UM Guidelines
Master Index

Listed Alphabetically


- A -

Adrenalectomy by Laparoscopy

Ambulatory Surgery Complications: Observation Care

Angioplasty, Percutaneous Coronary Intervention

Ankle Dislocation, Closed or Open Reduction

Ankle Fracture, Closed, Open Reduction, Internal Fixation (ORIF)

Aortic Aneurysm, Abdominal, Endovascular Repair

Apparent Life-Threatening Event

Appendectomy, without Abscess or Peritonitis, Pediatric

Appendectomy, without Abscess or Peritonitis

Appendectomy, with Abscess or Peritonitis, by Laparoscopy

Appendectomy, with Abscess or Peritonitis, by Laparoscopy, Pediatric

Applied Behavioral Analysis - For BlueCare Use Only

Assertive Community Treatment (ACT)/Program of Assertive Community Treatment (PACT)

Assistant Surgeon Guidelines

- B -

Bladder Incision: Cystotomy

Bone Excision

Breast Cancer - PALB2 Gene

Breast or Ovarian Cancer, Hereditary - BRCA1 and BRCA2 Genes (Sequence Analysis and Common Duplication or Deletion Variants)

- C -

Cardiac Pacemaker Implantation

Cardiac Valvotomy, Percutaneous

Carotid Artery Stenting

Carotid Endarterectomy

Cervical Fusion, Anterior

Cervical Laminectomy

Cesarean Delivery

Cholecystectomy with Common Duct Exploration by Laparoscopy

Cognitive Communication Disorders Rehabilitation

Comprehensive Child and Family Treatment (CCFT): Intensive Outpatient Program

Continuous Positive Airway Pressure (CPAP) Device

Continuous Treatment Team (CTT): Intensive Outpatient Program


Cyanoacrylate Adhesive, Varicose Vein Treatment

Cystic Fibrosis - CFTR Gene and Mutation Panel

- D -

Deep Brain Stimulation (DBS)

Delirium: Inpatient Care

- E -

Elbow Fracture, Open Treatment

Elbow Arthroplasty

Electrophysiologic Study and Implantable Cardioverter-Defibrillator (ICD) Insertion

Evaluation / Assessment for Applied Behavior Analysis

Evaluation / Assessment for Applied Behavior Analysis - For BlueCare Use Only

- F -

Foot Fracture, Calcaneus or Talus, Open Reduction, Internal Fixation (ORIF)

Foot Orthotics, Custom

Fundoplasty, Esophagogastric, by Laparoscopy, Pediatric

- G -

Gastric Restrictive Procedure with Gastric Bypass

Gastric Restrictive Procedure with Gastric Bypass by Laparoscopy

Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy

Gastric Restrictive Procedure, Sleeve Gastrectomy, by Laparoscopy

- H -


Hip: Congenital Dislocation, Open Reduction

Hip Arthroplasty

Home Phototherapy Device for Neonatal Hyperbilirubinemia

Hospice Care

Humerus Fracture, Closed or Open Reduction

Hyperemesis Gravidarum - Case Management

Hysterectomy, Abdominal

Hysterectomy, Vaginal

Hysterectomy, Laparoscopic

Hysterectomy, Vaginal, Surgical with Radical Laparoscopy

- I -


Immune Thrombocytopenic Purpura (ITP), Pediatric

Intensive Interventions for Families (IFF) - For BlueCare Use Only

Intestinal Obstruction

- J -

- K -

Knee Arthroplasty, Total

Knee Arthrotomy

Knee Dislocation, Closed or Open Reduction

Knee: Fracture of Tibial Plateau, Closed or Open Reduction

- L -

Laparotomy for Gynecologic Surgery, Including Myomectomy, Oophorectomy, and Salpingectomy

Left Atrial Appendage Closure, Percutaneous

Liver Transplant

Liver Transplant, Pediatric

Lumbar Laminectomy

Lumbar Laminectomy with Rhizotomy

Lysis of Adhesions by Laparoscopy

- M -

Mandibular Osteotomy

Mastectomy, Complete

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

Mastectomy, Complete, with Tissue Flap Reconstruction

Medical Nutrition Therapy for Dietary Counseling

- N -

Neck Dissection

Newborn Care, Routine

- O -

Other Psychiatric Disorders: Intensive Outpatient Program

Other Psychiatric Disorders: Residential Care

- P -

Patent Ductus Arteriosus, Open, Thoracoscopic, or Transcatheter Closure

Patent Ductus Arteriosus, Open, Thoracoscopic, or Transcatheter Closure, Pediatric

Pediatric Adenotonsillectomy for Obstructive Sleep Apnea Syndrome (OSAS): Observation Care

Percutaneous Revascularization, Lower Extremity

Prostate Cancer - BRCA1 and BRCA2 Genes

Prostatectomy, Radical

Psychosocial Rehabilitation - For BlueCare Use Only

Pyloromyotomy for Pyloric Stenosis

- Q -

- R -

Removal of Posterior Spinal Instrumentation

Respite Care, Adult: Residential Care

Respite Care, Child/Adolescent: Residential Care

- S -

Sclerotherapy, Leg Veins

Shoulder Arthroplasty

Shoulder Hemiarthroplasty

Shunt, Ventriculoperitoneal for Hydrocephalus

Skilled Nursing Facility/Inpatient Rehabilitation Fax Form

Skilled Nursing Facility (SNF) Levels of Care

Skilled Nursing Facility Admission for Enhanced Respiratory Care - Ventilator Weaning - For BlueCare Use Only

Slipped Upper Femoral Epiphysis, Closed Reduction

Splenectomy by Laparoscopy

Stereotactic Radiosurgery

Sub-Acute Behavioral Health Level of Care, Adult: Partial Hospital Program

Substance-Related Disorders, Adult: Inpatient Care

Substance-Related Disorders, Child or Adolescent: Inpatient Care

Supported Housing: Residential Care

Sympathectomy by Thoracoscopy or Laparoscopy

- T -

Thoracic Surgery & Pulmonary Disease Intensive Care Admission

Thoracotomy with Biopsy or Miscellaneous Procedures by Video-Assisted Thoracic Surgery (VATS)

Tibia/Fibula Shaft Fracture, Closed or Open Reduction

Tibial Osteotomy, Adult

- U -

Ureterotomy, Nontransurethral for Stone

Urethroplasty - Transpubic or Perineal, 1-Stage, for Reconstruction or Repair of Prostatic or Membranous Urethra

Uterine Artery Embolization

- V -

Vaginal Delivery

Vaginal Delivery - Operative

Vertebroplasty and Kyphoplasty

- W -- X - Y - Z -

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