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Procedures & services
Page last updated on: 6/20/25
Services not covered list
Services not covered list
There are hundreds of services not covered by our medical plans and it's impossible to list them all, but here is a brief list of some that cause frequent inquiries.
Service or device | Medical policy |
|---|---|
Automated percutaneous lumbar discectomy (APLD) | 91581 |
Autopsy | 91054 |
AxiaLIF™ lumbar interbody fusion | 91581 |
Cingulotomy | |
Extracorporeal shock wave therapy (ECWT) | 91527 |
Health education materials | |
IDET and other thermal intradiscal procedures (TIPs) | 91581 |
Intracranial angioplasty and stenting | 91495 |
Irreversible electroporation (IRE) or Nanoknife® | 91599 |
Patellofemoral replacement for isolated osteoarthritis of the knee | 91571 |
Phototherapy, monochromatic (anodyne therapy/ MIRE therapy/ low-level light therapy) | 91486 |
Platelet-rich plasma/ platelet-rich fibrin matrix | 91553 |
Refractive keeratoplasty/ LASIK | 91529 |
Respite care | 91520 |
Sperm and oocyte retrieval and storage | 91163 |
Termination of pregnancy | 91000 |
Therapy, craniosacral | |
Therapy, tinnitus retraining | 91482 |
Thermal capsulorrhaphy | 91551 |
Thermography | 91355 |
Ultrasound, high-intensity focused | 91601 |