“BCBST
UM Guidelines
Pediatric

Listed by Conditions


Apparent Life-Threatening Event

Appendectomy for Ruptured Appendix with Abscess or Generalized Peritonitis, Open or Laparoscopic, Pediatric

Appendectomy, Uncomplicated, Open or Laparoscopic, Pediatric

EEG, Video Monitoring, Pediatric

Failure to Thrive

Fundoplasty, Esophagogastric, by Laparoscopy, Pediatric

Hemophilia

Idiopathic Thrombocytopenic Purpura (ITP), Pediatric

Neutropenia after Chemotherapy, Pediatric

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

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

Slipped Upper Femoral Epiphysis, Closed Reduction

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