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	Abdominoplasty (Panniculectomy, Abdominal Suction-Assisted Lipectomy or Liposuction)		Abdominoplasty, also known as a tummy tuck, is a surgical procedure involving the removal of excess skin and fat from the middle and lower abdomen in order to tighten the abdominal wall muscles. A panniculectomy is a surgical procedure designed to remove a panniculus (excess ?apron? or accumulation of fat) from the abdomen and generally does not include tightening of the abdominal muscles. Abdominal suction-assisted lipectomy or liposuction is a surgical procedure designed simply to remove fat under the abdominal skin to improve appearance.

	Actiq (oral transmucosal fentanyl citrate)		Actiq, also called oral transmucosal fentanyl citrate (OTFC), is a powerful narcotic used to relieve breakthrough pain in cancer patients who are already receiving opioids and are tolerant of opioid therapy for their underlying persistent cancer pain. Each OTFC unit is a lozenge containing fentanyl. The lozenge allows drug delivery through the oral mucosa resulting in rapid pain relief.

	Acupuncture		Acupuncture is a Chinese medical practice that involves the insertion of hair-thin needles into nonanatomic energy channels, called meridians. Acupuncture has been used as a way to control nausea and vomiting, pain, and addictive behaviors.

	Air Ambulance		Air medical services transport critically ill or injured patients via air ambulance to a medical facility.

	Amevive (alefacept)		Amevive (alefacept) is a biologic drug indicated for the treatment of moderate-to-severe chronic plaque psoriasis. Amevive blocks and eliminates certain T-cells that play a role in psoriasis

	Amniotic Membrane (AM) Transplantation of the Eye		Amniotic membrane (AM) transplantation is a procedure that utilizes amniotic membrane tissue to reconstruct damaged ocular surfaces and promote healing of corneal, conjunctival and eyelid tissues after injury due to trauma, disease or surgery.

	Aranesp		Darbepoetin alfa is an erythropoiesis stimulating protein, closely related to erythropoietin, that is produced in Chinese hamster ovary cells by recombinant DNA technology. Darbepoetin alfa is a 165-amino acid protein that differes from recombinant human erythropoietin (epoetin alfa) in containing 5 N-linked oligosaccharide chains, whereas epoetin alfa contains 3 chains. The two additional N-glycosylation sites result from amino acid substitutions in the erythropoietin peptide backbone. The additional carbohydrate chains increase the approximate molecular weight of the glycoprotein from 30,000 to 37,000 daltons. Darbepoetin alfa is formulated as a sterile, colorless, preservative-free protein solution for intravenous or subcutaneous administration.

	Artificial Intervertebral Disc Replacement		Artificial intervertebral disc replacement is a medical device used as an alternative to spinal fusion in patients with degenerative disc disease (DDD). Also known as the Charite? Artificial Disc, the design of the device allows the spine to move.

	Autism-Related Services		Autism is a biologically based neurodevelopmental disability that develops prior to age three. Autism is referred to as a developmental disability. An autistic child is unable to use language meaningfully or to process information from the environment. In addition to social and communicative deficits, characteristics of autism include language-based cognitive deficits, restricted and repetitive behaviors and interests and a predictable clinical course. Autism can range from mild disorders that are amenable to therapy, resulting in individuals becoming functional, independent adults to the severely impaired, who usually have significant mental retardation requiring long-term care.

	Back Braces		Back bracing supports the back following injury or surgery and may decrease associated back pain.

	Bariatric Revision Surgery		Revisional bariatric surgery is a repeat bariatric surgical procedure performed in patients who fail to achieve adequate weight loss following an initial bariatric surgical procedure. Revised surgery is also performed on patients who lose adequate weight with an initial bariatric surgery, then re-gain the weight. Revisional bariatric surgery may also be performed due to early complications of the initial surgery. This guideline does not address revisional surgery for this indication. This guideline was written to address the issue of repeat bariatric surgery to enhance weight loss following initial surgery and patients who re-gain weight due to non-compliance following initial surgery.

	Birmingham Hip Resurfacing System		The Birmingham Hip Resurfacing (BHR) System is a metal on metal resurfacing system that was designed as an alternative to traditional total hip replacement (THR). The ball of the femur is resurfaced with a metal shell rather than being removed and replaced and the damaged surface of the hip socket is also resurfaced. The BHR System conserves more of the patient?s own bone and is intended for patients who may not be suitable for total hip replacement due to their relatively young age or increased activity level because of increased possibility of requiring future hip join revision.

	Bone Density Testing		Bone mineral density (BMD) testing evaluates bone loss in patients with strong risk factors for osteoporosis; to diagnose suspected osteomalacia or osteodystrophies; and to examine changes in bone associated with disease progression or response to therapy.

	Bone Growth Stimulators		Bone growth stimulation is used to assist the healing of fresh or nonunion/delayed union bone fractures. Bone growth stimulation is performed via electrical or ultrasound stimulation through invasive, semi-invasive, or noninvasive means. Interferential therapy has also been mentioned as a bone growth stimulator. Interferential therapy is a specific type of transcutaneous electrotherapy in which two slightly different, medium-frequency alternating currents are applied simultaneously through electrodes placed on the skin overlying the affected area of the body.

	Boniva (Ibandronate) Injection		Boniva injection is the first intravenous (IV) medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of postmenopausal osteoporosis. Boniva injection belongs to the bisphosphonate class of drugs and is administered to patients once every 3 months. The action of ibandronate on bone tissue is based on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Ibandronate inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.

	Botulinum Toxin		Botulinum toxin (BTX), administered in small doses, controls muscle spasms by temporarily weakening or paralyzing nerves. Other names for botulinum toxin include: BTX-A, known commercially as Botox; BTX-B known commercially as Myobloc.

	Breast MRI		In the past, MRI has been utilized for examinations of the internal organs or musculoskeletal system. However, in the mid-1990?s researchers began to investigate the use of MRI for breast cancer detection/diagnosis. In March 2007 the American Cancer Society published its recommended guidelines for use of the MRI for breast screening.

	Breath Tests for Airway Inflammation		Exhaled breath tests are non-invasive techniques proposed to verify markers for airway inflammation. Mainly used for the management of asthma, exhaled breath tests may also be used to evaluate other respiratory disorders that have an inflammatory component.

	Capsule Endoscopy		Capsule endoscopy is a diagnostic procedure performed to visualize the esophagus or small bowel. The PillCam SB (small bowel) Capsule Endoscopy, formerly known as the Given Diagnostic System, is a noninvasive diagnostic imaging device for use in viewing the small bowel. The PillCam ESO (esophageal) is intended for use as a diagnostic tool in the detection of abnormalities of the esophagus, such as gastroesophageal reflux disease (GERD), Barrett?s esophagus, and esophageal varices.

	Cardiac Rehabilitation		Cardiac rehabilitation is the process of supervised exercise and education that leads the post-coronary patient to improved exercise capacity and risk factor management.

