A higher standard for health.

AvMed is actively involved in the adoption and dissemination of standards, guidelines, and related documents for use by AvMed's Network Practitioners and AvMed's Members. A convenient and important resource for all healthcare professionals who have AvMed Members under their care, these documents contain current, evidenced-based information related to clinical and preventive care practice.

 

 If your office needs a hard copy of any of these documents, please call the Provider Service Center at 1-800-452-8633. You may also e-mail your request to: providers@avmed.org

AvMed Clinical Guidelines and Standards

Pediatric Preventive Care Recommendations and Immunizations

 

Pediatric Preventive Care Recommendations (pdf)

 

Adult Preventive Care Recommendations and Immunizations


Adult Preventive Care Recommendations (pdf)

 

AvMed Coverage Guideline

Abdominoplasty & Panniculectomy
Acoustic Rhinometry
Alair Thermoplasty
Allergy and Immunology Testing
Alopecia Areata Treatment
Alternative Methods for Breast Cancer Screnings
Argus II Retinal Prosthesis System
Atrial Appendage Closure
Attention Deficit Hyperactivity Disorder (ADHD) Treatment
Autism-Autism Spectrum Disorder, Diagnosis, & Treatment
Autologous Chondrocyte Implantation
Axial Lumbar Interbody Fusion (AxiaLif)
Benign Lesion Removal
Blepharoplasty & Brow Ptosis Repair
Bone Growth Stimulator
Breast Thermography-BreastCare DTS
Cane Crutches & Walker Coverage Guidelines
Cardiac Signal Analysis Procedures
Chelation Therapy
Chronic Cerebro-Spinal Venous Insufficiency (CCSVI)
Chronic Intermittent Intravenous Insulin Therapy (CIIIT)
Cochlear Implant, Bone Anchored Hearing Aids, and Auditory Brainstem Implant
Cold Therapy DME
Collagenase (Xiaflex) Treatment
Computerized Gait Analysis
Continuous Glucose Monitoring
Continuous Subcutaneous Insulin Infusion Pump
Cosmetic Surgery & Procedures
Cranial Sacral Therapy
Dental Appliances for Sleep Apnea
Electromagnetic Navigation Guided Bronchoscopy
EMS for Urinary Incontinence
Endo-PAT 2000
EndoCinch
Enteral Nutrition
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
Implantable Hormone Pellets
Implantable Infusion Pumps, Spinal Cord Stimulators, & Neuromusc Stimulators
In Utero Fetal Surgery
Inspire Upper Airway Stimulation
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
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
Neurostim in Resistant Depression
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
OxygenTherapy for Non-Medicare Advantage Members
Pectus Deformity Repair
Phototherapy & Photochemotherapy Treatment (PUVA, 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
Reduction Mammoplasty
Robotic Assisted Surgery
Skin Substitutes for Wound Care
Sleep Study Including Split-study Parameters & CPAP-BiPap
Solesta
Speech Generating Devices
Spinal Manipulation Under Anesthesia
Spinal Unloading Devices
Surgical Treatment for Gastro-Esophageal (G-E) Reflux
Telemedicine Communication
Temporomandibular Joint Orthotics
Thermal Capsulorrhapy
TMJ Orthotics
Total Ankle Arthroplasty
Transcatheter Aortic Valve Replacement
Nitric Oxide and ECMO Treatment
Ultrasound Treatment of Plantar Fasciitis
Urolift System (NeoTract Inc)
Varithena (Sclerosing Solution for Vericose Veins)
Ventricular Assist Devices (VAD)
Vertebroplasty & Kyphoplasty
Wheelchair Coverage Guidelines
Whole Body Vibrations

 

