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2009 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: 394
  • Experimental/Investigational-Overturned: 69
  • Experimental/Investigational-Upheld: 70
  • Medical Necessity Overturned: 109
  • Medical Necessity Upheld: 141
  • Withdrawn: 5

Independent Medical Reviews (IMR) Annual Report- January through December 2009

Reference # Diagnosis Treatment Experimental / Investigational-Overturned Experimental / Investigational-Upheld Medical Necessity Overturned Medical Necessity upheld Withdrawn
09-1118 Irritable Bowel Syndrome Diagnostic Tests     X    
09-1119 Hyperlipidemia Blood Testing Needed Following A Change In Medication To Monitor Impact Of Change.       X  
09-1120 Alcohol Dependence; Sedative-Hypnotic Dependence; Cannabis Abuse; Opiate Abuse Rehabilitation At The Betty Ford Ctr       X  
09-1121 Blocked Coronary Artery Stent Placed       X  
09-1122 Chemical Dependency Residential Treatment Vs Outpatient Treatment       X  
09-1123 Complex Regional Pain Syndrome Drug-Fentora 400       X  
09-1124 Heart Condition Homocysteine And Lipoprotein-Associated Phospholipase A2 Testing   X      
09-1125 Low Back Pain W/Bilateral Lower Extremity Pain, Lumbar Arthritis, Foraminal Stenosis,Degenerative Disc Disease, Nerve Entrapment, Spondylolysis, Bulging Disc, Radiculitis, Lumbar Pain Lumbar Laminotomy (Hemilaminectomy) And Foraminotomy Including Partial Facetectomy With Decompression Of The Nerve Roots And Therapeutic Steroid Injection, Left L5/S1   X      
09-1126 Stage IIIB Histiocytic Lymphoma In 1978 & Remained In Remission Until Diagnosed W/Stage II Invasive Ductal Carcinoma In 2005 Oncotype Dx X        
09-1127 Neck/Back Pain Epidural Steroid Injections   X      
09-1128 High Cholesterol Lipoprotein-Associated Phospholipase A-2 And Homocysteine Testing X        
09-1129 Substance Abuse / Alcohol Dependency Residential Treatment     X    
09-1130 Multiple Sclerosis Acupuncture       X  
09-1131 ADHD Psychiatric Residential Treatment     X    
09-1132 Chemotherapy-Related Anemia Aranesp Injections       X  
09-1133 ACL Tear (Left Knee) Custom Fit Don Joy Knee Brace       X  
09-1134 Lymphocytic Lymphoma And Neutropenia Chemo Therapy Drug Neupogen (Filgrastim)       X  
09-1135 Total Disk Arthroplasty Prodisk   X      
09-1136 Hypothyroidism, Osteoporosis, Testicular Hypofunction, Fatigue, Candidiasis, Allergic Rhinitis, Right Bundle Branch Block, Right Bundle Branch Block, Abnormal Heart Scan Computed Tomography (Ct) Scan Of The Heart   X      
09-1137 Arthritic Knee Synvisc Injections To The Knee     X    
09-1138 Obesity & Hyperlipidemia Lipitor       X  
09-1139 Prostate Cancer Prostate Cancer Therapy (Hifu With Sonablate)   X      
09-1140 Elbow Pain Acupuncture Treatment   X      
09-1141 Plagiocephaly Cranial Orthotic Support Device     X    
09-1142 Chest Pains & Hyperlipidemia Tomography   X      
09-1143 Bulimia Nervosa And Major Depressive Disorder Inpatient Treatment       X  
09-1144 Idiopathic Short Stature Growth Hormone Therapy (Somatropin Injections)          
09-1145 Bilateral Foot Pain, Bilateral Hallux Valgus Deformity Bunionectomy.     X    
09-1146 Post Lumbar Fusion Surgery Chiropractic Therapy       X  
09-1147 Interstitial Cystitis And Pelvic Floor Dysfunction Physical Therapy     X    
09-1148 Cervical Strain, Degenerative Disease Physical Therapy       X  
09-1149 Post Bunionectomy And Osteotomy Physical Therapy Services       X  
09-1150 Chronic Migraine Headaches Physical Therapy     X    
09-1151 Substance Abuse And Behavioral Problems Residential Behavioral Health Services     X    