	Carticel		Autologous chondrocyte transplantation (ACT) or autologous chondrocyte implantation (ACI) is a procedure utilized to treat traumatic cartilage defects of the knee joint. Chondrocytes (cartilage cells) are biopsied during arthroscopy (introduction of a thin fiberoptic scope into the knee to allow direct visualization of internal structures) and cultured in a laboratory. After 14 to 21 days, a surgeon performs an arthrotomy (incision into the knee joint), and injects the cultured chondrocytes under a periosteal flat at the site of the defect. The injected chondrocytes are intended to create new cartilage development in the knee joint.

	Celiac Plexus Block		Celiac plexus block (CPB) or neurolysis (CPN) are established techniques for relieving pain associated with cancers of the upper abdomen, particularly pancreatic cancer. The celiac plexus is primarily a sympathetic nervous system structure that transmits both visceral afferent and efferent information for the majority of the upper abdominal viscera. CPB may also be referred to as splanchnic nerve block.

	CellCept (mycophenolate mofetil), Intravenous		CellCept is an immunosuppressive agent indicated for the prophylaxis of organ rejection in patients receiving a renal, cardiac, or hepatic transplant.

	Chemotherapy Administration in the Home		Home chemotherapy is a safe and acceptable alternative to outpatient and inpatient hospital treatment. Home-based therapy is not possible or appropriate for all patients. Complex or prolonged chemotherapy regimens or those associated with a risk of an immediate serious complication are more appropriately administered at a hospital. However, many commonly administered chemotherapy regimens are suitable for administration in the home.

	Cochlear Implants, Auditory Brainstem Implants		A cochlear implant is an electronic device that can provide improved speech and hearing communication abilities for people who have severe to profound hearing loss in both ears. The implant is surgically placed under the skin behind the ear. It generally consists of four parts: a microphone, which picks up sound from the environment; a speech processor, which is externally worn or carried and arranges the sound transmitted by the microphone; a receiver/stimulator that receives signals from the speech processor and converts them into electrical impulses; and electrode(s), which collect the impulses from the stimulator and sends them to the brain.

	Consensus Interferon for Chronic Hepatitis C		Interferon alfacon-1 (consensus interferon) is a nonnaturally occurring, synthetic recombinant type-1 interferon used to treat chronic hepatitis C administered by subcutaneous injection. Consensus interferon was developed by assigning the most commonly observed amino acid of several natural interferon alfa subtypes to develop a novel type I interferon. The trade name for consensus interferon is Infergen.

	Copaxone (glatiramer acetate)		Glatiramer acetate (GA) is the first non-interferon maintenance immunotherapy for multiple sclerosis (MS). GA is a random polypeptide consisting of four amino acids in a specific molar ratio. GA is a disease-modifying drug, formerly known as copolymer-1.

	CPAP (Continuous Positive Airway Pressure)		Obstructive sleep apnea (OSA) is a condition characterized by periods of breathing cessation (apnea) and reduced breathing (hypopnea) due to upper airway collapse secondary to relaxation of pharyngeal dilating muscles during sleep. The number of breathing disturbances per hour of sleep, otherwise known as the apnea-hypopnea index (AHI) or respiratory distress index (RDI) is a measure of disease severity. Patients with OSA frequently complain of unrefreshing sleep, excessive daytime sleepiness, and impairment in cognitive tasks. CPAP, a noninvasive treatment for OSA, administers low levels of continuous air pressure to prevent the collapse of the oropharynx. The CPAP apparatus consists of an airflow generator, tubing, and a facemask fitted to the patient. CPAP provides symptomatic treatment but does not correct the underlying pathological condition.

	CPAP Titration during Polysomnography		To determine the appropriate pressure setting for CPAP, patients undergo a titration sleep study. CPAP, a noninvasive treatment for obstructive sleep apnea (OSA), administers low levels of continuous air pressure to prevent the collapse of the oropharynx. The CPAP apparatus consists of an airflow generator, tubing, and a facemask fitted to the patient. CPAP provides symptomatic treatment but does not correct the underlying pathological condition. Split-night polysomnography (PSG) is a combination sleep study where the first half of the night provides a diagnostic baseline PSG, and if this study indicates OSA, the second half of the night is used for CPAP evaluation and titration. Split-night PSG is considered as an alternative to full-night PSG followed by a second night PSG with CPAP titration in selected patients with OSA

	Deep Brain Stimulation		Deep brain stimulation (DBS) is used for the treatment of movement disorders and control of tremor in patients diagnosed with Parkinson?s disease (PD) or essential tremor (ET). An electrode is surgically implanted into the ventral intermediate nucleus (Vim), the internal globus pallidus (Gpi) or the subthalamic nucleus (STN) of the brain and connected to a pulse generator implanted in the chest. When activated, the system delivers a mild electrical stimulation that blocks the dysfunctional brain signals that cause tremor. The patient can activate and deactivate the device by waving a hand held magnet over the pulse generator. DBS is an alternative to pallidotomy and thalamotomy because, unlike these surgeries, DBS is reversible since no permanent lesion is created.

	Dental Services: Anesthesia and Facility Benefit		General anesthesia is an induced state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the ability to independently maintain an airway and respond purposefully to physical stimulation or verbal command. When a child or a person of any age with a disability needs extensive dental treatment, general anesthesia may recommended making delivery of that require treatment possible in a safe and comfortable manner.

	Diabetes Self-Management Education and Medical Nutrition Therapy		Diabetes self-management education is the process of providing an individual with diabetes the knowledge and skills to perform self-care on a day-to-day basis. Self-management education is delivered by an interdisciplinary team comprised of at least 1) a registered dietitian and 2) a Certified Diabetes Educator (preferred)*, who is either a registered nurse or other health professional. The education program should provide comprehensive instruction including, but not limited to, the disease process, nutrition, exercise and activity, medications, behavior change strategies, and the relationship among nutrition, exercise, medication, and blood glucose levels.

	Diabetes Self-Monitoring Devices		Glucose monitoring is the cornerstone of diabetes care. There are many devices diabetic patients may use to self-monitor glycemic status as part of their daily routine. By self-monitoring, diabetic patients can more effectively manage their condition and reduce incidence of complications. Monitoring devices range from implantable to non-invasive. The fingerstick is the standard method of self-monitoring glycemic status. A continuous glucose monitoring system monitors the glucose levels in a patient continuously over a two to three day period

	Durable Medical Equipment (DME)		Medical equipment covers a wide range of products used in a variety of health-care settings and includes such items as needles, syringes, walking aids, and blood glucose monitors. A medical device is any instrument, apparatus, appliance, material, or health-care product, excluding drugs, used for a patient for the purpose of diagnosis, prevention, monitoring, treatment, or alleviation of disease, injury, or handicap.

