BlueCross BlueShield of Tennessee Medical Policy Manual

Women's Health

• Analysis of Proteomic Patterns in Serum to Identify Ovarian Cancer

• Brachytherapy for Breast Cancer

• Breast Augmentation / Mammaplasty (Non-Cancerous)

• Breast Duct Endoscopy

• Breast Ductal Lavage for Cancer Risk Assessment

• Breast Implant Removal

• Breast Reconstructive and Symmetry Surgery Following Mastectomy

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

• Computer-Aided Detection of Malignancy with Magnetic Resonance Imaging of the Breast

• Cryosurgical Ablation of Miscellaneous Solid Tumors

• Cytologic Evaluation in Breast Cancer Risk Assessment

• Digital Breast Tomosynthesis

• Electrical Impedance Scanning of the Breast

• Endometrial Ablation for Treatment of Menorrhagia

• Gene Expression Profiling Assays as a Technique to Determine Prognosis for Managing Breast Cancer Treatment

• Genetic Testing for BRCA1, BRCA2 or CHEK2 for Breast or Ovarian Cancer

• Genetic Testing for HER-2

• Hematopoietic Stem Cell Transplant for Breast Cancer

• Human Papillomavirus (HPV) Vaccine

• Magnetic Resonance Imaging (MRI) of the Breast

• Mammography Screening

• MRI-Guided High Intensity Ultrasound Ablation of Uterine Fibroids

• Non-BRCA Breast Cancer Risk Assessment

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

• Ovarian and Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome

• Ovarian Cancer Tumor Markers

• Prophylactic Mastectomy

• Prophylactic Oophorectomy

• Reduction Mammaplasty (Non-Cancerous)

• Saliva Testing for Hormone Levels

• Serum Tumor Markers for Breast Malignancies

• Surgical Interruption of Pelvic Nerve Pathways for the Treatment of Chronic Pelvic Pain

• Vulvectomy

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