KB)
- Autologous Stem Cell Transplant (pdf, 124 KB)
- Automatic External Defibrillator (non-wearable) (replaces "Automatic External Defibrilator & Wearable Cardioverter Difibrilator") (pdf, 100 KB)
- Bedwetting Alarms for Nocturnal Enuresis (pdf, 65 KB)
- Biofeedback for Urinary Incontinence (pdf, 71 KB)
- Bone-Anchored Hearing Aids (pdf, 100 KB)
- Bone Growth Stimulators - Electric & Ultrasound (pdf, 79 KB)
- Cervical Artificial Disc Replacement (pdf, 77 KB)
- Cochlear Implants (pdf, 166 KB)
- Conformal and Intensity Modulated Radiation Therapy (IMRT) of the Breast (pdf, 121 KB)
- Cosmetic, Reconstructive, and Restorative Services (pdf, 196 KB)
- Cornea Transplant (pdf, 57 KB)
- Cranial Orthotic Devices for the Treatment of Plagiocephaly (pdf, 52 KB)
- Deep Brain Stimulation (pdf, 95 KB)
- Double Balloon Enteroscopy (pdf, 89 KB)
- Durable Medical Equipment (pdf, 61 KB)
- Extracorporeal Shock Wave Treatment (ESWT) for Chronic Plantar Fasciitis and Other Musculoskeletal Conditions (pdf, 57 KB)
- Fetal Surgery (in utero or intrauterine) (pdf, 63 KB)
- First Trimester Prenatal Screening (pdf, 95 KB)
- Genetic Testing (pdf, 239 KB)
- Heart Transplant (pdf, 68 KB)
- Heart-Lung Transplant (pdf, 68 KB)
- High Frequency Chest Wall Oscillation Vest (The Vest) (pdf, 60 KB)
- HIV-1 Co-receptor Tropism Assays (pdf, 62 KB)
- Home Prothrombin Time Testing (pdf, 110 KB)
- Home Polysomnography (pdf, 53 KB)
- Human Papilloma Virus (HPV) DNA Testing (pdf, 54 KB)
- Hyperbaric Oxygen Therapy (pdf, 70 KB)
- Infertility/Assisted Reproductive Technology Services (pdf, 135 KB)
- Insulin Pumps (pdf, 56 KB)
- Interspinous Process Decompression (X-Stop®) (pdf, 85 KB)
- In Vitro Chemoresponse Assays (pdf, 84 KB)
- Kidney Transplant (pdf, 60 KB)
- Light Box Therapy for Seasonal Affective Disorder (SAD) (pdf, 49 KB)
- Liver Transplant (pdf, 77 KB)
- Lumbar Artificial Disc Replacement (pdf, 83 KB)
- Lung Transplant (pdf, 66 KB)
- Neuromuscular Electrical Stimulation (pdf, 56 KB)
- Oncotype DxTM (pdf, 57 KB)
- Oral Retainers for Obstructive Sleep Apnea (pdf, 62 KB)
- Pancreas After Kidney (PAK) Transplant (pdf, 54 KB)
- Pap Smear/Cervical Cancer Screening (pdf, 68 KB)
- Percutaneous Vertebroplasty & Kypholplasty (or Balloon-Assisted Vertebroplasty) (pdf, 166 KB)
- Phototherapeutic Keratectomy (formerly "Photorefractive Keratectotomy") (pdf, 56 KB)
- Posterior Tibial Nerve Stimulation (pdf, 60 KB)
- Pulsed Dye Laser (formerly "Tunable Dye, Pulsed Dye Laser") (pdf, 52 KB)
- Sacral Nerve Stimulation for Urinary Urge Incontinence (pdf, 55 KB)
- Simultaneous Pancreas-Kidney (SPK) Transplant (pdf, 57 KB)
- Small Bowel, Small Bowel/Liver and Multi-Visceral Transplant (pdf, 60 KB)
- Speech Generating Devices (pdf, 64 KB)
- Speech Therapy (pdf, 52 KB)
- Spinal Cord Stimulation for the Treatment of Pain (pdf, 57 KB)
- Transcutaneous Electric Nerve Stimulation (TENS) (pdf, 55 KB)
- Vagus Nerve Stimulation (pdf, 58 KB)
- Vertebral Fracture Assessment (pdf, 81 KB)
- Varicose Vein Treatment (pdf, 62 KB)
- Weight Loss Surgery (pdf, 148 KB)
- Wireless Capsule Endoscopy (pdf, 101 KB)