	EEG-Video Monitoring		Electroencephalographic (EEG)-video monitoring is the simultaneous documentation of the clinical and electroencephalographic symptoms of seizures. The patient is recorded on video to allow frequent viewing of the clinical sequence so that a patient?s symptoms can be compared to identify seizures. This technology improves patient outcome by allowing the proper identification of the symptoms for accurate diagnosis and therapy. Video-EEG monitoring is sometimes referred to as ictal EEG monitoring.

	Electrical Bladder Stimulation for the Treatment of Urinary Incontinence		Electrical stimulation is performed to modify bladder/sphincter actions in an effort to decrease or eliminate urinary incontinence. Electrodes are placed vaginally, anally, percutaneously, or sacrally. A mild electrical current is then applied to the pelvic floor muscles or to the lower spine. Electrical stimulation can make lower pelvic muscles stronger, thus reducing or eliminating incontinence (Appendix A describes each form of incontinence). Sacral nerve electrical stimulation for urinary incontinence applies mild electrical stimulation of the sacral nerve through a system that is surgically implanted under the skin of the abdomen.

	Electrical Stimulators for Pain		Transcutaneous electrical nerve stimulation (TENS) and interferential current stimulation (ICS) are the two most common forms of transcutaneous electrical stimulation used for pain management therapy. Both therapies send electrical impulses from a portable, battery-powered pulse generator using skin electrodes placed over the affected tissue. ICS differs from TENS by allowing the electrical impulses to have a deeper penetration of the tissue. Percutaneous neuromodulation therapy (PNT) uses very fine, acupuncture-like needles inserted into the tissues surrounding the spine. Electrical current is applied to the needles which are then thought to stimulate peripheral nerves. This treatment cannot be used at home; it is intended for use by a physician. Pulsed electrical stimulation (PES) is another non-invasive, low amplitude device designed to decrease pain and increase function in patients with osteoarthritis (OA) of the knee. The device consists of a signal generator, signal applicator, and contact elements encased in a soft wrap with a Velcro closure, which is wrapped around the affected knee.

	Enbrel (etanercept)		Tumor necrosis factor (TNF)-alpha circulates in the bloodstream and plays an important role in the inflammatory process in the body. Overproduction of TNF-alpha may lead to some diseases associated with inflammation, such as Crohn?s disease (CD) and rheumatoid arthritis (RA). The FDA has approved three anti-TNF-alpha biologic agents: Remicade (infliximab) (IV), Enbrel (etanercept) (SC injection), and Humira (adalimumab) (SC injection).

	Epidural Steroid Injections for Pain Management		An epidural steroid injection (ESI) for pain management is used to relieve nerve root irritation (radicular pain or sciatica) due to bone encroachment or disk herniation in the spine. Selective or single nerve root injections refer to the specific nerve root targeted for the epidural injection; these areas can be cervical, thoracic, lumbar, and caudal. Transforaminal injections are a type of epidural injection in which fluoroscopic visualization is necessary for proper direction of the needle, and contrast medium is used to document adequate periradicular flow.

	Erythropoietic Stimulation Therapy (Epoetin alfa and Aranesp)		Epoetin alfa is a manufactured version of human erythropoietin (EPO). EPO is produced naturally in the body and stimulates the bone marrow to produce red blood cells. If the body does not produce enough EPO, severe anemia can occur. This often occurs in people whose kidneys are not working properly. Epoetin alfa is marketed under the brand names Epogen and Procrit. Aranesp, darbepoetin alfa, has been recently approved by the FDA. Aranesp has a longer terminal half-life than Epoetin alfa, allowing for less frequent administration than epoetin alfa.

	Extracorporeal Immunoadsorption (Prosorba)		Extracorporeal immunoadsorption (ECI) utilizing a Prosorba? column is performed for moderate to severe rheumatoid arthritis (RA), idiopathic thrombocytopenia purpura (ITP), thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS). For those patients with RA it is performed on adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).

	Facet Joint Blocks for Chronic Pain		Facet joint blocks are performed for diagnostic as well as therapeutic purposes. Facet blocks are performed to identify and treat facet (zygapophyseal) joint syndrome as a source of low back pain and cervical pain. Facet block may also be referred to as intraarticular or medial branch block.

	Fentora		Fentora, fentanyl citrate buccal tablet, is a powerful narcotic analgesic used to relieve breakthrough pain in cancer patients who are already receiving opioids and are tolerant to opioid therapy for their underlying persistent cancer pain. Each buccal tablet unit contains fentanyl citrate and is supplied in five dosage strengths: 100, 200, 400, 600, and 800mcg. The tablet utilizes an effervescent reaction at the buccal mucosa for rapid absorption and pain relief.

	Foot Orthotics for Plantar Fasciitis		Orthoses are designed to provide support for a number of musculoskeletal conditions, including plantar fasciitis, in an attempt to provide symptom relief. The most commonly used mechanical corrections for plantar fasciitis include arch taping, OTC arch supports, custom orthotics, and night splints.

	Forteo (teriparatide)		Forteo is a biologic injectable drug that is identical to the biologically active portion of naturally occurring human parathyroid hormone. Forteo increases the number and action of osteoblasts, stimulating new bone formation. Forteo may also be referred to as human parathyroid hormone or PTH.

	Gastric Pacing (Gastric Electrical Stimulation, Gastric Pacemaker)		Gastric pacing is utilized to treat patients with chronic, intolerable or drug-refractory nausea and vomiting secondary to gastroparesis. A gastric pacing system delivers electrical stimulation to the gastric muscles by means of two wires that are implanted directly into the stomach and connected to a generator that is implanted into the abdominal area. The device is regulated with an external programmer that noninvasively adjusts the level of gastric stimulation. The programmer also allows for the device to be completely turned off at any time. Internal battery replacement is required every five to ten years.

	Gene Expression Assay for Predicting Breast Cancer Recurrence (Oncotype DX?)		The gene expression assay (Oncotype?) is a diagnostic test designed to assist in the decision making in regards to chemotherapy treatments based on the possibility of the recurrence of breast cancer in those women with newly diagnosed, early-stage breast cancer.

	Genetic Testing for Breast and Ovarian Cancer Susceptibility (BRCA1 and BRCA2)		Genetic testing is used to detect gene mutations that are associated with most cases of familial breast and ovarian cancer to determine if an individual has an increased risk for either of these conditions. The two major breast and ovarian cancer predisposition genes are BRCA1 and BRCA2.

	Genetic Testing for Colorectal Cancer		Genetic testing is available to determine if a person has inherited susceptibility to colorectal cancer. Familial adenomatous polyposis (FAP) is an autosomal dominant trait and is characterized by early onset of adenomatous colorectal polyps that if left untreated have a very likelihood of colorectal cancer by age 40. Hereditary nonpolyposis colorectal cancer (HPNCC) is an autosomal dominant trait that is also characterized by early onset of colorectal and uterine cancer and an increased incidence of other cancers as well. With the knowledge of inherited susceptibility to colorectal cancer, patients can make informed decisions regarding surveillance and prophylactic measures.

