separator
Skip to Contentseparator HomeseparatorCheck License StatussepartorContact UssepartorRequest for Assistance
Welcome to the California Department of Insurance
Site tools
Decrease font size Increase font size Site map Help Print-friendly version
 
2011 Independent Medical Review Annual Report

The Department of Insurance manages the Independent Medical Review Program outlined in California Insurance Code Section 10169. The information provided on this web page provides statistical information.

  • Total Number IMR: 462
  • Experimental/Investigational-Overturned: 63
  • Experimental/Investigational-Upheld: 102
  • Medical Necessity Overturned: 111
  • Medical Necessity Upheld: 181
  • Withdrawn: 5

Independent Medical Reviews (IMR) Annual Report- January through December 2011

Reference #

Diagnosis

Treatment

Experimental /
Investigational- Overturned

Experimental /
Investigational- Upheld

Medical
Necessity
Overturned

Medical
Necessity
Upheld

Withdrawn

11-2001

Earache

Emergency
Services

   

X

   

11-2000

Migraine
Headache

Botox Injections

X

       

11-2002

Substance Use
Disorder

Residential
Treatment Center

   

Partial

   

11-2003

Sleep Apnea

Uvulopalatoplasty

   

X

   

11-2004

Brain Cancer

Perscription: Avastin

       

X

11-2015

Cystic Fibrosis

Synagis

 

X

     

11-2016

Heart Attack

Real-Time Remote
Heart Monitor

 

X

     

11-2017

Migraine
Headache

Botox Injections

X

       

11-2018

Focal
Osteochandral
Lesion

Osteochondral
Allograft

 

X

     

11-2019

Multiple
Sclerosis

Walk Aide
Functional Electrical
Stimulator

 

X

     

11-2020

Cervical Radiculopathy & Myelopathy

Cervical Disc
Replacement Surgery With Prodisc-C

 

X

     

11-2021

Preventive Care

Anesthesia During
Colonoscopy

     

X

 

11-2022

Depression,
Psychosis, Gilbert Syndrome

Inpatient Psychiatric
Care

   

X

   

11-2023

Calcinosis Cutis

Facial Laser
Surgery

   

X

   

11-2029

Clear Cell Renal
Carcinoma

Perscription: Procrit

   

X

   

11-2044

Bipolar 2
Disorder

Psychiatric
Residential
Treatment

     

X

 

11-2045

Depression

Outpatient
Psychotherapy

   

X

   

11-2046

Anxiety Disorder

Outpatient Family
Therapy

   

Partial

   

11-2048

Degenerative
Disc Disease

Spinal Fusion

     

X

 

11-2053

Impaired Visual
Field (Droopy
Eye Lids)

Blepharosplasty

   

X

   

11-2006

Autism

Speech &
Occupational
Therapy

   

X

   

11-2007

Autism

ABA

   

X

   

11-2005

Mood Disorder

Perscription:
Lexapro

     

X

 

11-2008

Diabetes Type II

Perscription:
Victoza

   

X

   

11-2009

Alzheimer

Perispinal
Administration

     

X

 

11-2010

Unknown

Cervical Spine
Intervertebral Disc
Replacement

 

X

     

11-2011

ADHD. Drug
Addiction. Mental
Health

Residential
Treatment Center

     

X

 

11-2012

Autism

Speech &
Occupational
Therapy

   

X

   

11-2013

Sleep Apnea

Tongue Suspension

     

X

 

11-2014

Depression & Anxiety

Transcranial
Magnetic
Stimulation

X

       

11-2051

Ovarian Cancer

Perscription:
Neulasta

X

       

11-2049

Normal Pressure Hydrocephalus (NPH)

Inpatient Hospital
Services

     

X

 

11-2038

Viral
Conjunctivitis

Lab Tests

X

       

11-2055

Cervical
Discectomy/ Discectomy Infusion

Physical Therapy

     

X

 

11-2056

Autism

ABA

   

X

   

11-2030

Prostate Cancer

IMRT With HDR
Brachytherapy

X

       

11-2047

Avascular
Necrosis With Collapse Of The Femoral Head Superiorly

Computer Navigation During Surgery

 

X

     

11-2054

Global
Development
Delay

Genetic Array
Genome Testing

X

       

11-2050

Depression

Transcranial
Magnetic
Stimulation

X

       

11-2052

Chronic
Inflammatory Demyelinating Polyneuropathy (CIDP)

Intravenous Immunoglobulin (IVIG)

X

       

11-2041

Poor
Biomechanics

Walk-Aide

 

X

     

11-2042

Diabetes Type I

Glucose Monitoring

X

       

11-2028

Lower Back Pain

Spinal
Decompression
Therapy

 

X

     

11-2040

Mental Health

Inpatient

     

X

 

11-2043

Low Back &
Bilateral Lower
Extremity Pain.

Spinal Fusion

     

X

 

11-2037

Pre-Operative
Diagnoses Of Gastroesophage al Reflux

Anesthesia

     

X

 

11-2025

Endoscopic

Anesthesia

     

X

 

11-2035

Unresectable
Intrahepatic Cholangiocarcino ma (Cancer Of The Liver) With Lymph Node Involvement

Radioactive Beads
(SIRT)

X

       

11-2034

Risk Of Coronary
Artery Disease

Diagnostic Testing
Including C- Reactive Protein; High Sensitivity (Hs- CRP) And Fibrinogen.

 

X

     

11-2031

Osteoarthritis

Synvisc One
Injection

     

X

 

11-2024

Eating Disorder

Partial
Hospitalization
Program

   

X

   

11-2027

Neuromonitoring

Spinal Muscular Atrophy Type III And Neuromuscular Scoliosis.

