BlueCross BlueShield of Tennessee Medical Policy Manual

Gastroenterology

• Ablation Treatments for Barrett’s Esophagus

• Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening

• Artificial Liver Assist Devices for the Treatment of Liver Conditions

• Bariatric Surgery for Morbid Obesity

• Botulinum Toxin

• Cryosurgical Ablation of Miscellaneous Solid Tumors

• Cutaneous Electrogastrography (EGG)

• Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy

• Endoscopic Injection Sclerotherapy for Treatment of Esophageal Varices

• Fecal Calprotectin Testing

• Galsulfase (Systemic)

• Gastric Electrical Stimulation for the Treatment of Gastroparesis and Obesity

• Genetic Testing for Helicobacter pylori Treatment

• Genotyping for Chronic Hepatitis C

• Immunochemical Fecal Occult Blood Tests

• In Vivo Analysis of Colorectal Polyps

• Ingestible pH and Pressure Capsule

• Ingestible Video Capsule Imaging of the Gastrointestinal Tract

• Multi-gene Expression Assay for Predicting Recurrence in Colon Cancer

• Natural Orifice Transluminal Endoscopic Surgery

• Pancreas/Pancreas-Kidney/Pancreatic Islet Cell Transplantation

• Positron Emission Tomography (PET) for Miscellaneous Applications

• Radioembolization for Primary Tumors of the Liver and Metastatic Tumors to the Liver

• Radiofrequency Energy Transanal Treatment of Fecal Incontinence

• Screening Colonoscopy for Colorectal Cancer in Individuals at Average Risk

• Serologic Diagnosis of Celiac Disease

• Serum Antibodies for the Diagnosis and Management of Inflammatory Bowel Disease: ANCA for Ulcerative Colitis and ASCA for Crohn's Disease

• Serum Tumor Markers for Gastrointestinal Cancer

• Small Bowel/Small Bowel-Liver/Multivisceral Transplantation

• Transesophageal Endoscopic Therapies for Gastroesophageal Reflux (GERD)

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