	Genetic Testing for Long QT Syndrome		Genetic testing is performed to assess risk of certain inheritable diseases, to predict the possibility of future illness, or to identify carriers of genetically determined diseases. It is also used to determine prenatal and clinical diagnosis and prognosis.

	Growth Hormone		Recombinant human growth hormone (GH) is used as replacement therapy in children and adults with endogenous growth hormone deficiency (GHD), such as those with idiopathic or acquired GHD. The goal of GH therapy is to improve and normalize abnormalities associated with GHD, both in the short and long term. Abnormalities associated with GHD include a variety of metabolic, structural, psychological, and quality-of-life problems. GH may also be referred to as somatropin, somatrem, or any of the names under which GH is manufactured: Humatrope, Genotropin, Geref, Nutropin, Nutropin AQ, Nutropin Depot, Serostim, Saizen, Tev Tropin, Zorbtive, Protropin, and Norditropin.

	High Frequency Chest Compression		High-frequency chest compression is a mechanical form of chest physiotherapy used as an alternative to conventional chest physical therapy in patients with an impairment of the ability to clear pulmonary secretions. These devices consist of an air generator and an inflatable vest that covers the chest. Increases in air pulses are delivered to the vest with altering airflow patterns, causing external manipulation of the chest. The intended use of the system is to promote airway clearance or improve bronchial drainage in order to reduce the risk of infection and lung damage.

	Humira		Tumor necrosis factor (TNF)-alpha circulates in the bloodstream and plays an important role in the inflammatory process in the body. Overproduction of TNF-alpha may lead to some diseases associated with inflammation, such as Crohn?s disease (CD) and rheumatoid arthritis (RA). The FDA has approved three anti-TNF-alpha biologic agents: Remicade (infliximab), given IV, Enbrel (etanercept), administered via SC injection, and Humira (adalimumab), also administered via SC route. Infliximab is a genetically engineered human/mouse monoclonal antibody that binds to TNF-alpha and neutralizes its effects.

	Hydrotherapy		Hydrotherapy is a physical therapy modality that involves the therapeutic use of water to treat a number of conditions under the supervision of a medically trained professional. Hydrotherapy may also be referred to as aquatic therapy or pool exercise therapy.

	Hyperbaric Oxygen Therapy		Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen in a pressurized chamber. The patient is placed in a sealed chamber under elevated atmospheric pressure.

	Immunochemical Fecal Occult Blood Testing (FOBT)		A fecal occult blood test (FOBT) is a noninvasive diagnostic test that detects blood in fecal (stool) samples. This test is one of several recommended options for colorectal cancer screening in the average risk population beginning at age 50. A positive result leads to follow-up with further testing, such as a sigmoidoscopy or colonoscopy. Immunochemical FOBT differs from guaiac-based FOBT in that there are no dietary or drug restrictions prior to this form of testing.

	Immunoglobulin, Intravenous (IVIG)		IVIG is used to provide passive immunity or to alter the immune response by increasing an individual?s antibody titer and antigen-antibody reaction potential. IgG antibodies help to prevent or modify certain infectious diseases in susceptible individuals. Immune globulin is a sterile, nonpyogenic solution containing many antibodies normally found in an adult?s blood. Commercially available immune globulin is prepared by cold alcohol fractionation of plasma pooled from the venous blood of 1000 or more individuals. This pooling of donors maximizes the diversity of antibodies found in the final product. Since the antibody repertoire of the human species is much greater than that of an individual, the antibody diversity of IVIG is much greater than in an individual patient. In addition to general immune globulin preparations that have small amounts of numerous types of antibodies, some immune globulin preparations have large amounts of one specific type of antibody. These products are prepared from the pooled plasma of persons with high titers of antibodies to a specific antigen.

	Immunomodular Therapy for MS		Immunomodulators are agents designed to modify the immune system in order to alter the course of multiple sclerosis (MS). Immunomodulator therapy in multiple sclerosis includes beta interferon 1a-intramuscular (Avonex), beta interferon 1a-subcutaneous (Rebif), beta interferon 1b (Betaseron), and glatiramer acetate (Copaxone).

	Implantable Infusion Pumps for Pain or Spasticity		Implantable infusion pumps are used to administer opioid drugs intrathecally or epidurally to treat severe chronic intractable pain of either malignant or non-malignant origin. This procedure may also be referred to as intraspinal infusion pump.

	Insertable Loop Recorder		Insertable, or implantable, loop recorder (ILR) provides a diagnostic approach for patients with transient symptoms that may suggest cardiac arrhythmias, such as unexplained syncope. The ILR allows for long-term cardiac monitoring to capture the ECG during a spontaneous episode. The ILR has an estimated shelf life of 14 months and is explanted when a diagnosis is made or at the end of the battery life.

	Insulin Infusion Pump		External and implantable insulin pumps deliver insulin via intraperitoneal or subcutaneous routes in a programmed and controlled manner to patients with diabetes mellitus.

	Insulin-Like Growth Factor Therapy (Iplex and Increlex)		Insulin-like growth factor-1 (IGF-1) is the principal hormonal mediator of statural growth. IGF-1 must be present in order for children's bones, cartilage, and organs to grow normally. Under typical circumstances, growth hormone (GH) binds to its receptor in the liver and other tissues, and stimulates the synthesis/secretion of IGF-1. In target tissues, the Type 1 IGF-1 receptor, which is homologous to the insulin receptor, is activated by IGF-1, leading to intracellular signaling which stimulates multiple processes leading to statural growth. The metabolic actions of IGF-1 are in part directed at stimulating the uptake of glucose, fatty acids, and amino acids so that metabolism supports growing tissues. Primary IGF-1 deficiency (IGFD) is a distinct diagnosis of short stature. These patients are not GH deficient and therefore cannot be expected to response to exogenous GH treatment.

	Intercostal Nerve Block for Chronic Pain		Intercostal nerve block is performed to relieve chronic, post-surgical pain of the chest or for postherpetic intercostal neuralgia. The block is performed followed by an ablative procedure such as radiofrequency ablation.

	Interferon alfa 2a/2b (Roferon-A and Intron-A)		Interferon alfa (IFN) is a recombinant injectable drug that inhibits viral replication, suppresses cell proliferation, and regulates immune response to treat a variety of conditions. IFN alfa is also called Intron-A (IFN alfa 2b) or Roferon-A (IFN alfa 2a).

	Interferon Beta for Multiple Sclerosis (Avonex, Betaseron, Rebif)		Interferon is produced naturally in the body to regulate the immune system. Interferon beta is a recombinant type of human interferon used to treat multiple sclerosis (MS). Currently, there are three interferons on the market that have FDA approval for treating MS: Avonex and Rebif, both of which are referred to as Interferon Beta-B1a, and Betaseron, which is referred to as Interferon Beta-B1b. Interferon beta may also be referred to as IFN??.