09-1152 Small Stature Adult Growth Hormone Drug       X  
09-1153 Coronary Heart Disease Diagnostic Testing-Coronary Calcium Score X        
09-1154 Migraine, Libido And Incontinence Testosterone Pellet Treatment   X      
09-1155 Unknown Etiology, Symptoms Were Headache And Fever Inpatient Hospital Stay       X  
09-1156 Congenital Unilateral Hearing Loss FM Phonak     X    
09-1157 Post Bilateral Reduction Mammoplasty Liposuction Of Residual Fullness Along The Anterior       X  
09-1158 Cervical -Facial Muscle Dysfunction With Masseter And Cervical Paraspinal Spasms And Temporal Mandibular Joint Disorder-Like Syndrome. Physical Therapy       X  
09-1159 Severe Dyslexia Special Program Used For Stroke Patients       X  
09-1160 Spasmodic Torticollis Botox A       X  
09-1161 Anxiety & Depression Substance Abuse 24 Hr Residential Treatment Services       X  
09-1162 Colon And Lung Cancer Avastin To Tx The Cancer     X    
09-1163 Fecal Incontinence Biofeedback   X      
09-1164 Achilles Tendonitis Extracorporeal Shock Wave Therapy   X      
09-1165 Lung Cancer IMRT Radiation   X      
09-1166 Low Back Pain Intradiscal Electrothermal Annuloplasty Procedure   X      
09-1167 Renal Mass Radiofrequency Ablation (RFA) X        
09-1168 Bilateral Plantar Fasciitis Extracorporeal Shock Wave Lithotripsy   X      
09-1169 ACL And Meniscal Tear Treatment Post Knee Surgery - Treatment: Use Of Continuous Passive Motion (CPM) Machine       X  
09-1170 Tinnitus And Burning-Tongue Syndrome Lab Tests       X  
09-1171 Verbal Apraxia Or The Severity Of A Recognized Speech/Language Problem Resulting From A Known Or Likely Medical Condition That Meets Criteria For Intervention Continued Speech Therapy For Dep After Age 3     X    
09-1172 Liver Cancer RX Sutent     X    
09-1173 Morbid Obesity With Uterine Hyperplasia IUD X        
09-1174 Colon Cancer Pet Scan X        
09-1175 Stage 3 Cancer Chemo-Radiation Therapy   X      
09-1176 Pancreatic Cancer Endoscopic Retrograde Cholangiopancreatography (ERCP) X        
09-1177 Dysphagia Speech Therapy     X    
09-1178 Post Traumatic Ankle With Posterior Avacular Necrosis Total Ankle Arthroplasty   X      
09-1179 Varicose Veins Venous Ablation / Sclerotherapy       X  
09-1180 Ovarian Cyst & Irregular Uterine Bleeding Robotic-Assisted Total Laparoscopic Hysterectomy With Bilateral Salpingo-Oophorectomy   X      
09-1181 Bunionectomy And Fusion To First Metatrsocuneiform Joint On The Left Foot Pneumatic Compressor       X  
09-1182 Oppositional Defiant Disorder & Polysubstance Dependence Residential Treatment       X  
09-1183 Attention Deficit/Hyperactivity Disorder, Oppositional Defiance Disorder/Asperger's Syndrome, Mixed Substance Abuse And Mood Disorder Acute Inpatient Psychiatric Level Of Care       X  
09-1184 Schizophrenia Inpatient Treatment       X  
09-1185 Symptomatic Varicose Veins Sclerotherapy And Phlebectomy       X  
09-1186 Intractable Epilepsy Encephalography (MEG) X        
09-1187 Chronic Back Pain Back Fusion Surgery       X  
09-1188 Synovial Cell Sarcoma Ct-Guided Radiofrequency Tumor Ablation X        
09-1189 Prostate Cancer High-Intensity Focused Ultrasound   X      
09-1190 Pregnancy -True Knot In The Umbilical Cord Aggressive Fetal Surveillance Consisting Of Weekly Non-Stress (Nst), Twice Weekly Biophysical Profile (Bpp), Twice Weekly Unbilical Artery Dopplers And Twice Weekly Middle Cerebral Artery (Mca) Dopplers.   X      
09-1191 Post Care For Broken Leg Manual Therapy       X  
09-1192 Post Care For Broken Leg Electrical Stimulation   X      
