BlueCross BlueShield of Tennessee Medical Policy Manual

Endocrinology

• Diabetes Management

• Goserelin Acetate

• Histrelin Acetate Implant

• Human Growth Hormone Replacement Therapy

• Insulin Potentiation Therapy

• Lanreotide Acetate

• Leuprolide Acetate

• Mastectomy for Gynecomastia

• Mecasermin (rDNA origin)

• Microalbumin Screening for Diabetic Nephropathy

• Nutritional Treatment of Inborn Errors of Metabolism

• Pegvisomant

• Positron Emission Tomography (PET) for Miscellaneous Applications

• Short-Term and Long-Term Continuous Glucose Monitoring of the Interstitial Fluid

• Thyroidectomy for the Prevention of Medullary Thyroid Carcinoma

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