	Interferon Gamma 1-b (Actimmune)		Interferon gamma is a naturally occurring human protein that stimulates the immune system by stimulating a class of immune cells known as macrophages. This action results in an increase in the killing and removal of infectious organism, such as bacteria and fungi. Actimmune is a recombinant version of interferon gamma and is administered via SC injection. Interferon gamma may also be referred to as IFN gamma or IFN-??.

	Intra-articular Viscosupplemental Agents		Viscosupplementation using hyaluronic acid derivatives is used for the intra-articular treatment for osteoarthritis (OA). Use of sodium hyaluronate has been studied primarily in the treatment of Knee OA, but has also been studied for OA of the hip and temporomandibular joint disorders due to OA. OA is a painful joint disease in which hyaluronate, a component of synovial fluid and cartilage that provides viscoelastic properties that lubricate, protect and cushion the joint, is diminished in quality and concentration.

	Intradialytic Parenteral Nutrition (IDPN)		The goal of intradialytic parenteral nutrition (IDPN) is to improve the nutritional status of patients with end-stage renal failure treated by hemodialysis. Patients receive IDPN during hemodialysis.

	Intrastromal Corneal Ring Implants (Intacs)		Intrastromal Corneal Ring Segments (Intacs) inserts are clear, micro-thin intracorneal ring prescription inserts indicated for the use in the correction of nearsightedness and astigmatism for patients with keratoconus, where contact lenses and glasses are no longer suitable. Intacs are also used to correct myopia unrelated to keratoconus.

	Intrauterine Fetal Surgery		The purpose of intrauterine fetal surgery is to correct fetal malformations that interfere with organ development and fetal survival and can have potentially fatal consequences. Intrauterine fetal surgery involves opening the uterus using either an open or a minimally invasive, endoscopic technique, surgically correcting the fetal abnormality followed by closing the uterus to permit completion of the gestational development until delivery.

	Kineret (anakinra)		Kineret (anakinra) is a biologic therapy, which is a selective blocker of interleukin-1 for rheumatoid arthritis (RA). It is a recombinant form of the human interleukin-1 receptor antagonist (IL-1Ra) prescribed to treat rheumatoid arthritis (RA). Kineret blocks the activity of Il-1 by competitively inhibiting IL-1 binding to the interleukin-1 type I receptor, which is expressed in a wide variety of tissues and organs. IL-1 production is induced in response to inflammatory stimuli and mediates various physiologic responses to inflammatory and immunological responses. The levels of naturally occurring IL-1Ra in synovium and synovial fluid from RA patients are not sufficient to compete with the elevated amount of locally produced Il-1. Kineret is given via SC administration.

	Knee Braces		Knee braces are used to treat or prevent knee injuries or disorders. They are designed to allow the muscles of the thigh freedom to move the knee joint through its normal pattern by permitting tensionless movement while preventing any abnormal movement

	Laser Therapy for Psoriasis		Laser therapy is used to treat small, localized areas of psoriasis. High-intensity laser light is directed onto psoriatic lesions, thus sparing normal skin of unwanted side effects of treatment.

	Lucentis (ranibizumab)		Lucentis (Ranibizumab) is a recombinant monoclonal antibody developed by Genentech, Inc. and approved by the United States Food and Drug Administration (FDA) for the treatment of patients with neovascular (wet) age-related macular degeneration (AMD). Lucentis?? binds to and inhibits vascular endothelial growth factor (VEGF-A) from promoting growth of new blood vessels beneath the retina. It is injected directly into the vitreous portion of the eye once monthly. Although less effective, treatment may be reduced to one injection every three months after the first four injections if monthly injections are not feasible.

	Lumbar Sympathetic Block		Lumbar sympathetic blockade is used for the temporary or permanent relief of pain conducted by the sympathetic nervous system as well as a diagnostic tool to establish pain source. Lumbar sympathetic blocks are used for conditions affecting the lower extremities. Using fluoroscopy to guide needle insertion, the physician injects a local anesthetic, such as lidocaine or bupivacaine, into sympathetic nerve tissue to block sympathetic nerves.

	Lung Volume Reduction Surgery (LVRS)		Lung volume reduction surgery (LVRS) is a procedure that removes that damaged and non-functional lung tissue (approximately 20% to 30% of the tissue from one or both lungs) in those patients with chronic obstructive pulmonary disease (COPD) due to emphysema. The procedure allows the remaining part of the lung to expand and the diaphragm to strengthen. The procedure may also reduce the size of the thoracic (chest) cavity to achieve a more optimal respiratory muscle action and ventilatory capacity. This procedure does not cure emphysema; however, it may improve a patient?s lung capacity, breathing ability, and quality of life (QOL).

	Lupron Depot (leuprolide acetate)		Lupron depot is a synthetic nonapeptide analog of naturally occurring gonadotropin-releasing hormone (GnRH) or luteinizing hormone-releasing hormone (LH-RH) agonist. A GnRH agonist acts as an inhibitor of gonadotropin secretion when given continuously in therapeutic doses.

	Meningococcal Vaccine		Inoculation with meningococcal vaccine attempts to protect individuals from infections of the blood and meninges by the bacteria Neisseria meningitidis. Meningococcal vaccine cannot prevent all types of meningococcal disease; however, it can prevent four types, including two of three types common to the U.S. Even though anyone can get meningococcal disease, the vaccine is not routinely recommended for most people. The FDA has approved two meningococcal vaccinations for use in the U.S.: Menomune? and Menactra?. Both vaccinations protect against the four serogroups A, C, Y, and W-135. The FDA recently approved Menactra in January 2005. Menactra differs from Menomune in that Menactra is conjugated to diphtheria toxoid protein.

	Meniscal Allograft		Meniscal allograft involves the transplantation of a donor meniscus into the knee of a patient who has a damaged meniscus. This procedure is also used to reintroduce a meniscus in cases when meniscectomy have not produced desired results. The procedure attempts to restore knee stability and functioning. Menisci are capable of bearing loads, absorbing shock, stabilizing, and lubricating the knee joint. Loss of meniscal function leads to progression of degenerative changes within the knee.

	Negative Pressure Wound Therapy		Vacuum-assisted closure, also referred to as controlled negative pressure therapy, is a treatment for chronic or difficult-to-treat wounds. Controlled negative pressure is used to evacuate wound fluid and stimulate granulation tissue, and decrease bacterial colonization. This reportedly leads to more rapid healing of wounds.

	Neuromuscular Stimulators,		Neuromuscular electrical stimulators (NMES) are small electronic devices that are affixed externally by the patient to the skin by way of electrodes to provide direct stimulation of affected muscles. NMES differ from transcutaneous electrical nerve stimulation (TENS) units, which are used for pain management therapy. (See Electrical Stimulators).

	Neuropsychological Testing		Neuropsychological assessment uses a set of standardized tests and procedures to evaluate cognitive and behavioral functions in patients suspected of brain dysfunction. Through neuropsychological evaluation, clinicians gather information to assist in determining a diagnosis, planning treatment and rehabilitation, or developing a management plan. Neuropsychological evaluation tests various mental functions, including intelligence, problem solving and conceptualization, planning and organization, attention, memory, learning, language, academic skills, perceptual and motor abilities, emotions, behavior and personality.