09-1193 Status Post Complex Revision Right Total Hip Replacement Skilled Nursing Facility Stay     X    
09-1194 Polysubstance Dependence And Mood Disorder Not Otherwise Specified (Nos) Residential Care       X  
09-1195 Serious Eating Disorder With Suicidal Ideation And Suicide Attempts With Other Co-Morbidities Including Dissociative Identity Disorder And Severe Depression 24 Hour Sub-Acute & Acute Inpatient Treatment       X  
09-1196 Psoriasis With Psoriatic Arthritis Remicade Medication     X    
09-1197 Lung Cancer Pet Scan     X    
09-1198 Violent Behavior Residential Mental Health Services     X    
09-1199 Multiple Spine Surgeries, Digestive And Respiratory Problems/Complications Continued Skilled Nursing Care       X  
09-1200 Neck Dystonia Botulinum Toxin X        
09-1201 Crohn's Disease Endoscopy          
09-1202 Menopausal Hormonal Imbalance Hormone Implants   X      
09-1203 Liver Cancer With Metasteses Radiation Therapy Services (SIRT) X        
09-1204 Cancer Of Stomach, Stage 4 Avastin   X      
09-1205 Pancreatic Cancer Pet Scan     X    
09-1206 Breast Cancer Oncotype Dx Assay (Gene Expression Profiling)       X  
09-1207 History Of Osteogenesis; Post Anterior Cruciate Ligament, Reconstruction Rehabilitation. Custom Knee Brace       X  
09-1208 Abnormal Sensation By History And By Examination On The Left Side Of The Body Magnetic Resonance Angiography     X    
09-1209 Cystic Lesion In The Left Medial Temporal Lobe Magnetic Resonance Spectroscopy (Mrs) X        
09-1210 Coronary Artery Disease Computerized Tomography Angiography   X      
09-1211 Dyslipidemia; Atypical Chest Discomfort; Post Heart Bypass Surgery Lp-Pla2 Testing   X      
09-1212 Osteoarthritis Of The Right Hip Right Hip Resurfacing Arthroplasty   X      
09-1213 Metastatic Sarcoma Of The Spleen Stereotactic Radiosurgery (Cyberknife Raidotherapy)   X      
09-1214 Post Lumbar Surgery, Sciatica, Scoliosis, Lupus, Osteoporosis, Rheumatoid Factor Arthritis, Osteo Arthritis & Other Ailments Electric Stairlift       X  
09-1215 Recovery From Knee Replacement Surgery Physical Therapy     X    
09-1216 Scoliosis Chiropractic Treatment       X  
09-1217 TMJ Articular Disc Disorder, Tendinitis Not Otherwise Specified, Myalgia And Myositis, Unspecified TMJ Treatment       X  
09-1218 Multi-Level Lumbar Degenerative Disc Disease Physical Therapy Services       X  
09-1219 Lyme Disease Bicillin L-A Injections   X      
09-1220 Large B Cell Lymphoma PET Scan   X      
09-1221 Degenerated Kneecap Transplantation Of Cafticel Cartilage In The Complainant's Knee.   X      
09-1222 Aggressive Prostate Cancer. Prostascint Scan       X  
09-1223 Pre-Malignant Lesion On Lower Lip Cryotherapy Services     X    
09-1224 Increased Risk Of Osteoporosis Bone Density Scan       X  
09-1225 Osteochondral Lesion Talus Autologous Chondrocyte Implantation Of Ankle       X  
09-1226 Prostate Cancer (IMRT) Intensity Modulated Radiation Therapy       X  
09-1227 Lung And Brain Cancer Avastin       X  
09-1228 Thrombocytopenia Drug-Neumega     X    
19-1229 Poly Substance Abuse, Depressive Disorder Residential Facility Services     X    
09-1230 Muscle Cramps EDX (Electrodiagnostic Test)       X  
09-1231 Rapid Heart Rate/Tachycardia And Irregular/Skipped Heartbeats For A Pregnant Woman Echocardiogram (ECHO), Electrocardiography (EKG), Stress Testing, Holter Monitor (Overnight) And Event Monitoring     X    
09-1232 Chronic Sinusitis Septorhinoplasty       X  
09-1233 Morbid Obesity Surgery Bariatric Surgery   X      
09-1234 Anorexia Nervosa Residential Services X        
09-1235 Post-operative Care For Right Shoulder Surgery Physical Therapy     X    
