MEDICAL TECHNOLOGY/COVERAGE GUIDELINES

AvMed keeps pace with changes that provide Members and Practitioners with new developments in technology through our Medical Technology Assessment Committee (MTAC). The technologies presented are comprised of medical and behavioral health procedures, pharmaceuticals, devices, and new applications of existing technologies for inclusion in benefit plans.   The MTAC includes Board Certified physicians with varied specialties.  A new technology or a new development in technology is presented to the MTAC by unbiased Specialists who are experienced in the technology.  Prior technology determinations are also revisited as the scientific evidence and/or the medical literature change.  In addition, the MTAC is provided with information for review from appropriate government regulatory bodies, such as the FDA and CMS. Relevant scientific evidence from varied sources and professional organizations such as the American Medical Association and scientific journals, such as PubMed are also used to assist in making a determination on the technology. 

The variables used to make a determination for approval include:

  • A safe and efficient technology;
  • An improvement of health outcomes;
  • Potential benefits outweigh potential negative effects and
  • The technology’s comparison to those of established alternatives

The complete approved AvMed’s Coverage Guidelines can be found below. At any time, Members or Practitioners may ask for consideration of a new technology. 

 

For these requests or any other question regarding medical technologies, please contact:  

Members:  AvMed’s Member Engagement Center at 1-800-782-8633 (TTY 711)

Practitioners: AvMed’s Provider Service Center at 1-800-452-8633

AvMed Coverage Guidelines

Abdominoplasty & Panniculectomy
Acoustic Rhinometry
Alair Thermoplasty
Allergy and Immunology Testing and Treatment
Alopecia Areata Treatment
Alternative Methods for Breast Cancer Screenings
Argus II Retinal Prosthesis System
Attention Deficit Hyperactivity Disorder (ADHD) Treatment
Autism Spectrum Disorder, Diagnosis, & Treatment Guidelines
Autologous Chondrocyte Implantation
Axial Lumbar Interbody Fusion (AxiaLif)
Benign Lesion Removal Coverage Guidelines
Blepharoplasty & Brow Ptosis Repair
Bone Growth Stimulator Coverage Guidelines
Breast Thermography BreastCare DTS
Brexanolone Treatment for Post-Partum Depression
Cane Crutches & Walker Coverage Guidelines
Cardiac Signal Analysis Procedures
Chelation Therapy
Chronic Cerebro-Spinal Venous Insufficiency (CCSVI)
Chronic Intermittent Intravenous Insulin Therapy (CIIIT)
ClariFix
Cochlear Implant, Bone Anchored Hearing Aids, and Auditory Brainstem Implant
Cold Therapy Durable Medical Equipment (DME)
Collagenase (Xiaflex) Treatment
Computerized Gait Analysis
Continuous Glucose Monitoring
Continuous Subcutaneous Insulin Infusion Pump
Cosmetic Surgery & Procedures Coverage
Cranial Sacral Therapy Guidelines
Cryoablation for Treatment of Malignant and/or Benign Breast Tumors
Dental Appliances for Sleep Apnea
Drug Testing During Substance Abuse Treatment
Electromagnetic Navigation Guided Bronchoscopy
Endo-PAT 2000
Enteral Nutrition
Extracorporeal Magnetic Stimulation (EMS) for Urinary Incontinence
Eye Surgery & Procedures
Fecal Bacteriotherapy
Gastric Surgery for Clinically Severe (Morbid) Obesity
Gender Reassignment Surgery
Genetic Testing Guidelines
Graston Technique for Injury Rehabilitation
Guidelines for Implantable Infusion Pumps, Spinal Cord Stimulators & Neuromuscular Stimulators
High Frequency Chest Wall Oscillation
Hyperbaric Oxygen Therapy for Wound Care Treatment
Iatrogenic Infertility Preservation Of Fertility
Implantable Hormone Pellets
In Utero Fetal Surgery
Inspire Upper Airway Stimulation (UAS) System
INTACS for Keratoconus
Interventional Pain Management
Intradiscal Electrothermal Therapy (IDET)
Irreversible Electroportation NanoKnife
Left Atrial Appendage Closure Devices
Ligament Augmentation & Reconstruction System (LARS)
Low-Energy Ultrasound Therapy using MIST Therapy System
Maestro Rechargeable System
Minimally Invasive Palatal Stiffening (MIPS) for Sleep Apnea
MLS Laser Therapy for Treatment of Pain
MRI-Guided Focused Ultrasound Treatment of Fibroids
Myo-electric Microprocessor Controlled Upper & Lower Prostheses
Negative Pressure Wound Therapy
Neuromonics Tinnitus Treatment
Neuropsychiatric EEG-Based Assessment Aid (NEBA) System
Neuropsychological Testing Coverage Guidelines
Neurostimulation in Resistant Depression
Nitric Oxide and ECMO Treatment
Non-Invasive Fetal Testing (NIFT)
Non-Participating Pathology Services
Nucleus Hybrid L24 Cochlear Implant
Optune System Therapy
Oral Endoscopic Myotomy (POEM) for Achalasia
Oral Pressure Therapy for Treatment of Obstructive Sleep Apnea
Oxygen Therapy Coverage Guidelines for Non-Medicare Advantage Members
Pectus Deformity Repair
Phototherapy & Photochemotherapy Treatment (Ultraviolet A [PUVA] and B [UBV])
Platelet Rich Plasma and Fibrin Matrix
Prophylactic Mastectomy
Proton Beam Radiation Therapy
PT or INP Monitoring at Home
Pudendal Nerve Decompression Surgery for Treatment of Pudendal Neuralgia
Pyrocarbon Metacarpophalangeal and Proximal Interphalangeal Joint Implants
Quantitative Electroencephalogram (QEfor Evaluation of Depression
Reduction Mammoplasty
Robotic Assisted Surgery
Skin Substitutes for Wound Care
Sleep Study Coverage Guidelines Including Split-study Parameters & CPAP-BiPap
Solesta®
Speech Generating Devices
Spinal Manipulation Under Anesthesia
Spinal Unloading Devices
Supervised Exercise Therapy for the Treatment of Symptomatic Peripheral Artery Disease PAD
Surgical Treatment for Gastro-Esophageal (G-E) Reflux
Telemedicine Communication
Temporomandibular Joint Orthotics
Thermal Capsulorrhapy
Total Ankle Arthroplasty
Transcatheter Aortic Valve Replacement (TAVR)
Transcutaneous Vagus Nerve Stimulation 
Ultrasound Treatment for Plantar Fasciitis
Urolift System (NeoTract Inc)
Varithena (Sclerosing Solution for Varicose Veins)
Ventricular Assist Devices (VAD)
Vertebroplasty & Kyphoplasty
Wheelchair Coverage Guidelines
Whole Body Vibrations for the Promotion of Bone Growth in Postmenopausal Women

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