     

X

 

11-2033

Microsurgical
Repair Of The Radial Digital Artery & Nerve Of Left Ring Finger.

Assistant Surgeon

   

Partial

   

11-2039

Depression

Neurostar Transcranial Magnetic
Stimulation Therapy

   

X

   

11-2026

Polyarthralgias

Rheumatologic Lab

     

X

 

11-2036

Bulimia,
Anorexia

Inpatient Treatment

   

X

   

11-2057

Lumbar
Radiculapathy

Discectomy

X

       

11-2032

Back Pain

Chiropractic Care

     

X

 

11-2087

Shoulder Injury

Physical Therapy

   

X

   

11-2088

Bilateral
Temporomadibul ar Disorder

Upper Jaw Surgery

     

X

 

11-2094

Incompetent
Vein For
Varicose Veins

Endovenous
Ablation Therapy

     

X

 

11-2093

Pituitary
Dwarfism

Somatropin Growth
Hormone (GH) Injections

     

X

 

11-2092

Varicose Veins

Endovenous
Ablation Therapy & Stabphlebectomy

   

X

   

11-2090

Depression

Inpatient Mental
Services

     

X

 

11-2091

Growth Hormone
Deficiency

Growth Hormone
Injections

     

X

 

11-2089

Bi-Polar, Anxiety, Pervasive Developmental Disorder

Inpatient Psychiatric
Treatment

   

X

   

11-2079

Lumbar
Herniated Disc

Lumbar Fusion With Cougar Cages & Synthes Plates

     

X

 

11-2067

Anorexia
Nervosa

Inpatient
Hospitalization

   

X

   

11-2076

Degenerative
Disc Disease

Lumbar Spine
Fusion

     

X

 

11-2074

Obsessive Compulsive Disorder; Anxiety Disorder, Post Traumatic Stress Disorder; Depressive Disorder; And Eating Disorder.

Residential
Treatment

     

X

 

11-2075

Facial Nerve
Damage

Nerve Damage
Treatment

     

X

 

11-2063

Anterior Hip
Tendinopathy

Platelet Rich
Plasma Transfusion/Injectio n

 

X

     

11-2066

Vitiligo

Monochromatic
Light Therapy / A&B Excimer Laser Treatment

X

       

11-2068

Anxiety Disorder, Post-Traumatic Stress Disorder
& Dissociative
Identity Disorder

Outpatient Mental
Health Services

     

X

 

11-2065

Degenerative
Disc Disease

Percutaneous
Decompression Of
Disc

 

X

     

11-2058

Barrett's
Esophagus, GERD And IBS

Endoscopy & Ablation

 

X

     

11-2072

Sleep Apnea

Intraoral Splint

   

X

   

11-2062

Breast Cancer
History W/ Detection Of Mass In Breast

MRI

 

X

     

11-2073

Bipolar Disorder

Hospitalization

     

X

 

11-2071

AIDS

Perscription: Provigil

   

X

   

11-2070

Gastrointestinal
Bleeding

Anesthesia For An
Endoscopy

     

X

 

11-2078

Back Pain

Discectomy

     

X

 

11-2077

Disc
Degeneration

Prodisc C (TDR)
Procedure

 

X

     

11-2061

Degenerative Disc Disease With Sciatic Pain

Perispinal
Etanercept (Enbrel)

 

X

     

11-2064

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation (TMS)

X

       

11-2059

Glaucoma

Canaloplasty

X

       

11-2080

Eating Disorder,
Substance
Abuse

Residential
Treatment

     

X

 

11-2060

Intractable
Epilepsy

PET Scan

 

X

     

11-2069

Post-Surgical Re

Continuous Passive hMotion (CPM)

     

X

 

11-2084

Epilepsy

Perscription: Keppra
XR

   

X

   

11-2081

Lumbar
Spondylosis

Radiofrequency
Neurotomy

 

X

     

11-2086

Cervical
Degenerative
Disease

Spinal Injections

     

X

 

11-2083

Obstructive
Sleep Apnea

Ct Colonoscopy
(Virtual)

   

X

   

11-2082

Brain Tumors

Perscription: Vorinostat & Zolinza

     

X

 

11-2085

Meniscal Tear Of
Left Knee

Custom Knee Brace

     

X

 

11-2095

Autism

Speech &
Occupational
Treatment

X

       

11-2096

Mood Disorder; Anxiety Disorder; Borderline Personality Disorder, Bipolar Disorder

Inpatient Psychiatric Services; Electroconvulsive Therapy (ECT)

     

X

 

11-2097

Cranial
Misshapen

Cranial Arthotic

   

X

   

11-2099

Severe
Emotional
Disturbance

Behavioral Therapy

     

X

 

11-2098

Parsonage
Syndrome

IVIG

 

X

     

11-2101

Cervical
Spondylosis

Chiropractic

   

X

   

11-2104

Depressive
Disorder

Transcranial
Magnetic
Stimulation

 

X

     

11-2103

Herniated/Displa ced Disc

Lumbar
Decompression & Spinal Fusion

     

X

 

11-2102

Alcohol/Drug
Dependence

Residential
Treatment

     

X

 

11-2100

Ovarian Cancer

Lab Test: HE4 Test

X

       

11-2120

Osteoarthritis

Lumbar Fusion

     

X

 

11-2109

Depression

Transcranial
Magnetic
Stimulation

 

X

     

11-2108

Congenital
Deformity

Subtalar Joint
Arthroereisis

X

       

11-2112

Blood/Bone
Cancer

Interferon

X

       

11-2129

Spinal Stenosis
& Spondylolisthesis

Spinal Fusion

     