09-1236 Labral Tear With Calific Tendinitis Physical Therapy     X    
09-1237 Neck And Shoulder Pain Chiropractic Manipulation       X  
09-1238 Aggressive Large B Cell Lymphoma Computed Tomography (CT) Scan Of The Neck Soft Tissue Without Contrast       X  
09-1239 Panhypopituitarism Growth Hormone Therapy     X    
09-1240 Migraines Botox Injections   X      
09-1241 Unspecified Chest Pain, Hypertension With A Family Hx Of Ischemic Heart Disease; Homocysteine, Apolipoprotein And Lipoprotein High Resolution Fractionation And Quantitation Testing Was Denied   X      
09-1242 Left Knee Pain Post Arthroscopy For Patellar Microfracture Physical Therapy     X    
09-1243 Chronic Paranoid Schizophrenia Acute Care, Only Partial Hospitalization       X  
09-1244 Bi-Polar, Substance Abuse Adult Substance Abuse- Subacute Residential Tx Ctr Rehab       X  
09-1245 Ankylosing Spondylitis & Post Arthroplasty To The Right Hip. Physical Therapy     X    
09-1246 Low Back Pain From Herniated Disc Intraoperative Monitoring During Surgery       X  
09-1247 Eating Disorders Residential Services       X  
09-1248 History Of Mid-Back Pain Secondary To Various Sport-Related Injuries Insured Sustained Through The Years As Well As Wear And Tear On The Back MRI Of The Thoracic Spine And MRI Of The Cervical Spine       X  
19-1249 Celiac Disease And Hypothyroidism Protonix     X    
09-1250 Gastrointestinal Stromal Tumor Pet Imaging     X    
09-1251 Traumatic Brain Injury With Subarachnoid Hemorrhage & Intracranial Hemorrhage, Status Post Rt Frontal Craniotomy With Hydrocephalus & Persistent Pneumonia And Went Into Sepsis Because Of Last Move Sub-Acute Care Facility       X  
09-1252 Obesity Laparoscopic Sleeve Gastrectomy   X      
09-1253 Cyberknife Stereotactic Body Radiation Therapy (SBRT) Liver Lesions From Metastatic Lung Cancer X        
09-1254 Stage IV Rectal Cancer With Liver Metastasis Selective Internal Radiation Therapy X        
09-1255 Diabetes Continuous Blood Glucose Monitor     X    
09-1256 Osteoporosis Bone Mineral Density Test     X    
09-1257 Intestinal Infection Sporanox       X  
09-1258 Ischemic Optic Neuropathy Hyperbaric Oxygen Therapy   X      
09-1259 Attenuation Pet Scan X        
09-1260 Pelvic Congestion Syndrome Ovarian & Internal Iliac Vein Transcatheter X        
09-1261 Multiple Myeloma-Stage III Pet Scan X        
09-1262 Stage IV Liver Cancer Pt Thera-Sphere Therapy   X      
09-1263 Type I Diabetes And Erectile Dysfunction Trimix Injection X        
09-1264 Thoracic Disc Extrusion Pre-Authorization Requested For Thoracic Posterior Spinal Fusion With Instrumentation       X  
09-1265 Depression / Eating Disorder Residential Inpatient Care       X  
09-1266 Arthritic Condition Both Knees; Microfracture Of Right Knee And Status Post Menisectomies Of Both Knees Causing Bilateral Knee Pain Regenexx Injections   X      
09-1267 Eating Disorder Sub-Acute Residential Services       X  
09-1268 Right Lower Extremity Ulcer Ultrasound Mist Therapy X        
09-1269 Right Shoulder And Rotator Cuff Tendonitis And Right cervical/ Trapezius Strain With C4-7 Degenerative Disc Disease Physical Therapy     X    
09-1270 Right Elbow Fracture Assistant Surgeon     X    
09-1271 Coronary Artery Disease Diagnostic Testing       X  
09-1272 Hip Impingement Syndrome Femoro-Acetabular Surgery X        
09-1273 Migraines Botox Injections X        
09-1274 Eating Disorder Inpatient Hospital Level Care Services     X    
09-1275 Basal Ganglion - CVA Skilled Nursing Facility Care       X  
09-1276 High Cholesterol Levels Medication (Vytorin)       X  
