Medical Necessity Guidelines

B

Blepharoplasty (Eyelid Surgery) 

Brachioplasty (Arm Lift) 

Breast Reduction Surgery

C

Contact Lenses 

D

Dental Implants 

Dentures 

E

Egg Freezing (Oocyte Cryopreservation) 

Eyeglasses 

H

Home Health Care Services 

I

Implantable Cardioverter-Defibrillators (ICDs) 

L

Labiaplasty 

Laser Hair Removal 

LASIK 

Liposuction 

M

Medical Food / Enteral Nutrition 

O

Orthodontics (Braces, Brackets, Aligners) 

Oxygen Therapy 

P

Panniculectomy, Tummy Tuck, and Excess Skin Removal 

R

Rhinoplasty (Nose Job) 

W

Whirlpools / Hot Tubs