X

 

11-2119

Suicidal

Inpatient
Hospitalization

     

X

 

11-2126

Varicose Veins

Venous Ablation

   

X

   

11-2111

Cervical
Spondylosis

Botox Injection

 

X

     

11-2110

Degenerative
Disc Disease

Artificial Disc
Replacement

 

X

     

11-2107

Attention Deficit
Hyperactivity
Disorder

Biofeedback

 

X

     

11-2121

Alcohol/Drug
Dependence

Drug Rehabilitation
Program

     

X

 

11-2114

Herniated/Displa
ced Disc

Stimulator

   

X

   

11-2130

Contracture Of
Joint - Upper
Limb

Dynasplint

     

X

 

11-2118

Bulimia

Partial
Hospitalization

   

X

   

11-2117

Degenerative
Disc Disease

Fusion

     

X

 

11-2116

Degenerative
Disc Disease

Fusion

     

X

 

11-2115

Foot Problem

Inpatient
Hospitalization

     

X

 

11-2124

Spinal Stenosis
& Spondylolisthesis

Fusion

     

X

 

11-2123

Developmental
Delays

Speech Therapy

   

X

   

11-2105

Coronary Artery
Disease

Angiography

 

X

     

11-2125

Ulcerative Colitis

CT Scan

     

X

 

11-2106

Rheumatoid
Arthritis, Lyme
Disease

Long Term
Antibiotic Therapy - Rocephin

 

X

     

11-2128

Chronic Venous
Disease Class V

Vein Ultrasound

X

       

11-2113

Wrist Pain

MRI Of Both Hands

   

X

   

11-2127

Anorexia
Nervosa

Residential
Treatment

     

X

 

11-2131

Disc Herniation
C3-4

Cervical Spinal Stenosis  

X

     

11-2122

Disc Herniation
Of Back

Back Fusion

     

X

 

11-2135

Degenerative
Disc Disease

MRI

   

X

   

11-2133

Post Brain
Hemorrhage

Cognitive
Rehabilitation

X

       

11-2132

Eye Disorders

Vision Therapy

 

X

     

11-2136

Idopathic Short Stature

Growth Hormone

     

X

 

11-2134

Degenerative
Disc Disease

Artificial Cervical
Disc Replacement

 

X

     

11-2137

Osteopenia (Low
Bone Mineral
Density)

Dual Energy X-Ray
Absorptiometry
(DEXA) Scan

   

X

   

11-2147

Autism

ABA

X

       

11-2143

ADHD / Drug
Addiction / Mental Health

Residential
Treatment

   

X

   

11-2141

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation

X

       

11-2139

Bilateral Occipital
Neuralgia

Occipital Nerve
Stimulator

X

       

11-2138

Osteoarthritis Of
Right Hip

Hip Replacement
Surgery

     

X

 

11-2144

Oxycontin
Dependence

Residential
Rehabilitation & Day
Treatment

     

X

 

11-2145

Alcohol
Dependence

Emergency
Services

     

X

 

11-2146

Diabetes,
Diabetic Polyneuropathy, Chronic Pain.

Pain Medication

   

Partial

   

11-2140

Bilateral
Pulmonary
Embolism

Inpatient Services

     

X

 

11-2142

Autism

ABA

   

X

   

11-2148

Hip Impingement
Syndrome

Femoro-Acetabular
Surgery

X

       

11-2154

Post Right Knee Medial Meniscus Allograft Replacement

Physical Therapy

   

X

   

11-2150

Metastatic
Urothelial Cancer

Prolia Injection

X

       

11-2152

Left Eye Lesion

Slit Lamp Photo

X

       

11-2153

Ovarian Cancer

Lipoprotein Testing

 

X

     

11-2149

Upper
Respiratory
Infection

Emergency
Services

     

X

 

11-2151

Crohn's Disease

Pharmacy-
Prescription Drugs

 

X

     

11-2159

Tachyarrhythmia

Remote Real Time
Cardiac Monitor

 

X

     

11-2162

Bulimia

Residential
Treatment

     

X

 

11-2171

Bulimia

Psychiatric
Treatment

     

X

 

11-2175

Lumbar Disc
Herniation And
L2-L3 Disc Bulge

Physical Therapy

   

X

   

11-2163

Acute
Papilledema

MRI

   

X

   

11-2166

Major
Depressive
Disorder

Inpatient Psychiatric
Hospitalization

     

X

 

11-2158

Ligaments - Post
Hip Surgery

CPM Machine

 

X

     

11-2164

Derangement Of
Medial Meniscus

ACL Reconstruction
& Meniscus Allograft

     

X

 

11-2172

Drug Induced
Disorders

Residential
Rehabilitation

     

X

 

11-2165

Major
Depressive
Disorder

Psychotherapy

     

X

 

11-2173

Major
Depressive
Disorder

Acute Inpatient
Hospitalization

     

X

 

11-2174

Post Right Hallux
Rigidus Correction & Partial Excision Of B158 Plantar Fascia Mass Operation

Toe Dynasplint
System

     

X

 

11-2157

Congenital Heart
Defect

Genetic Testing

X

       

11-2155

Congenital Heart
Defect

Genetic Testing

X

       

11-2156

Congenital Heart
Defect

Genetic Testing

X

       

11-2168

Psychotic
Disorder

Acute Inpatient
Psychiatric Hospital

   

X

   

11-2167

Anorexia
Nervosa

Residential
Treatment

   

X

   

11-2160

Left Foot, Plantar
Faciitis

Dynasplint

X

       

11-2169

Drug Dependency

Hospitalization

     

X

 

