“BCBST
UM Guidelines
General Surgery

Listed by Conditions


Appendectomy, without Peritonitis

Appendectomy, without Peritonitis, by Laparoscopy

Bowel Surgery: Small Intestine Resection

Cholecystectomy with Common Duct Exploration by Laparoscopy

Esophageal Diverticulectomy, Endoscopic

Fundoplasty, Esophagogastric, by Laparoscopy

Gastrectomy, Partial - Billroth I or II

Gastric Restrictive Procedure with Gastric Bypass by Laparoscopy

Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy

Hernia Repair (Non-Hiatal)

Liver Transplant

Lysis of Adhesions by Laparoscopy

Mastectomy, Complete

Mastectomy, Complete, with Insertion of Breast Prosthesis or Tissue Expander

Mastectomy, Partial (Lumpectomy)

Neck Dissection

Pancreatectomy

Pyloroplasty and Vagotomy

 

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