09-1277 Autism ABA Therapy     X    
09-1278 Alcohol Dependence, Bipolar Disorder And Anxiety Disorder Residential Treatment       X  
09-1279 Obesity Panniculectomy And Abdominoplasty       X  
09-1280 Lymphedema In Arm, Chest & Abdomen Flexitouch Pneumatic Compression Device     X    
09-1281 Breast Cancer Zometa-For Hormonal Therapy And Aromatase Adjuvant Radiation Therapy     X    
19-1282 Monoclonal Gammopathy PET CT Scan     X    
09-1283 Borderline Lipid Profile Ultrasonographic Measurements Of The Carotid Intimal Medial Thickness   X      
09-1284 Cardiovascular Condition Computed Tomography (CT) Scan Of The Heart And Coronary Vessels X        
09-1285 Post Care For Shoulder Surgery Pneumatic Compression Therapy System   X      
09-1286 Morbid Obesity Sleeve Gastrectomy X        
09-1287 Total Ankle Arthroplasty Ankle Arthritis   X      
09-1288 Co-Morbid Obesity Duodenal Switch Procedure     X    
09-1289 Status Post Left Knee Total Arthroplasty/Replacement Use Of A Continuous Passive Motion (CPM) Device In The Home       X  
09-1290 Speech Disorder Speech Therapy     X    
09-1291 Osteoporosis Dual Energy X-Ray Absorptiometry (DEXA) Scan     X    
09-1292 Morbid Obesity Laparoscopic Gastric Sleeve Surgery   X      
09-1293 Type 1 Diabetes Insulin Infusion Pump     X    
09-1294 Left Knee Pain And Right Shoulder Pain Chiropractic Care       X  
09-1295 Metastatic Sarcoma Of The Spleen Stereotactic Radiosurgery (Cyberknife Raidotherapy)       X  
09-1296 Atypical Melanocytic Hyperplasia Mohs Micrographic Surgery     X    
09-1297 Neuropathy In Both Feet And Sciatica In Both Legs Neurography Scan   X      
09-1298 Liposarcoma, Multiple Abdominal Masses Nexavar X        
09-1299 Nasal Septal Deviation Septoplasty & Submucous Resection Of Deviated Nasal Septum       X  
09-1300 Alcohol And Chemical Dependence Partial Hospitalization Day Treatment Program Services     X    
09-1301 Opiate Dependence, Depression, With Anxiety, And Suicidal Ideations. Acute Psychiatric Inpatient Treatment     X    
09-1302 Suicide Threats, Bi-Polar, Depression Psychiatric Facility For A 72 Hour Psychological Evaluation     X    
09-1303 Short Stature And Growth Deficiency Nutropin AQ     X    
09-1304 Symptomatic Varicose Veins Sclerotherapy And Phlebectomy       X  
09-1305 Depression, Drug/Alcohol Dependence. Inpatient Drug/Alcohol Rehabilitation       X  
09-1306 Interstitial Cystitis And Pelvic Floor Dysfunction Physical Therapy       X  
09-1307 Chronic Neck, Back And Shoulder Pain And Multilevel Degenerative Disc Disease Breast Reduction Surgery       X  
09-1308 Polysubstance Abuse Residential Treatment       X  
09-1309 Ulcerative Colitis Prometheus IBD 7 Serology Panel. X        
09-1310 Bilateral Thoracic Syndrome, Cervical Dystonia And Muscle Spasm And Bilateral Carpal Tunnel. Botox Injections   X      
09-1311 Symptomatic Polycythemia Without Hemorrhage Or Trombosis Phlebotomy Of 250cc Of Blood       X  
09-1312 Bi-Polar Residential Treatment     X    
09-1313 Bipolar, High Functioning Autism And Reactive Disorder Psychiatric Inpatient Services     X    
09-1314 Hernia Repair Surgery Panniculectomy/Abdominoplasty     X    
09-1315 Drug Abuse And Dysfunctional Behavior Psychiatric Residential Treatment     X    
09-1316 Idiopathic Hypersomnolence And Parkinson's Disease Provigil       X  
09-1317 Depression / Attempted Suicide - Treatment Inpatient Acute Psych Facility       X  
09-1318 Multiple Sclerosis Walkaide System X        
09-1319 Bilateral Leg Pain With Venous Insufficiency Ultrasound Guided Transcatheter Endovenous Chemical Ablation   X      