11-2170

Polysubstance
Dependence

Residential
Substance Abuse
Rehabilitation

     

X

 

11-2161

Anorexia
Nervousa

Psychiatric
Treatment

   

X

   

11-2176

Bulimia

Behavioral Therapy

   

X

   

11-2182

Concussion

Neuropsychological
Testing

   

X

   

11-2183

Growth Hormone
Deficiency

Perscription: Saizen

   

X

   

11-2181

Crohn's Disease

Remicade Injections

     

X

 

11-2179

Multiple
Sclerosis

Perscription: Acthar
Gel

   

X

   

11-2177

Lung Cancer

Perscription: Avastin

 

X

     

11-2180

Demyelinating
Disease Of CNS

IVIG Therapy

   

X

   

11-2178

Autism

ABA

   

X

   

11-2185

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation

 

X

     

11-2184

Lung Cancer

SBRT - Radiation
Therapy

X

       

11-2186

Chronic
Tonsillitis, Chronic Pharyngitis

Tonsillectomy, Adenoidectomy, Pharyngolasty

   

Partial

   

11-2187

Inpingement
Syndrome

Arthroscopic
Femoral Neck
Resection

     

X

 

11-2189

Anorexia
Nervosa

Residential
Treatment

   

X

   

11-2188

Substance
Abuse

Residential
Treatment

     

X

 

11-2190

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation

 

X

     

11-2192

Autism

ABA

X

       

11-2191

Autism

ABA

X

       

11-2197

Varicose Veins

Venous Ablation

     

X

 

11-2196

Herniated /
Displaced Disc

Laminectomy

 

X

     

11-2195

Barrett's
Esophagus

Radiofrequency
Ablation

 

X

     

11-2194

Inflammatory
Bowel Disease

Immunofluorescent
Antibody Study

 

X

     

11-2198

Migraine
Headaches

Botox Injection

   

X

   

11-2193

Major
Depressive
Disorder

Residential
Treatment

     

X

 

11-2201

Paraplegic

Easty Standing
Frame

 

X

     

11-2217

Degenerative
Disc Disease

Spinal Fusion

     

X

 

11-2214

Bipolar.
Depression

Inpatient Treatment

   

X

   

11-2209

Right Ankle
Contracture

Ankle Dynasplint

X

       

11-2207

Rotator Cuff

Platelet Rich
Plasma Injection

 

X

     

11-2208

Breast
Carcinoma

Intensity Modulated
Radiation Therapy

 

X

     

11-2222

Spinal Stenosis
& Spondylolisthesis

Spinal Fusion

   

X

   

11-2211

Lyme's Disease

Antibiotics

 

X

     

11-2206

Distal Radius
Fracture

Joint Manipulation
Under Anesthesia

 

X

     

11-2200

Barrett's
Esophagus

Radiofrequency
Ablation

 

X

     

11-2202

Cervicalgia with Cervicalgia Radiculitis

Water Circulating Head Pad with Pump

 

X

     

11-2204

Menopausal
Symptoms

Testosterone Pellet
Insertion

 

X

     

11-2212

High Risk
Pregnancy

Hospitalization

   

Partial

   

11-2220

Varicose Veins

Ablation

   

X

 

11-2219

Herniated /
Displaced Disc

Physical Therapy

     

X

 

11-2205

Frontal Sinus

Endoscopic Frontal
Sinusplasty And Balloon Frontal Sinusplasty

 

X

     

11-2221

Heart
Palpitations After Chemotherapy For Breast Carcinoma

Mobile Outpatient
Cardiac Telemetry

 

X

     

11-2199

Severe
Intracranial & Facial Abnormalities On Prenatal Ultrasound

3-D Surface
Ultrasound

X

       

11-2210

Degenerative
Disc Disease

Radiofrequency
Neurolysis

X

       

11-2203

Herniated /
Displaced Disc

Radiofrequency
Ablation

 

X

     

11-2213

Leg Fracture

Acute Inpatient
Rehabilitation

     

X

 

11-2216

Behavioral
Problem

Residential
Treatment

   

X

   

11-2218

Right Shoulder
Pain. Bursitis

MRI

   

X

   

11-2215

Depression And
Chronic Pain

Psychiatric
Residential
Treatment

     

X

 

11-2229

Prostate Cancer

Intensity Modulated
Radiation Therapy

   

X

   

11-2228

Myelodysplasia

Perscription:
Aranesp. Infusion. Injection Therapy

     

X

 

11-2226

Right Knee
Osteoarthritis

Synvisc Injections

     

X

 

11-2223

Tinnitus

Neuromonics
Device

 

X

     

11-2225

Short Stature

Perscription:
Trevtropin

   

X

   

11-2224

Lyme's Disease

Neurospychological
Testing

   

X

   

11-2227

Prostate Cancer

Intensity Modulated
Radiation Therapy

   

X

   

11-2231

Autism

ABA

X

       

11-2230

Degenerative
Disc Disease

Fusion

     

X

 

11-2232

Autism

Speech and Occupational Therapy

   

X

 

 

11-2236

Osteoarthritis

Game Ready Cold
Therapy

     

X

 

11-2234

Ascending
Thoracic
Aneurysm

CT Angiography Of
The Chest

     

X

 

11-2233

Adenocarcinoma
Of The Uterus

CT Scan Of Chest

     

X

 

11-2235

Psychotic
Disorder

Inpatient
Rehabilitation

   

X

   

11-2237

Scleroderma

Perscription: Tevatio

X

       

11-2238

Osteoarthrosis /
Osteoarthritis

Hip Surgery

X

       

11-2239

Cervical Cancer

Diagnostic Testing

 

