BlueCross BlueShield of Tennessee Medical Policy Manual

Obstetrics and Gynecology

• Cervical Cancer Screening Technologies (Pap/HPV/Speculoscopy/Cervicography)

• Endometrial Ablation for Treatment of Menorrhagia

• Fetal Echocardiography

• Fetal Fibronectin (fFN) to Predict Preterm Labor

• Fetal Surgery for Prenatally Diagnosed Malformations

• First-Trimester Detection of Down Syndrome Using Fetal Ultrasound Markers Combined with Maternal Serum Assessment

• Home Uterine Activity Monitoring (HUAM)

• Hysteroscopic Techniques for Permanent Sterilization

• Occlusion of Uterine Arteries Using Transcatheter Embolization or Surgical Occlusion for the Treatment of Fibroids

• Physician Attendance at Delivery for Newborn Care

• Prophylactic Oophorectomy

• Treatments of Twin-to-Twin Transfusion Syndrome (TTTS)

• Vulvectomy

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