09-1320 Extracorporeal Shockwave Lithotripsy Plantar Fasciitis X        
09-1321 Left Ankle Osteoarthritis Total Ankle Replacement X        
09-1322 Bilateral Leg Pain With Venous Insufficiency Ultrasound Guided Transcatheter Endovenous Chemical Ablation For Bilateral Leg Pain     X    
09-1323 Left Ankle Pain Due To Osteochondral Lesion Of The Medial Talar Dome Autologous Chondrocyte Implantation Of Ankle       X  
09-1324 Erectile Dysfunction Cialis     X    
09-1325 Periprosthetic Capsular Contractures Bilateral Removal Of Breast Implants       X  
09-1326 Expressive Language Disorder Speech Therapy Evaluation And Services     X    
09-1327 Diagnostic Test 21-Gene RT_PCR For Prediction Of Breast Cancer Oncotype DX Breast Cancer Assay Testing       X  
09-1328 Synovial Sarcoma PET/CT Scan X        
09-1329 Venous Insufficiency W/History Of Spider Telangiectasias Sclerotherapy X        
09-1330 Overactive Bladder Detrol LA       X  
09-1331 Degenerative Arthritis Of Right Knee Orthovisc Injections To Right Knee       X  
09-1332 Breast Cancer Post Double Mastectomy Breast Reconstruction     X    
09-1333 Peripheral Vascular Disease MRI Of Heat W/O Contrast, MRI Neck, W/O Contrast, MRI Of Cervical Spine W/O Contrast And MRI Of Brain (Head) Without Contrast Material       X  
09-1334 Cervical Spondylosis Cervical Disc Arthroplasty     X    
09-1335 Substance Abuse / Depression In-Patient Hospitalization       X  
09-1336 Post Lumbar Surgery, Sciatica, Scoliosis, Lupus, Osteoporosis, Rheumatoid Factor Arthritis, Osteo Arthritis & Other Ailments Electric Stairlift       X  
09-1337 Fibromyalgia Medication--Xyrem     X    
09-1338 Knee Injury- Arthroscopic Anterior Cruciate Ligament Repair Physical Therapy       X  
09-1339 Epilepsy Magnetoencephalogram (MEG) To Further Define The Location Of Insured's Seizures So That The Extent Of Sub-Dural Grid Placement Can Be Defined X        
09-1340 Cerebrovascular Disease Homocysteine Testing   X      
09-1341 Bi-Polar, Schizoaffective Disorder In-Patient Hospital Care       X  
09-1342 COPD With History Of Heart Attack CT Scan Thorax W/O Dye & Nuclear Perfusion Test     X    
09-1343 Bilateral Knee Pain And Arthritis Celebrex Medication     X    
09-1344 Alcoholism Inpatient Rehabilitation For Acute Detox Medical Treatment       X  
09-1345 Anorexia Inpatient Mental Health     X    
09-1346 Back Pain MRI       X  
09-1347 Osteoporosis DEXA Bone Scan     X    
09-1348 Eating Disorder Residential Eating Disorder Program       X  
09-1349 Hysterectomy 2 Add'l Inpatient Stay Post Surgery       X  
09-1350 Substance Abuse Psychiatric Hospitalization       X  
09-1351 Severe Depression Out-Of-Network Psychiatric Treatment     X    
09-1352 Adenocarcinoma Of The Prostate, Post Prostatectomy Doctor Request Image Guided Intensity Modulated Radiation Therapy ( IMRT)     X    
09-1353 Osteoarthritis Rt Shoulder Hyaluronic (Synvisc) Injections X        
09-1354 Low Back Pain Mechanized Spinal Distraction Therapy   X      
09-1355 Right Knee Meniscal Tear With Chondral Defects And Is Status Post Arthroscopy With Abrasion To The Medial And Lateral Facets Of The Patella ACI (Autologous Chondrocyte Implantation)   X      
09-1356 Right Humeral Fx Dynamic Adj Elbow Extension X        
09-1357 Bilateral Subtalar Joint Arthroereisis Reconstructive Foot Surgery X        
09-1358 Migraines Headaches; Cervical Dystonia Botox Injections X        
09-1359 Ovarian Cancer Avastin X        
09-1360 Soft Tissue Injury & Possible Disc Injury Following Auto Accident MRI     X    
09-1361 Autism Occupational Therapy     X    
