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Please enter the policy number associated with the account that you would like to make a payment on and select 'find my account' to proceed. This clinical policy has been developed by appropriately experienced and licensed health care professionals based on a review and consideration of currently available generally accepted standards of medical practice Description sacroiliac joint (sij) fusion, or arthrodesis, is a surgical technique that fuses the iliac bone to the sacrum for stabilization

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This procedure may be performed in a minimally invasive manner or as an open surgical procedure requiring a larger incision and subsequent increased recovery time. Up to 1 month of total treatment (a single continuous course of therapy up to 4 weeks is recommended) Providers are expected to exercise professional medical judgment in providing the most appropriate care and are solely responsible for the medical advice and treatment of members/enrollees.

If only the donor is covered by ambetter, ambetter will pay for the donor’s medical and/or travel costs as outlined in their eoc

However, no benefits will be provided for the recipient unless the transplant recipient is covered by ambetter (see scenario #1). Overview preimplantation genetic testing involves analysis of biopsied cells from an embryo as a part of an assisted reproductive procedure Sclerotherapy and chemical endovenous ablation for varicose veins and other symptomatic venous disorders If request is for a dose increase, new dose does not exceed an incremental increase of more than 0.2 mg/day and a total dose of 1.6 mg/day;

Providers are expected to exercise professional medical judgment in providing the most appropriate care, and are solely responsible for the medical advice and treatment of members.