Pharmacy Coverage Guidelines

Abatacept (Orencia)
Abiraterone (Zytiga)
Adalimumab (Humira)
ADHD Greater than 18 yrs
Ado-Trastuzumab Emsantine (Kadcyla)
Afatanib (Gilotrif)
Alemtuzumab (Lemtrada®)
Alosetron (Lotronex)
Aloxi
Alzheimers Agents
Anakinra (Kineret)
Angiotensin II Receptor Antagonists
Anti-Fungal Therapy
Antidepressants (Cymbalta, Pristiq, Viibryd)
Antihemophilic factor, Fc fusion protein (Eloctate®)
apremilast (Otezla)
Aprepitant (Emend)
Aranesp Attachment A
Arformoterol (Brovana) or Formoterol (Performomist)
Aripiprazole (Abililfy)
Aspariganase (Erwinaze)
Atezolizumab (Tecentriq)
Avonex Betaseron
Axitinib (Inlyta)
Bedaquiline (Sirturo™)
Belatacept (Nulojix)
Belimumab (Benlysta)
Belinostat (Beleodaq®)
Bendamustine (Treanda, Bendeka)
Bevacizumab (Avastin)
Blinatumomab (Blincyto®)
Bosutinib (Bosulif)
Botulinum Toxins
Brentuximab Vedotin (Adcetris)
Buprenorphine (Probuphine)
Buprenorphine Patch(Butrans)
C1 Inhibitor, Human (Cinryze)
Cabazitaxel (Jevtana)
Cabozantinib (Cometriq)
Carfilzomib (Kyprolis)
Celecoxib (Celebrex)
Ceritinib (Zykadia)
Certolizumab Pegol (Cimzia)
Cetuimab (Erbitux)
Cholic Acid (Cholbam)
Concomitant Use of Buprenorphine-Naloxone
Concurrent Osteo Med
Corticotropin (H.P. Acthar Gel)
Crizotinib (Xalkori)
Crofelemer (Fulyzaq)
Cyclosporine (Restasis)
Cysteamine Bitartratre (Procysbi™)
Cysteamine Ophthalmic Solution (Cystaran™)
Dabrafenib (Tafinlar)
Daclatasvir (Daklinza)
Dalfampridine (Ampyra)
Darbepoetin Alfa (Aranesp)
Deferiprone (Ferriprox)
Dextromethorphan-Quinidine (Nuedexta)
Dihydroergotamine Mesylate (DHE 45 Injectable)
Dimethyl Fumarate (Tecfidera)
DPP-4 Inhibitors
Dronabinol (Marinol)
Eculizumab (Soliris)
Eliglustat (Cerdelga®)
Elosulfase alfa (Vimizim)
Eltrombopag (Promacta)
Enzalutamide (Xtandi)
Erectile Dysfunction Agents
Erlotinib (Tarceva®)
Erythropoietin, Epoetin Alfa (Procrit, Epogen)
eslicarbazepine acetate (Aptiom)
Etanrecept (Enbrel)
Everolimus (Afinitor, Afinitor Disperz®)
Evolocumab (Repatha™)
Ezogabine (Potiga)
Fentanyl Nasal Spray (Lazanda)
Ferric Carboxymaltose (Injectafer)
Fibric Acid Derivatives
Fidaxomicin (Dificid)
Filgrastim, GCSF (Neupogen)
Fingolimod (Gilenya)
Firazyr
Fuzeon
Gattex
Glucarpidase (Voraxaze)
Glumetza (metformin extended release tablets)
Glycerolphenylbutyrate (Ravicti) & Sodium Phenylbutyrate (Buphenyl)
Golimumab (Simponi)
Growth Hormone Attachment
Growth Hormone Somatropin (except Serostim)
HAE Berinert, Firazyr, Kalbitor
Hepsera
HIV Aids Med Nutrition Therapy Protocol
Ibrutinib (Imbruvica)
Idelalisib (Zydelig®)
Imiglucerase (Cerezyme)
Implantable Hormone Pellets
Incivek, Victrelis
Infliximab (Remicade)
Insomnia Agents (Lunesta, Rozerem, Zolpidem)
Interferon Alfa-2b (Intron A)
Intravenous Immune Globulin (IVIG)
Intron A Attachment A
Intron A Medicare
Ipilimumab (Yervoy)
Isavuconazonium (Cresemba®)
Itraconazole (Sporanox)
Ivacaftor (Kalydeco)
IVIG Attachment A
IVIG Medicare
Lenvatinib (Lenvima®)
Leukine Attachment B
Leuprolide (Lupron) & Histrelin (Supprelin LA)
Linezolid (Zyvox)
LMWH, Arixtra
Lomitapide (Juxtapid)