09-1362 Vivaglobin Injections     X    
09-1363 Idiopathic Short Stature/Growth Failure Growth Hormone Tx (Nutropin Medication)     X    
09-1364 Metastatic Disease Incl Right Breast And Liver, Bone Density Osteoporosis CT Scan Bone Density     X    
09-1365 Attention Deficit Hyperactivity Disorder (ADHD) Provigil       X  
09-1366 Malignant Schwannoma PET Scan X        
09-1367 Hx Of Benign Biopsy. Suspicious Breast Lesion(S) MRI   X      
09-1368 Obesity Laparoscopic Duodenal Switch Procedure   X      
09-1369 Lung Cancer State TINOMO Without Evidence Of Metastatic Disease Proton Beam Radiation Therapy   X      
09-1370 Tubular Adenomatous Colon Polyp Pathfinder TG X        
09-1371 Post Rollover Motor Vehicle Accident-Multiple Open Wounds To Right Arm, Radial Head Dislocation, Distal Humeral Fracture, And Extensor Tendon Ruptures. JAS Splint     X    
09-1372 Substance Abuse. Bipolar Disorder Inpatient Residential Care       X  
09-1373 High-Grade Myxoid Fibrosarcoma Of The Left Lower Extremity PET/CT Scan X        
09-1374 Intractable Migraine Headaches Drug AXERT     X    
09-1375 Drug/Alcohol Abuse, Depression. Residential Tx For Mental Health And Substance Abuse       X  
09-1376 Stage IIA Carcinoma Of The Breast Infiltrating Ductal Carcinoma And Positive Lymph Breast Lumpectomy Chemotherapy Treatment/Insulin Potentiation Therapy (IPT)       X  
09-1377 Alcohol And Substance Abuse Extended Stay At Detox Facility       X  
09-1378 Low Radiating Back Pain Physical Therapy       X  
09-1379 Acute Adult Inpatient Detoxification Addiction To Alprazolam     X    
09-1380 Severe Cardiomyopathy And Ventricular Ectopy Wearable Cardioverter Defibrillator     X    
09-1381 Schizophrenia Affective Disorder Lock Down Psychiatric Hospital     X    
09-1382 Sleep Apnea / Sleeplessness Ambien     X    
09-1383 Neutropenia Neupogen Injections       X  
09-1384 Alcohol/Drug Dependency Residential Treatment       X  
09-1385 Lung Cancer Neupogen       X  
09-1386 Lung Cancer Avastin X        
09-1387 Hypopituitarism Genotropin, Somatropin RDNA Injection, Recombinant Growth Hormone   X      
09-1388 Rare Bone Marrow Cancer Like Disease Amyloidosis, Similar To Myeloma Infusion Autologous Stem Cell Transplants And Melphalan Services X        
09-1389 Antibiotic Dependent Pouchitis Xifaxan     X    
09-1390 Hyperlipidemia Lipoprotein Test   X      
09-1391 Persistent Medial Femoral Condylar Pain And Full Thickness Chondral Lesion Articular Cartilage Paste Grafting And All Related Procedures   X      
09-1392 Accident-Head Injury Presented At Emergency Room Elective Follow-Up Visit To Emergency Room For Removal Of Stitches       X  
09-1393 Breast Cancer Prescription Drug Emend For Nausea       X  
09-1394 Attention Deficit Hyperactivity Disorder (ADHD) Provigil       X  
09-1395 Scoliosis Physical Therapy     X    
09-1396 Pancreatic Transplant, Diabetic, Previous Surg: Had Pancreas, Spleen, Gallbladder, Partial Intestine, Partial Bowel Removed. Fever FUO Pancreatic Transplant     X    
09-1397 Pemphigus Vulgaris Therapy-IVIG X        
09-1398 Metastatic Breast Cancer And Status Post Right-Sided Axillary Lymp Node Dissection, Lymphedema Insulin Potentiation Therapy   X      
09-1399 Post Traumatic Injury To The Right Shoulder W/Subsequent Headaches & Backache. Physical Therapy       X  
09-1400 Left Shoulder Pain Status Post Rotator Cuff Repair Surgery Physical Therapy       X  
09-1401 Lumbar Spinal Pain With Radiculopathy / Numbness In Left Toes Physical Therapy/ Meds   X      
09-1402 Joint Pain, Food Allergies, Chronic Fatigue & Edema, Adrenal Insufficiency, Hypothyroidism, Insulin Resistance, Facet Syndrome Lab Tests   X      