	Occipital Nerve Block		Occipital nerve blockade is an anesthetic block of the greater occipital nerve to reduce pain associated with severe headache or migraine headache.

	Occlusal Splint for TMD		Temporomandibular disorders (TMD) are a collection of conditions that affect the muscles of mastication, the temporomandibular joints, or both. Many experts recommend noninvasive, reversible stabilization splints for early treatment of TMD.

	Oral Appliances for Sleep Disordered Breathing		Oral appliances are devices that adjust jaw and/or tongue position to increase airflow into the lungs during sleep. These devices include mandibular advancing devices and tongue retainers.

	Orencia (abatacept)		Orencia (abatacept) is the first drug in a new class of drugs known as costimulation blockers. Abatacept is a genetically engineered drug that allows other immune pathways to intact and modulates rather than blocks T cell activation. Abatacept is used as second line therapy to treat moderate to severely active rheumatoid arthritis and can be used alone or in combination with DMARDs, with the exception of TNF inhibitors, such as Enbrel, Remicade, and Humira. Abatacept is give via IV infusion three times during the first month and monthly thereafter.

	Orthognathic Surgery		Orthognathic surgery is the surgical modification of skeletal deformities of the jaw (mandible, maxilla, or both) to improve function

	Osteochondral Allograft of the Knee		Osteochondral allografting involves transplantation of a piece of articular cartilage and attached subchondral bone from a cadaver donor to a damaged region of the articular surface of a joint. The goal of this procedure is to provide viable chondrocytes and supporting bone that will be sufficient to maintain the cartilage matrix and thereby relieve pain and reduce further damage to the articular surface of the joint.

	Oxygen Therapy for Home Use		Oxygen therapy is the administration of oxygen at concentrations greater than that in ambient air with the intent to treat or prevent symptoms and manifestations of hypoxia. Oxygen therapy is also used to treat acute attacks of cluster headache. Home oxygen therapy is delivered in three ways: compressed gas in a cylinder, liquid oxygen, or oxygen concentrator.

	Pegasys		Peginterferon alfa- 2a is a covalent conjugate of recombinant alfa-2a interferon with a single branched bis-monomethoxy polyethylene glycol chain. Interferons bind to specific receptors on the cell surface initiating intracellular signaling via a complex cascade of protein-protein interactions leading to rapid activation of gene transcription. Interferon-stimulated genes modulate many biological effects including the inhibition of viral replication in infected cells, inhibition of cell proliferation and immunomodulation. The clinical relevance of these in vitro activities is unknown.

	PEG-Intron		Peginterferon alfa-2b is a covalent conjugate of recombinant interferon alfa-2b with monomethoxy polyethylene glycol. Interferons bind to specific receptors on the cell surface initiating intracellular signaling via a complex cascade of protein-protein interactions leading to rapid activation of gene transcription. Interferon-stimulated genes modulate many biological effects including the inhibition of viral replication in infected cells, inhibition of cell proliferation and immunomodulation. The clinical relevance of these in vitro activities is unknown.

	Percutaneous Vertebroplasty, Kyphoplasty (Balloon-Assisted Vertebroplasty)		Percutaneous vertebroplasty is a procedure that involves injection of bone cement into an osteoporotic vertebral body compression fracture or osteolytic lesion of the spine with the goals of relieving pain, improving mobility, and preventing further collapse of the bone. A kyphoplasty (also known as balloon assisted vertebroplasty) is a modification of the vertebroplasty procedure that involves the use of an inflatable balloon to reduce the fracture prior to the injection of the bone cement. The goal of a kyphoplasty is to restore height to the bone, thereby reducing the deformity of the spine.

	Percutaneous Vertebroplasty/Kyphoplasty		Percutaneous vertebroplasty (PVP) is a therapeutic, interventional radiologic procedure that involves the percutaneous injection of bone cement into a vertebral body compression fracture. This procedure attempts to relieve pain, improve mobility, and prevent further bone collapse. Kyphoplasty is a modification of the vertebroplasty procedure. Kyphoplasty involves the use of an inflatable bone tamp to reduce the fracture prior to injection of the bone cement. The physician makes a small incision and inserts a tube in the center of the vertebral bone with the fracture. The balloon is placed through the tube into the center of the bone and then the balloon is inflated, pushing the bone back to its normal height and shape. This also creates a cavity in the bone, which the surgeon fills with bone cement. Kyphoplasty expands the vertebra with the goal of restoring some vertebral height in patients with compression fractures.

	Pharmacognetic Testing		Pharmacogenetics is the study of how genetic factors may influence our response to medicines. Examples of this type of genetic testing are Oncotype testing, Extreme Drug Resistance Assay?, Invader UGT1A1 Molecular Assay and the Amplichip Cytochrome P450 Test. Thiopurine s-methyltransferase (TPMT) is an enzyme that is involved in the metabolism of drugs called thiopurines that are used to treat inflammatory bowel disease (IBD). In the general population there is wide variation in TMPT enzyme activity that is largely genetically determined by the TPMT gene. TPMT genotyping is a test that tells whether or not a patient has certain types of genes that would affect the ability to metabolize thiopurines. TPMT genotyping has the potential to be used to identify IBD patients who are at an increased risk of bone marrow complications so that treatment decisions can be made before they are given the drugs.

	Phototherapy for Diseases of the Skin		Phototherapy is the treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. Phototherapy may also be referred to as photochemotherapy, UVA, UVB, psoralen UVA, PUVA, narrow-band UVB, broad-band UVB or ultraviolet light.

	Phototherapy in the Home for Neonatal Jaundice		Phototherapy is the treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. Other names for phototherapy for neonatal jaundice are photochemotherapy bililights, or bilirubin lights.

	Physical Therapy (PT) / Occupational Therapy (OT)		PT and OT are two different types of rehabilitative therapy. PT consists of a prescribed program of exercises and physical activities as well as physical modalities such as massage or the application of heat to relieve symptoms, improve function, and prevent further disability for individuals disabled by chronic or acute disease or injury. OT uses real life activities in specific areas, with specific goals to help patients regain performance skills lost through injury or illness.

	Prevnar (pneumococcal 7-valent conjugate vaccine)		Prevnar is a vaccine developed to help protect infants and toddlers from potentially serious invasive pneumococcal diseases, such as pneumococcal meningitis and bacteremic pneumonia. Pneumococcal infections can be difficult to treat because the bacteria have become resistant to some of the drugs used to prevent these infections.

