Medical Policies
Medical Policies act as guidance to help RMHP physicians determine whether a request for certain care is medically necessary. All medical policies are reviewed by the RMHP “New Technology and Assessment Guideline” (NTAG) Committee made up of physicians, most being providers in the community (not RMHP employees). All medical policy changes are also sent out to our large network of providers to allow for questions or concerns to be raised before being reviewed by the NTAG Committee. For Medicare Advantage, National and Local Coverage Determination (NCD/LCD) is reviewed. If there is no coverage determination regarding specific care, RMHP medical policies are used.
- 6 RMHP Lumbar Total Disc Arthroplasty (TDA) 27.0 2024 Review
- 7 RMHP Autologous Chondrocyte Transplantation (ACT) Knee 27.0 Review 2024
- 8 MCG 0415 AC – Autologous Chondrocyte Implantation, Knee
- 9 RMHP Autologous Pancreatic Islet Cell Transplantation 27.0 Review 2024
- 11 RMHP Balloon Sinus Ostial Dilation (Sinuplasty) 27.0 Review 2024
- 12 MCG A-0478 AC – Sinuplasty
- 13 RMHP Bone Conduction Hearing Aid 27.1 Review 2024
- 14 UHC hearing-aids-devices-including-wearable-bone-anchored-semi-implantable – excludes CO
- 15 RMHP Spinal Fusion Enhancement Products 27.0 Review 2024
- 17 RMHP Cryosurgical Ablation of Solid Tumors 27.0 Review 2024
- 18 RMHP Continuous Glucose Monitoring (CGM) 27.0 Review 2024
- RMHP Alternating Electric Field Therapy – Tumor Treatment Field Therapy (TTFT)
- RMHP Anorexia Nervosa Adult Inpatient Care
- RMHP Anorexia Nervosa Child or Adolescent Inpatient Care
- RMHP Apheresis Therapeutic
- RMHP Bariatric Surgery
- RMHP Behavioral Health Vagus Nerve Stimulation, Implantable
- RMHP Bioengineered Skin Substitute and Wound Care Products
- RMHP Bioprosthetic Valve Insertion Procedure 0744T
- RMHP Bulimia Nervosa Binge Eating Disorder and Other Specified Feeding or Eating Disorders Adult Inpatient Care
- RMHP Bulimia Nervosa Binge Eating Disorder and Other Specified Feeding or Eating Disorders Child or Adolescent Inpatient Care
- RMHP Cardioverter Defibrillator Wearable
- RMHP Cochlear Implant
- RMHP Continuous Glucose Monitoring (CGM)
- RMHP Corneal Collagen Crosslinking
- RMHP Dental Anesthesia
- RMHP Eating Disorders Inpatient Behavioral Health Level of Care Adult
- RMHP Eating Disorders Inpatient Behavioral Health Level of Care Child or Adolescent
- RMHP Enteral and Parenteral Nutrition Medical Foods
- RMHP Facet Joint Injection
- RMHP Gastric Electrical Stimulation Neurostimulator Gastric Pacing
- RMHP Hip Arthroscopy and Labrum Reconstruction
- RMHP Hyperbaric Oxygen
- RMHP Hyperthermic intraperitoneal chemotherapy (HIPEC)
- RMHP Hypoglossal Nerve Neurostimulation for Obstructive Sleep Apnea
- RMHP Implantable Beta-Emitting Microspheres for Treatment of Malignant Tumors
- RMHP Implantable Magnetic Esophageal Ring (Linx)
- RMHP Implantation of Intrastromal Corneal Ring Segments (INTACS)
- RMHP Insertion of Ocular Telescope Prosthesis
- RMHP Insertion or Replacement of Penile Prosthesis
- RMHP Insulin Infusion Pump
- RMHP Intragastric Bariatric Balloon
- RMHP Intrauterine Fetal Surgery
- RMHP Keratoprosthesis (Artificial Cornea)
- RMHP Laser Treatment of Skin Conditions
- RMHP Lower Limb Prosthesis
- RMHP Meniscus Implant and Allograft
- RMHP Micro-Invasive Glaucoma Surgery (MIGS)
- RMHP Negative Pressure Wound Therapy (Wound Vac-NPWT)
- RMHP Occipital Nerve Ablation
- RMHP Orthoptic Training
- RMHP Percutaneous or Posterior Tibial Nerve Stimulation (PTNS)
- RMHP Peripheral Nerve Transcutaneous Magnetic Stimulation 27.0
- RMHP Peroral Endoscopic Myotomy (POEM) 43497 27.0
- RMHP PH Vagus Nerve Stimulation, Implantable (VNS) 27.0
- RMHP Proprietary Laboratory Analyses (PLA) Outliers 27.0
- RMHP Prostate Mapping Biopsy (Saturation Biopsy) 27.0
- RMHP Prothrombin Time (INR) Home Monitoring Device 27.0
- RMHP Radiofrequency nasal valve collapse repair 30469 27.0
- RMHP Reduction Mammaplasty (Mammoplasty) 27.0
- RMHP Sacroiliac Joint (SIJ) Injections 27.1
- RMHP Sacroiliac Joint Fusion 27.1
- RMHP Saphenous Vein Ablation, Laser 27.0
- RMHP Saphenous Vein Stripping 27.0
- RMHP Sclerotherapy Plus Ligation, Saphenofemoral Junction 27.0
- RMHP Sclerotherapy, Leg Veins 27.0
- RMHP Spinal Cord Stimulator (SCS) – IES-SC 25.2
- RMHP Stab Phlebectomy 27.0
- RMHP Surface Mechanomyography (sMMG) 27.0
- RMHP Surgical Repair of the External Ear 27.1
- RMHP Transoral (Endoluminal) Gastroplication or Suturing 27.0
- RMHP Transpupillary Thermotherapy 27.1
- RMHP Voice Prosthesis 27.1
- RMHP Wound Care Clinic 27.0
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