X

     

11-2240

Drug
Dependency

Inpatient Treatment

     

X

 

11-2241

Herniated Discs

Artificial Disc
Replacement

     

X

 

11-2242

Arthralgia Of
Shoulder

MRI

     

X

 

11-2243

Radiculopathy

Physical Therapy

     

X

 

11-2244

Burn To Foot

Gamma Graft

X

       

11-2245

Testicular
Cancer

Pet Scan

X

       

11-2246

Chronic Low
Back Pain / Right
Posterior Superior Iliac Spine

Radio Frequency
Ablation

X

       

11-2247

Chronic Low
Back Pain With
Radiculopathy

Percutaneous
Discectomy/Nucleo plasty Surgery

 

X

     

11-2248

Mastodynia

MRI

X

       

11-2249

Left Knee Pain

Autologous
Chondrocyte Implantation Surgery

X

       

11-2250

Anorexia
Nervosa

Inpatient Eating
Disorder Treatment

   

X

   

11-2251

Mood
Disorder/Depres sion

Inpatient Residential
Treatment

   

X

   

11-2252

Toenail Fungus / Onychomycosis

Perscription: Penlac

       

X

11-2253

Anorexia
Nervosa

Hospitalization

     

X

 

11-2254

Depression

Psychotherapy

   

X

   

11-2255

Compulsive And
Obsessive
Behavior

Psychotherapy

   

X

   

11-2256

Breast Cancer

Color Doppler
Evaluation / Doppler Flow Study / Ultrasound

   

X

   

11-2257

Anxiety Disorder

Inpatient Treatment

     

X

 

11-2258

Special
Screening For Malignant Neoplasmas Colon

Anesthesia

   

X

   

11-2259

Chronic Low
Back Pain / Degenerative Disc Disease

Spinal Fusion L5-S1

     

X

 

11-2260

Chronic Lumbar
Pain

Lumbar Fusion

     

X

 

11-2261

Degenerative
Disc Disease

Fusion

     

X

 

11-2262

Peyronie's
Disease

Intron-A Injections

     

X

 

11-2263

Severe
Migraines

IG Allergens
Bloodwork

X

       

11-2264

Post Left Knee
Arthroscopy & Partial Lateral Meniscectomy

Continuous Passive
Motion Machine

     

X

 

11-2265

Bipolar Disorder. Drug Abuse

Inpatient Care

     

X

 

11-2266

Mental Disorder

Biofeed Back

 

X

     

11-2267

Osteoporosis

Diagnostic Testing

 

X

     

11-2268

Kerataconus

Corneal Ring
Implants

X (Partial)

       

11-2269

Spinal Stenosis,
Lumbar Region

Facet Injections And
Facet Blocks

   

X

   

11-2270

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation

 

X

     

11-2271

Knee Meniscal
Tear

MRI

   

X

   

11-2272

Autism, Asperger Syndrome, And Attention Deficit Disorder

Physical Therapy

   

X

   

11-2273

Depression

Transcranial
Magnetic

 

X

     

11-2274

Autism

ABA Treatment

X

       

11-2275

Anorexia
Nervosa

Inpatient Treatment

     

X

 

11-2276

Drug
Dependency

Substance Abuse
Residential Treatment/Detoxific ation

     

X

 

11-2277

Substance
Abuse

Residential
Treatment Center

     

X

 

11-2278

Colon Cancer

Chemotherapy. FX
Assay Test

 

X

     

11-2279

Progressive
Tumor

Magnetic
Resonance
Spectroscopy

X

       

11-2281

Osteoporosis

Collagen Crosslink

     

X

 

11-2282

Vitiligo

Prescription Drugs

   

X

   

11-2283

Dysfunctional Lt
Scapula

Physical Therapy

     

X

 

11-2280

Osteoarthritis
Bilateral Knees

Physical Therapy

     

X

 

11-2293

Endometrial Stromal Sarcoma Recurring

Prescription Drugs

X

       

11-2294

Multiple
Superficial Venous Unsufficiencies

Endo-Venous
Ablation

X

       

11-2295

Ductal
Carcinoma In
Situ

MRI

 

X

     

11-2296

Degenerative
Disc Disease

Artificial Disc -
Prodisc

 

X

     

11-2297

Cervical
Spondylosis

Artificial Disc
Replacement

 

X

     

11-2304

Anorexia
Nervosa

Residential
Treatment

     

X

 

11-2298

Bi-Polar Disorder

Residential
Treatment

     

X

 

11-2299

Alcohol
Dependence

Inpatient Treatment

     

X

 

11-2300

Colonoscopy
And Endoscopy

General Anesthesia

     

X

 

11-2301

Left Side
Shoulder Pain

Chiropractic PT

     

X

 

11-2302

Ulcerative Colitis

Functional Electric
Stimulator

X

       

11-2303

Depressive
Disorder

Transcranial
Stimulation

 

X

     

11-2288

Alcohol Dependence

Residential Treatment

     

X

 

11-2289

Aggressive
Breast Cancer

Pet Scan

   

X

   

11-2290

Intervertebral
Disc Disease

MRI Of The Lumbar
Spine

     

X

 

11-2291

Major
Depressive Disorder And Chronic Fatigue Syndrome

Provigil

 

X

     

11-2305

Drug And
Alcohol
Dependence

Inpatient Treatment

       

X

11-2292

Ovarian Cancer

Diagnostic Imaging

 

X

     

11-2284

Anxiety

Prescription Drugs

     

X

 

11-2285

Degenerative
Joint Disease

Facet Injections

     

X

 

11-2286

Major
Depressive Disorder & Chronic Fatigue Syndrome

Prescription Drugs

     

X

 

11-2287

Gynecomastia

Prescription Drugs

     

X

 

11-2306

Cleft Lip

Dental And
Orthodontic
Services

     

X

 

11-2307

Herniated
Nucleus
Pulposus At L4-5.

