BlueCross BlueShield of Tennessee Medical Policy Manual

Neurology

• Acupuncture

• Adrenal-to-Brain Transplantation for the Treatment of Parkinson's Disease

• Apomorphine Hydrochloride

• Biofeedback

• Botulinum Toxin

• Cranial Electrotherapy Stimulation and Transcranial Magnetic Stimulation for the Treatment of Depression and Other Psychiatric Disorders

• Craniosacral Therapy

• Deep Brain Stimulation for the Treatment of Movement Disorders

• Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds / Ulcers

• Electrocorticography (ECoG)

• Electroencephalograms (EEGs) by Telemedicine Transmission

• Electrophrenic Pacemaker

• Extracorporeal Shock Wave Therapy in the Treatment of Peyronie's Disease

• Hypertension Therapy Using Low Level Electrical Stimulation

• Interferential Current Therapy for the Treatment of Pain

• Intraepidermal Nerve Fiber Density Testing

• Intraoperative Neurophysiologic Monitoring

• Ketogenic Diet Counseling for Refractory Seizure Control

• Low Level Laser Therapy (LLLT)

• Lumbar Epidural Steroid Injections for Treatment of Low Back Pain

• Lumbar Facet Steroid Injections for Treatment of Low Back Pain

• Lysis of Epidural Adhesions for Chronic Pain Syndrome

• Magnetoencephalography and Magnetic Source Imaging of the Brain

• Music Therapy for the Treatment of Neurologic Conditions / Diseases

• Needle Electromyography (EMG)

• Nerve Conduction Studies

• Neuromuscular Electrical Stimulation

• Neuromuscular Reeducation

• Pelvic Floor Stimulation

• Percutaneous Electrical Nerve Stimulation (PENS)

• Percutaneous Transluminal Angioplasty of Intracranial Atherosclerotic Stenoses With or Without Stenting

• Positron Emission Tomography (PET) for Miscellaneous Applications

• Posterior Tibial Nerve Stimulation (PTNS) for Voiding Dysfunction

• Quantitative Sensory Testing

• Rufinamide

• Sacral Nerve Stimulation/Modulation for Pelvic Floor Dysfunction

• Sacroiliac Joint Steroid Injection for the Treatment of Low Back Pain

• Selective Dorsal (Posterior) Rhizotomy for Spasticity in Cerebral Palsy

• Somatosensory Evoked Potentials (Non-intraoperative)

• Spinal Cord Stimulation for Treatment of Pain

• Stereotactic Radiofrequency Pallidotomy for Treatment of Parkinson's Disease

• Stereotactic Radiosurgery of Central Nervous System (CNS) Lesions

• Sural Nerve Graft in Association with Radical Prostatectomy

• Surface Electromyography (SEMG)

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

• Sympathetic Therapy for the Treatment of Pain

• Thermography

• Thoracic Sympathectomy for the Treatment of Hyperhidrosis

• Topographic Brain Mapping

• Transcutaneous Electrical Nerve Stimulation (TENS)

• Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Nausea and Vomiting

• Vagus Nerve Stimulation for the Treatment of Depression

• Vagus Nerve Stimulation for the Treatment of Medically Refractory Movement Disorders, Headaches and Obesity

• Visual and Auditory Evoked Potentials

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