Lovaza, Vascepa Fish Oil
Lumacaftor/Ivacaftor (Orkambi™)
Lupron & Lupron Depot Medicare
Luteinizing Attachment A
Macitentan (Opsumit)
Makena
Mechlorethamine Gel (Valchlor)
Methylnaltrexone Bromide (Relistor)
Mifepristone (Korlym)
Miltefosine (Impavido®)
Mipomersen Sodium (Kynamro)
Modafinil (Provigil) & Armodafinil (Nuvigil)
Nasal Steroids
Natalizumab (Tysabri)
Netupitant/Palonosetron (Akynzeo®)
Neulasta Attachment A
Neumega Attachment A
Neumega Medicare
Neupogen Attachment A
Neupogen Medicare
Niaspan (Niacin Sustained Release)
Nintedanib (Ofev®) and Pirfenidone (Esbriet®): (IPF Agents)
Nivolumab (Opdivo®)
Obeticholic Acid (Ocaliva)
Obinutuzumab (Gazyva)
Olaparib (Lynparza®)
Omacetaxine Mepesuccinate (Synribo)
Omalizumab (Xolair)
Opioid Quantity Limits
Oprelvekin (Neumega)
Oral Contraceptives
Orencia Medicare
Oxycontin (Extended Release Oxycodone)
Paclitaxel Protein Bound Particles (Abraxane)
Palbociclib (Ibrance®)
Palivizumab (Synagis)
Panitumumab (Vectibix)
Panobinostat (Farydak®)
Parathyroid Hormone (Natpara®)
Pasireotide (Signifor)
Pazopanib (Votrient™)
Peg Intron, Pegasys, Copegus, Rebetrol
Pegfilgrastim (Neulasta)
Peginterferon Alfa-2b (Sylatron)
Peginterferon Beta-1a (Plegridy®)
Pegloticase (Krystexxa)
Pembrolizumab (Keytruda®)
Pemetrexed (Alimta)
Perampanel (Fycompa)
Pimavanserin (Nuplazid)
Pomalidomide (Pomalyst)
Ponatinib (Iclusig)
Posaconazole (Noxafil)
Preventive Care for Comm Mbrs
Procrit Attachment A
Proton Pump Inhibitors (PPIs)
Pulmonary Arterial Hypertension (Adcirca, Flolan, Veletri, Revatio, Tracleer, Tyvaso, Ventavis)
Quetiapine Ext Release (Seroquel XR)
Quinine Sulfate (Qualaquin)
Ramucirumab (Cyramza™)
Regorafenib (Stivarga)
Remicade Medicare
Reslizumab (Cinqair)
Rifaximin (Xifaxan) 550mg
Riociguat (Adempas)
Rituxan Medicare
Rituximab (Rituxan)
Rituximab Attachment A
Roflumilast (Daliresp)
Romiplostim (Nplate)
Ruxolitinib (Jakafi)
Sargramostim, GM-CSF (Leukine) Medicare
Sargramostim, GM-CSF (Leukine)
Sebelipase Alpha (Kanuma)
Secukinumab (Cosentyx®)
Selzentry
Serostim Treatment Guidelines
Serotonin-Receptor Agonists
Short Acting Beta Agonists (Proair HFA, Proventil HFA, Xopenex HFA)
Siltuximab (Sylvant)
Simeprevir (Olysio)
Sipuleucil-T (Provenge)
Sodium Oxybate (Xyrem)
Sofosbuvir (Sovaldi)
Sofosbuvir-Ledipasvir (Harvoni)
Sofosbuvir Velpatasvir (Epclusa)
Solesta
Somatropin (Serostim)
Sovaldi
Subcutaneous Immune Globulin (SCIG)
Sumatriptan succinate (Imitrex) Injection
Supersaturated Calcium Phosphate Rinse (Caphosol, Mugard, Episil)
Telithromycin (Ketek)
Teriflunomide (Aubagio)
Teriparatide Injection (Forteo)
Testosterone Topical Products
Tetrabenazine (Xenazine®)
Tobi
tocilizumab (Actemra)
Tofacitinib (Xeljanz)
Tolvaptan (Samsca®)
Trametinib (Mekinist™)
Trastuzumab (Herceptin)
treprostinil (Orenitram)
Ustekinumab (Stelara)
Vedolizumab (Entyvio)
Velaglucerase Alfa (Vpriv)
Vemurafenib (Zelboraf)
Venetoclax (Venclexta)
Vincristine Liposomal (Marqibo)
Vismodegib (Erivedge)
Weight Loss Meds
Xolair Medicare
Ziv-Afliercept (Zaltrap)

Preventive Services