Acute Inpatient
Level Of Care

   

X

   

11-2308

Autism

Speech Therapy

   

X

   

11-2309

Prostrate Cancer

Image Guided
Radiation (IMRT- IGRT) And Cyberknife Stereotactic Body Radiosurgery Therapy (SBRT)

 

X

     

11-2310

Coats' Syndrome

Avastin

X

       

11-2311

Major
Depression

Transcranial
Magnetic
Stimulation

 

X

     

11-2312

Degenerative
Disc Disease

Artificial Disc
Replacement

 

X

     

11-2313

Polymorphic
Ventricular
Tachycardia

Genetic Testing

X

       

11-2314

Moderate To Severe Traumatic Brain
Injury Secondary To Motor Vehicle Accident

Inpatient Services

   

X

   

11-2315

Nasal
Obstruction

Ablation Of The
Nasal Turbinates

   

X

   

11-2316

Stroke

Skilled Nursing
Facility

     

X

 

11-2317

Opioid Type
Dependence

Inpatient Substance
Abuse Treatment

     

X

 

11-2318

Bulimia, Depression

Inpatient Behavioral
Health Treatment

     

X

 

11-2319

Status Post
Prostatectomy

Viagra

     

X

 

11-2320

History Of
Gastroesophage al Reflux
Disease And
Gastric Ulcer

Anesthesia For Esophagogastroduo denoscopy

     

X

 

11-2322

Left Knee Pain

MRI

   

X

   

11-2321

Temporomandib
ular Joint
Disorder

Expenses Related
To Treatment TMJ

     

X

 

11-2327

Bilateral
Shoulder Adhesive Capsulitis

Physical Therapy

     

X

 

11-2328

Alcoholism

Naltrexone Pellet

 

X

     

11-2329

Colorectal
Cancer State IV

Colorectal Cancer
State IV

X

       

11-2330

Breast Cancer /
Langerhans Cell Histiocytosis (LCH) -AP

Pet Scan

   

X

   

11-2331

Acute Sigmoid
Colon Diverticulitis With Abscess

Inpatient Care

   

X

   

11-2334

Degenerative
Disc Disease

Artificial Disc
Replacement

 

X

     

11-2323

Left Knee
Replacement

Computer Assisted
Navigation (CAS)

 

X

     

11-2324

Immunodeficienc y And Rheumatologic Disorder Along With Pre-Existing Juvenile Arthritis.

Immune Globulin
Infusion

   

X

   

11-2325

Osteoarthritis

Hyaluronic Acid
Injections

     

X

 

11-2326

Obesity

Laparoscopic Roux-
En-Y Gastric
Bypass

   

X

   

11-2332

Major
Depressive
Disorder

Residential
Treatment

   

X

   

11-2333

Preconception
And Prenatal
Screening

Gynecologic
Services

   

X (Partial)

   

11-2336

Diagnosis: Right Lateral Epicondylitis And Right Frozen Shoulder

Physical Therapy

 

X

     

11-2337

Varicose Veins
With
Inflammation

Venous Duplex

   

X

   

11-2355

Prostrate Cancer

Imrt-Igrt

 

X

     

11-2356

Headaches

Botox

 

X

     

11-2357

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation

 

X

     

11-2358

Bunion/Bunionec tomy

Dynasplint Low-
Load Prolonged
Duration Stretch

 

X

     

11-2359

Lumbar
Degenerative Disc Disease, Scoliosis And Lumbar Spondylosis

Radiofrequency
Facet Rhizotomy

X

       

11-2360

Spect Scan

Moyamoya Disease

 

X

     

11-2361

Disc
Degeneration, Lumbar

Vertebral Axial
Decompression

 

X

     

11-2362

Alcohol / Drug
Dependence

Inpatient
Detoxification
Program

     

X

 

11-2363

Schizophrenia,
Drug
Dependence

Residential Care

     

X

 

11-2364

Alcohol / Drug
Dependence

Inpatient Drug
Rehabilitation

     

X

 

11-2365

Left Knee
Arthroscopic Surgery With Partial Medial Meniscectomy

Physical Therapy

     

X

 

11-2366

Colonscopy

Anesthesia

     

X

 

11-2367

Bipolar

Out Patient Therapy

     

X

 

11-2368

Colon Cancer

Chemo FX Lab
Testing

     

X

 

11-2369

Brain Metastases

Radiosurgery

     

X

 

11-2370

Cocaine Abuse

Residential
Rehabilitation

     

X

 

11-2371

Substance/Alcoh
ol Dependence

Residential
Treatment

     

X

 

11-2372

Short Stature

Growth Hormone
Treatment

     

X

 

11-2373

Major
Depression And Panic Disorder With Agoraphobia

Intensive Outpatient
Services

     

X

 

11-2346

Spinal Muscular
Atrophy Type I

Synagis

   

X

   

11-2347

Lipodystrophy -
HIV Related

Egrifta--
Perscription

   

X

   

11-2348

Talipes Valgus
Of The Feet, Bilaterally

Subtalar
Arthroereisis

X

       

11-2349

Chronic Neck
Pain

Total Disc
Replacement

 

X

     

11-2350

Spinal Stenosis

Cervical Artificial
Discectomy

 

X

     

11-2351

Multiple
Sclerosis

IVIG Infusion

   

X

   

11-2352

Cervicogenic
Headaches

Multilevel Cervical
Fusion

   