	Proton - Neutron Beam Therapy		Proton beam radiation therapy is a type of external beam radiation that utilizes protons (positively charged subatomic particles) that are precisely targeted to a specific tissue mass. Proton beams have the capability to penetrate deep into tissues to reach tumors while delivering less radiation to superficial tissues such as the skin, which may make photon beam radiation therapy more effective for inoperable tumors or for those patients in which damage to healthy tissue would pose an unacceptable risk. Neutron beam radiation therapy is a specialized type of external beam radiation therapy using high energy neutrons to treat a variety of cancers. The neutrons (neutral charged subatomic particles) are targeted towards tissue masses that are characterized by lower tumor oxygen levels and a slower cell cycle since neutrons require less oxygen and are less dependent on the cell?s position in the cell division cycle. Neutrons impact with approximately 20 to 100 times more energy than conventional photon radiation and may be more damaging to surrounding tissues. For that reason, the radiation is delivered utilizing a sophisticated planning and delivery system.

	Pulmonary Hypertension Therapy		Standard management of patients with pulmonary arterial hypertension (PAH) include anticoagulants to decrease the risk of pulmonary thromboembolism or systemic embolism, diuretics for fluid retention caused by right-side heart failure, and digoxin for patients with right ventricular failure. Patients who respond to acute vasoreactivity testing should be started on oral calcium channel blockers (diltiazem or nifedipine) as first-line therapy. Other medications approved for PAH include: Revatio (sildenafil citrate), Tracleer (bosentan), Remodulin (treprostinil), Flolan (epoprostenol), and Ventavis (iloprost).

	Pulmonary Rehabilitation		Pulmonary rehabilitation (PR) is a multidisciplinary approach to educate and rehabilitate patients with chronic respiratory impairment. A PR program consists of the following components: Medical evaluation, pulmonary function testing, psychological screening, education, and counseling, breathing exercise and retraining, training in respiratory therapy techniques, personalized exercise training, review of home care and equipment needs, occupational therapy and group therapy.

	Radiofrequency Denervation for Chronic Pain		Radiofrequency ablation is a pain management technique performed percutaneously using radiowaves to interrupt the nerve impulse that carries the pain signal. Radiofrequency denervation may be referred to as the following terms: Radiofrequency ablation, percutaneous radiofrequency facet denervation, percutaneous facet coagulation, percutaneous radiofrequency neurotomy, radiofrequency facet rhizotomy, facet neurotomy, thermocoagulation, pulsed radiofrequency ablation, and radiofrequency articular rhizolysis.

	Raptiva (efalizumab)		Raptiva (efalizumab) is a biologic agent used to treat chronic moderate to severe plaque psoriasis. Raptiva is given once per week via subcutaneous injection.

	Reduction Mammoplasty		A reduction mammoplasty is the surgical reduction of the breast size. Breast reduction surgery, technically known as reduction mammoplasty, reduces disproportionate, oversized breasts by removing fat, glandular tissue, and skin from the breasts which makes them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

	Remicade (infliximab)		Tumor necrosis factor (TNF)-alpha circulates in the bloodstream and plays an important role in the inflammatory process in the body. Overproduction of TNF-alpha may lead to some diseases associated with inflammation, such as Crohn?s disease (CD) and rheumatoid arthritis (RA). The FDA has approved three anti-TNF-alpha biologic agents: Remicade (infliximab), given IV, Enbrel (etanercept), administered via SC injection, and Humira (adalimumab), also administered via SC route. Infliximab is a genetically engineered human/mouse monoclonal antibody that binds to TNF-alpha and neutralizes its effects.

	Removal of Skin Lesions		Skin lesions may be malignant, potentially malignant, or benign. The mainstay of treatment for malignant or potentially malignant lesions is complete removal of the cancerous or suspicious tissue.

	Reveal Insertable Loop Recorder		Insertable, or implantable, loop recorder (ILR) provides a diagnostic approach for patients with transient symptoms that may suggest cardiac arrhythmias, such as unexplained syncope. The ILR allows for long-term cardiac monitoring to capture the ECG during a spontaneous episode. The ILR has an estimated shelf life of 14 months and is explanted when a diagnosis is made or at the end of the battery life.

	Rituxan (rituximab) for Rheumatoid Arthritis		Rituxan (rituximab) is an infusion used in the treatment of certain cancers and recently has been approved by the FDA for the treatment of rheumatoid arthritis. Rituxan is a monoclonal antibody that targets the CD20 antigen.

	Robot-Assisted Surgeries		Robotic-assisted surgeries are minimally invasive procedures in which robotic equipment is utilized by the surgeon to perform the surgery. The robotic devices are designed to access surgical sites through smaller incisions or ports using an endoscope. The surgeon sits at a console that has a three-dimensional video monitor as well as hand and/or foot controls. The robotic arms are equipped with a variety of surgical instruments, a miniature video camera and flexible ?wrists? that will allow them to duplicate the motion of surgeon?s wrists.

	Sacroiliac Joint (SIJ) Injection		Sacroiliac joint (SIJ) injection is performed to diagnose and/or treat the SIJ as a source of low back pain.

	Special Formulas for Infants		Inborn errors of amino acid metabolism are rare disorders in which the body cannot metabolize food components properly, and if left untreated, can lead to severe mental retardation or death. These disorders are treated through diet, which might include restriction of one or more amino acids, the restriction of total nitrogen or the supplementation of specific substances. Commercially available medical foods are crucial for active, ongoing treatment. Severe food allergies and digestive enzyme deficiencies may also require use of highly specialized formulas.

	Speech Generating Devices		Speech generating devices (SGD) are also known as augmentative or alternative communication devices. These devices are utilized to help those individuals who have severe speech impairments such as aphasia, apraxia, or dysarthria. The individuals may also have impairments that interfere with writing.

	Speech Therapy		Speech therapy is the study, diagnosis, and treatment of speech, language, and communication to enable communication at patient's highest level of ability. Speech therapy is also used in the treatment of eating and swallowing disorders. The impairment may be caused as a result from birth, disease, previous medical treatment, or injury.

	Spinal Cord Stimulation		Spinal cord stimulation (SCS) is a reversible, non-destructive procedure used as a last resort for many chronic pain disorders. The system is designed to send mild electrical stimulation to the spinal cord to repress pain. The electrical impulses block the signal of pain from reaching the brain and can be aimed at the specific site where pain is felt by using the same path as pain signals travel.

	Stellate Ganglion Block		Stellate ganglion blockade is a sympathetic block of the upper extremity. The goal of the block is to reduce pain associated with reflex sympathetic dystrophy, regional pain syndrome, and facial palsy. A sympathetic block of the upper extremity is called a stellate ganglia block.

	Stereotactic Radiosurgery (SRS)		Stereotactic radiosurgery (SRS) is a procedure in which three-dimensional images are utilized to direct precisely focused radiation to obliterate abnormal tissues, such as vascular malformations and malignant or benign tumors. SRS was designed to cause destruction to the target tissue with minimal exposure to surrounding healthy tissue.

