BlueCross BlueShield of Tennessee Medical Policy Manual

Obstetrics and Gynecology

• Cancer Screening of the Cervix

• Cervical Cerclage

• Endometrial Ablation for Treatment of Menorrhagia

• Fetal Echocardiography

• Fetal Fibronectin (fFN) to Predict Preterm Labor

• Home Uterine Activity Monitoring (HUAM)

• Hysteroscopic Techniques for Permanent Sterilization

• Intrauterine Laser Ablation of Placental Vessels for Twin-to-Twin Transfusion Syndrome (TTTS)

• Intrauterine Myelomeningocele Repair

• Nuchal Translucency with or without Maternal Serum PAPP-A and Free ß-hCG Levels as a First-Trimester Screening for Down Syndrome (Trisomy 21) and Edward Syndrome (Trisomy 18)

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

• Physician Attendance at Delivery for Newborn Care

• Prophylactic Oophorectomy

• Salivary Estriol Testing

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