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Experimental Investigational Clinical Coverage Guidelines


AcuTect (Diatide, Inc., Londenderry, NH) is a complex of a small-molecule synthetic peptide, apcitide, and the radionuclide, technetium (Tc) 99m (a gamma ray emitter).

Autologous blood-derived growth factors (i.e. platelet rich plasma) is a covered benefit only for patients who have chronic non-healing diabetic, pressure, and/or venous wounds and when all the following conditions are met.


Computed tomography (CT) perfusion imaging provides a quantitative measurement of regional cerebral blood flow.


The Electro-Oculography (EOG) is an electrophysiological test of function of the outer retina and retinal pigment epithelium (RPE) in which the change in the electrical potential between the cornea and the ocular fundus is recorded during successive periods of dark and light adaptation

Scientific evidence regarding experimental and investigational procedures and devices is under a constant state of review.


Alzheimer’s disease (AD), which is the most common form of dementia, is a progressive, neurogenerative disorder characterized by amyloid plaques and neurofibrillary tangles in the brain.


Heart transplantation is a widely accepted therapy for the treatment of end-stage cardiac disease.

HUAM consists of a combination of telemetric recordings of uterine contractions combined with daily telephone calls from a health care practitioner to provide support and advice.


In vitro assays are intended for use with clinical decision-making to guide the pretherapeutic selection of chemotherapeutic agents.


Low level light therapy (LLLT) has been available for over 10 years as one of several physical agents used in physiotherapy.


The RedPath Integrated Pathology (Pittsburgh, PA) PathFinderTG test is not a single test, but rather, is an advanced pathology service that includes microdissection, selection of regions to be analyzed, analysis of these regions using a variety of molecular tests (topographic genotyping), and expert pathologist interpretation of the results along with what is known about the particular case.

Collaborative care models in primary care can improve pain management and patient outcomes.


HP Acthar Gel is an adrenocorticotropic hormone (ACTH) analogue indicated as monotherapy for the treatment of infantile spasms in infants and children under 2 years of age. HP Acthar Gel is also indicated for the treatment of exacerbations of multiple sclerosis in adults.


Inflammatory bowel diseases (IBDs), which include ulcerative colitis and Crohn’s disease, affect approximately one million Americans, and the incidence and prevalence of these diseases is increasing in western societies.


Although the Food and Drug Administration approved terbutaline for treatment of asthma, not preterm labor, subcutaneous infusion of this drug has been evaluated as a long-term or maintenance therapy for preterm labor.


The X Stop® Interspinous Process Decompression (IPD) System has been developed as part of a surgical method to treat lumbar spinal stenosis that includes neurogenic intermittent claudication, a disorder in which spinal nerves are compressed or “pinched.”

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Last Updated On: 6/19/2018