	Surgical Treatment for Severe Obesity		Gastroplasty or gastric bypass surgery (also known as bariatric surgery) is a surgical intervention to accomplish weight reduction. Bariatric procedures for weight reduction share two major designs: Intestinal malabsorption and gastric restriction. Malabsorptive procedures involve rearrangement of the small intestine to decrease the functional length or efficiency of the intestinal mucosa for nutrient absorption. Restrictive operations involve creation of a small neogastric pouch and gastric outlet to decease food intake.

	Surgical Treatment of CHest Wall Deformities		CHA Health members may be eligible under the Plan for surgical treatment of chest wall deformities associated with pectus excavatum with a CT Haller index* of greater than 3.25 and ONE of the following indications: ? Cardiac compression demonstrated by cardiac testing, such as echocardiography or stress echocardiography; OR ? Restrictive lung disease as demonstrated by a Total Lung Capacity (TLC) < 80% of predictive value per pulmonary function testing.

	Surgical Treatments for Obstructive Sleep Apnea		A variety of surgeries are available to patients to treat obstructive sleep apnea (OSA), including uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatopharyngoplasty (LAUP), radiofrequency volumetric tissue reduction (RFVTR), genioglossal advancement (GA) with hyoid myotomy or suspension, mandibular or maxillary osteotomy and advancement.

	Synagis (palivizumab)		Palivizumab is a humanized monoclonal antibody (IgG1k) produced by recombinant DNA technology, directed to an epitope in the A antigenic site of the F protein of respiratory syncytial virus. Palivizumab exhibits neutralizing and fusion-inhibitory activity against respiratory syncytial virus (RSV). It is given by intramuscular injection to help prevent or reduce hospitalizations due to RSV in patients at high-risk for RSV disease.

	Titanium Rib (Vertical Expandable Prosthetic Titanium Rib (VEPTR))		A vertical expandable prosthetic titanium rib (VEPTR) implant is a surgically implanted device used to treat thoracic insufficiency syndrome (TIS).

	Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Pain		Transcutaneous Electrical Nerve Stimulator (TENS) is a battery operated pulse generator that sends impulses by way of electrodes to the surface of the skin over the peripheral nerves to be stimulated.

	Trigger Point Injections		Trigger point injections are used in the management of pain of soft tissue. Trigger points are highly sensitive bundles of fibers within a muscle, which become ?knotted? and inelastic, unable to contract or relax, due to an injury or repetitive movements.

	Uterine Artery Embolization for Treatment of Fibroids		Uterine artery embolization (UAE) is a pelvic angiographic procedure used to occlude the uterine arteries that supply the uterus and fibroids with blood, thereby, depriving the tumors of their blood supply, and shrinking the fibroids. Interventional radiologists perform UAE, a minimally invasive procedure.

	Vagus Nerve Stimulation (VNS)		Vagus nerve stimulation (VNS), originally designed as a treatment option for medically refractory epilepsy, has recently been introduced as an adjunctive therapy for treatment-resistant major depression and bipolar disorder. Vagus nerve stimulation therapy system consists of an implantable pulse generator, a lead, and an external programming system used to change stimulation settings. The implantable pulse generator is battery operated and is muck like a cardiac pacemaker that is surgically placed under the skin in the upper left chest. The lead is fed through to the lower neck and is wrapped around the vagus nerve, allowing intermittent impulses. The vagus nerve in turn sends signals to the brain, thereby stimulating the area of the brain believed to be involved in mood regulation. The pulse generator can be programmed to tailor the stimulation parameters to the patient?s needs. Also, a hand held magnet may be utilized to activate the device or to stop stimulation.

	Varicose Vein Treatment		Varicose veins are dilated, tortuous superficial veins that result from defective structure and function of the valves of the saphenous veins, from intrinsic weakness of the vein wall, from high intraluminal pressure, or, rarely, from arteriovenous fistulas. The categories of varicose veins are primary or secondary. Primary varicose veins originate in the superficial system. Secondary varicose veins result from deep venous insufficiency and incompetent perforating veins or from deep venous occlusion causing enlargement of superficial veins that are serving as collaterals. Surgical techniques to treat varicose veins include ligation, stripping, and ambulatory phlebectomy. The following are other treatment options for varicose veins:

	Vestibular Rehabilitation		Vestibular rehabilitation (VR) is a noninvasive treatment for vertigo. VR consists of a series of maneuvers and exercises aimed at reducing dizziness, chronic balance disorders, and ambulation problems that may result from a variety of peripheral vestibular dysfunctions, including benign paroxysmal positional vertigo, by facilitating central nervous system compensation for peripheral vestibular dysfunction. VR is usually administered as adjunctive therapy by a physical therapist.

	Virtual Colonoscopy (Computed Tomography Colonography)		Virtual colonoscopy is a diagnostic test that is intended to detect colorectal polyps and colorectal cancer. It involves the use of helical computed tomography (CT) scanning and computer generated images to produce high-resolution two and three-dimensional images of the colon and rectum. Prior to virtual colonoscopy, standard bowel cleansing preparations are needed to evacuate any stool and fluid from the colon. During the procedure, a rectal tube is inserted and the colon is distended using room air or carbon dioxide and images are then taken by a helical CT scanner. The results are interpreted by a radiologist. If suspicious lesions are detected, the patient generally must undergo further testing via a conventional colonoscopy.

	Vivitrol Injection		Vivitrol was FDA approved on April 13, 2006 for alcohol dependence. This is the first extended release injectable agent approved by the FDA for this indication. Vivitrol is indicated for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with Vivitrol. Patients should not be actively drinking at the time of initial Vivitrol administration. Treatment with Vivitrol should be part of a comprehensive management program that includes psychosocial support.

	Wireless Esophageal pH Monitoring (Bravo pH Capsule)		Traditionally, esophageal pH monitoring involves placing a transnasal catheter with a pH measuring electrode at its tip in the patient?s esophagus for 24 hours. The Bravo pH Capsule is a catheter-free (wireless) system for measuring acid reflux. The Bravo pH monitoring system utilizes a miniature radiotelemetry pH capsule (about the size of a gelcap) that is attached to the wall of the patient?s esophagus. The capsule is attached using a loading device following an upper endoscopy to ensure proper placement. The capsule transmits data to a pager-sized receiver attached to the patient?s belt. The patient can maintain all normal activities, as well as eat a normal diet, and maintains a diary of symptoms during this time.

	Wound Healing Skin Substitutes		Human skin equivalent (skin substitute) is manufactured by starting with a few human cells in which tissue engineers simulate the environments that allow cells to develop into viable tissue. The specific procedure varies by company, but it generally involves seeding the selected cells onto some type of matrix, where they are then provided with the proteins and growth factors necessary for them to grow and multiply into the desired tissue. It is used for the treatment of patients with life threatening full-thickness or deep partial-thickness burns, surgical wounds, diabetic ulcers and venous ulcers.

	Xolair (omalizumab)		Xolair is a humanized monoclonal antibody for the potential treatment of allergy-related, moderate-to-severe asthma in patients age 12 and older, also referred to as adult allergic asthma.