X

   

11-2353

Bilateral Knee
Osteoarthritis

Supartz Injections

     

X

 

11-2354

ACL Reconstruction

CPM Machine

     

X

 

11-2338

Speech Delay
Following Head Injury Due To Accident At 7
Months

Speech Therapy

   

X

   

11-2339

Substance Abuse, Major Depressive Disorder With History Of ADHD

Psychiatric Partial Hospitalization Program Treatment

   

X

   

11-2340

Bilateral -Severe
To Profound Sensorineural Hearing Loss

Nucleus 5
Processor Implant

     

X

 

11-2341

Major
Depressive Disorder, Bipolar Disorder And ADD

Transcranial Magnetic Stimulation

 

X

     

11-2342

Alcohol
Dependence

Residential
Treatment

     

X

 

11-2343

Bipolar Disorder, Type II, Post- Traumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder And Benzodiazephine Dependency

Inpatient Mental
Health Services

     

X

 

11-2344

Hypomania And Insomnia Secondary To Medical Therapy For Treatment Of Bipolar Disorder

Seroquel 25 Mg

   

X

   

11-2345

Obsessive
Compulsive Behavior/Aggres sion

Inpatient Mental
Health

     

X

 

11-2379

Spinal Stenosis
& Spondylolisthesis

X-Stop Intraspinal
Distraction Device

 

X

     

11-2380

Vaginal
Hemorrhage

Emergency
Services

   

X

   

11-2381

Tourette's
Syndrome

Drug, Xenazine

   

X

   

11-2382

Otitis Media

Emergency
Services

   

X

   

11-2383

Severe Systemic
Mysthenia Gravis

Ivig

X

       

11-2384

Depression

TMS - Transcranial
Magnetic
Stimulation

X

       

11-2385

Major
Depressive
Disorder

TMS - Transcranial
Magnetic
Stimulation

X

       

11-2386

Rheumatoid
Arthritis

Munoassay
Antibody Diagnostic
Tests

X

       

11-2388

Pericardium

Cellular Tissue Grafts

 

X

     

11-2387

Alcohol
Dependence

Residential Mental
Health Care

     

X

 

11-2389

Chronic Neck Pain - Cervicalgia

Spine Nerve
Treatment (Radiofrequency Neurolysis)

 

X

     

11-2390

Degenerative
Disc Disease

Artificial Disc
Replacement

 

X

     

11-2391

Deviated Septum
- Nasal
Obstruction

Septoplasty -
Radiofrequency Or Laser Ablation Of Nasal Tubinates

 

X

     

11-2392

Monitor The Heart Rate, Fainting Spells

External Mobile Cardiovascular Telemetry With EEG

 

X

     

11-2393

Deviated Septum
- Nasal Obstruction, Sleep Apnea

Nasal & Throat Surgery, Septoplasty

 

X

     

11-2394

Derangement Of Medial Meniscus Left Knee Pain

Artiledge Cells Tranplant And Meniscal Transplant Surgery  - Allograft / Osteochondral

 

X

     

11-2395

Displacement Of
Intervertebral - Neck Pain And Left Upper Extremity Pain And Weakness

Cervical Artificial
Disc Replacement.

 

X

     

11-2396

Deviated Septum
- Nasal
Obstruction

Radiofrequency /
Laser Ablation (Reduction Of Tissue Volume)

 

X

     

11-2397

Alcohol
Dependence

Residential
Treatment

     

X

 

11-2398

Schizophrenia

Res Psych Ward

       

X

11-2399

Degenerative
Disc Disease

Fusion Surgery

   

X

 

 

11-2400

Alcohol Dependence

Sub Acute Residential Treatment Services

     

X

 

11-2401

Anxiety, Major
Depression, Benzodiazepine Dependence, Alcohol Abuse & Substance Abuse

Residential
Treatment

     

X

 

11-2402

Gastritis & Duodenitis

Anesthesia
Services, Endoscopy

     

X

 

11-2403

Traumatic
Amputation

Microprocessor
Controlled Lower
Limb Prosthesis

     

X

 

11-2404

Obesity

Gastric Bypass

     

X

 

11-2405

Anxiety, Suicidal, Cutting

Hospitalization,
Residential
Treatment Center

       

X

11-2406

Obesity

Gastric Bypass

     

X

 

11-2407

Obesity

Gastric Sleeve
Procedure

     

X

 

11-2408

Knee Instability,
Post Surgery

Knee Brace

     

X

 

11-2409

Coronary Artery
Disease

C-Reactive Protein
Testing

X

       

11-2410

Prostate Cancer

IMRT - Radiation
Therapy

   

X

   

11-2375

Alcohol
Dependence

Residential
Treatment

     

X

 

11-2376

Major
Depressive
Disorder

Tms - Transcranial
Magnetic
Stimulation

 

X

     

11-2377

Shoulder Pain,
Tendonitis

MRI

     

X

 

11-2378

Degenerative
Disc Disease

Cervical Total Disc
Replacement
Therapy

 

X

     

11-2374

Bipolar

Residential Mental
Health Treatment

     

X

 

11-2414

Injury -
Muscular/Skeleta l

ER Room
Treatment

     

X

 

11-2412

Exudative
Tonsils W/ Probable Acute Pharanitis

Zithromax And An Opioid Pain Medication

   

X

   

11-2413

Chronic Pain
Syndrome

Actiq LOZ 1600 Mcg
Every 8 Hours As
Needed

   

X

   

11-2414

Knee Pain, Neck
Pain And Back
Pain

Physical Therapy

     

X

 

11-2415

Neck Pain,
Cervical Strain, Lumbosacral A Strain, Sciatic Nerve Lesion

Physical Therapy

     

X

 

11-2416

Mastocytosis

Laser Skin Tag
Removal

     

X

 

11-2417

Panhypopituitaris
m

Growth Hormone
Therapy

     

X

 

11-2418

Hip Pain, Hiking
Injury

Physical Therapy

     

X

 

11-2419

Breast Cancer

Med (Sprycel)
Designed To Treat
Bone Tumors

 

X

     

11-2420

Osteoarthrosis

Synvisc Injection

 

X

     

11-2421

Foot Drop Resulting From CVA (Stroke)

Functional Electrical
Stimulator Walk
Aide

X

       

11-2422

Breast Cancer

Mammaprint Testing
- Gene Expressing
Profile

 

X

     

11-2423

Chronic Sinusitis

Balloon Sinuplasty

 

X

     

11-2424

Major
Depressive
Disorder

Transcranial
Magnetic
Stimulation

 

X

     

11-2425

Degenerative
Disc Disease

Spinal Fusion

     

X

 

11-2426

Major
Depressive Disorder With Psychotic Features, Paranoid Schizophrenia, Suicidal Idealization

Inpatient Psych
Hospitalization

   

X

   

11-2427

Depression And
Suicidal Ideation

Psychiatric
Residential
Treatment

   

X

 

 

11-2428

Hypothyroidism

MRI

 

 

 

X

 

11-2429

 Autism

Outpatient Mental
Health Services

 

 

 X

 

 

11-2430

Major
Depressive
Disorder

 Therapy, 4x Week

 

 

 

 X

 

11-2431

Chemical
Dependency

In Patient
Substance Abuse Sub Acute Residential Treatment Services

 

 

 

 X

 

11-2432

Anorexia
Nervosa

Residential
Treatment

 

 

 

 X

 

11-2438

Bipolar, Severe
Emotional
Disturbances

Inpatient &
Residential
Treatment

 

 

X

 

 

11-2439

 Degenerative
Disc Disease

Lower Lumbar
Vertebrae Fusion / Low Back Fusion Surgery

 

 

 

X

 

11-2440

 Painful Degenerative Disc L4-5

 Surgical Intervention
Lumbar Fusion At L4-5 Or Total Disc Replacement At L4-
5.

 

 

 

 X

 

11-2441

 Bi-Polar

Inpatient Psychiatric
Care

 

 

 

 X

 

11-2433

 Psycohotic
Disorder

 Acute Inpatient
Psychiatric Services

 

 

 Partial

 

 

11-2434

 Hepatitis C

Prescription For
Humira

 

 

 

 X

 

11-2435

Lower Back
Pain, Radiculopathy

 Lumbar Spinal
Fusion

 

 

 

 X

 

11-2436

Unknown
Etiology

 Ct Scan

 

 

 X

 

 

11-2437

Anorexia
Nervosa

Residential
Treatment

 

 

 

 X

 

11-2442

Surgical Repair
Of Right Knee

Custom Knee
Brace

 

 

 

 X

  

11-2443

Hypertriglyceride
mia (High
Triglycerides)

 Lovaza

 

 

 

 X

 

11-2444

Degenerative
Disc Disease

 Artificial Disc

 

 X

 

 

 

11-2445

Breast Cancer
(Invasive Ductal
Carcinoma)

 Low Dose
Chemotherapy

 

 X

 

 

 

11-2446

Degenerative
Disc Disease

 Artificial Disc

 

 X

 

 

 

11-2447

Low Back Pain -
Degenerative
Disc Disease

 Lumbar Artificial
Disc Arthroplasty

 

 X

 

 

 

11-2448

 Piriformosis
Syndrome

 MRI - Magnetic
Resonance Imaging

 

 

 Partial

 

 

11-2449

Low Back Pain -
Chronic Low Back Pain And Left Leg Pain

Facet Joint
Injections - Lumbar Epidural And Steroid Injections

 

 

 

 X

 

11-2450

Schizophrenia

Hospitalization

 

 

 

X

 

11-2451

Genetic
Predisposition To Hypertrophic Cardiomyopathy

 External Mobile Cardiovascular Telemetry (MCOT)

 

 

 

 X

 

11-2452

Alcohol / Drug
Dependence

Residential
Treatment

 

 

 

 X

 

11-2453

Alcohol / Drug
Dependence

Residential
Treatment

 

 

 

 X

 

11-2454

Necrotizing
Fasciitis & Toxic Affect Of Unspecified Metal

 Hyperbaric Oxygen
Therapy

 

 

 

 X

 

11-2455

Left Thigh
Contusion & Hematoma

 Physical Therapy

 

 

 

 X

 

11-2456

Herniated /
Displaced Disc

Artificial Disc
Replacement

 

 X

 

 

 

11-2457

Bilateral Nasal
Obstruction

Septoplasty /
Rhinoplasty

 

 

X

 

 

11-2458

 Lumbago, Spinal
Stenosis,
Disorder Of Bone
And Cartilage

 Lumbar Spinal
Fusion

 

 

 

 X

 

11-2462

 Depression

Weekly Outpatient
Mental Health
Treatment

 

 

Partial

 

 

11-2459

Drug/Alcohol
Dependence, Major Depressive Disorder, Attention Deficit/Hyperacti vity Disorder

 Residential Mental
Health Treatment

 

 

 

 X

 

11-2460

Anorexia
Nervosa

Residential
Treatment

 

 

 X

 

 

11-2461

 Bulimia

Partial
Hospitalization
Program

 

 

 

 X

 

Totals

63

102

111

181

5


 

Back to Top
separator