09-1403 Myasthenia Gravis Intravenous Immunoglobulin (IVIG) X        
09-1404 Post Left Hip Arthroscopy Continuous Passive Motion(CPM) Machine X        
09-1405 Lime's Disease Intravenous Rocephin       X  
09-1406 Delayed Speech Speech Therapy     X    
09-1407 Autistic Child W/Multiple Diagnoses Involving Abdominal, Digestive And Metabolic Problems Treatment By An Out-Of-Network Provider Specializing In Treating Autistic Children       X  
09-1408 Autistic Child W/Multiple Diagnoses Involving Abdominal, Digestive And Metabolic Problems Treatment By An Out-Of-Network Provider Specializing In Treating Autistic Children       X  
09-1409 Shingles Zoster Vaccination       X  
09-1410 Substance Abuse Residential Substance Abuse Treatment Facility     X    
09-1411 Anxiety, Depression & Substance Abuse Residential Care     X    
09-1412 Coronary Artery Disease External Counterpulsation (EECP)       X  
09-1413 Severe Wrist Injury / Surgery Dynasplints (Dynamic Adjustable Wrist Extension)     X    
09-1414 Hyperlipidemia Zetia 10mg     X    
09-1415 Left Knee & Shoulder Pain MRI     X    
09-1416 Autism, ODD & Anxiety Child/Adolescent Psychiatric Residential Treatment       X  
09-1417 Migraine Headaches Botox Injections X        
09-1418 Coronary Artery Disease CT Coronary Calcium Scoring       X  
09-1419 Mass In Right Breast/Breast Cancer PET/CT Scan X        
09-1420 HX Of Moderate Coronary Calcificaction & Dyslipidemia CT Scan X        
09-1421 Morbid Obesity Vertical Sleeve Gastrectomy X        
09-1422 Chronic Debilitating Pain Radiofrequency Neurolysis Of Sacroiliac Joint   X      
09-1423 Coronary Artery Disease CT Angiogram X        
09-1424 Diabetes Continuous Interstitial Glucose Monitor & Supplies For The TX Of Insulin Treated Diabetes Mellitus X        
09-1425 Stage IV Metastatic Melanoma Subcutaneous GM-CSF (Leukine) X        
09-1426 Low Back Pain Axial Decompression   X      
09-1427 Metastasis Gastric Cancer PET Scan X        
09-1428 Left Breast Cancer Oncotype DX       X  
09-1429 Osteoporosis Reclast     X    
09-1430 Morbid Obesity Laparoscopic Gastric Bypass Surgery       X  
09-1431 Mandibular Oral Motor Disturbance Trigger Injections; Trigeminal Nerve Anesthesia       X  
09-1432 Osteoporosis Dual Energy X-Ray Absorptiometry (DEXA)     X    
09-1433 Idiopathic Short Stature Nutropin Medication     X    
09-1434 Asthma Xolair Injections.         X
09-1435 Cataract Crystanlens Insertion       X  
09-1436 Hip Pain Post Left Hip Arthroscopy W/Partial Anterior Labral Resection. Use Of A Continuous Passive Motion Device       X  
09-1437 Diarrhea Alinia 500 Mg     X    
09-1438 Bulimia/Anorexia Intensive Outpatient Treatment       X  
09-1439 Coronary Artery Disease Computed Tomographic Angiography (CTA) X        
09-1440 Morbid Obesity Vertical Sleeve Gastrectomy         X
09-1441 Benign Prostate Hyperplasia Avodart 0.5mg       X  
09-1442 Cleft Palate Inpatient Hospitalization         X
09-1443 Colonoscopy Anesthesia     X    
09-1444 Diarrhea, Nausea, Muscle Atrophy And Hypothyroidism Heavy Metal Toxicity Testing       X  
09-1445 Bilateral Gynecomastia Male Bilateral Mastectomy       X  
09-1446 Bilateral Total Knee Replacement Rehabilitation Lite Gate Device   X      
09-1447 Posterior Labral Tear Left Hip Arthroscopy X        
09-1448 Metastatic Breast Cancer MRI       X  
09-1449 Pelvic Floor Tension Myalgia & Vulvodynia Pelvic Floor Therapy       X  
09-1450 Scleroderma Physical Therapies     X    
09-1451 Knee And Lower Back Pain Physical Therapies       X  
09-1452 Growth Hormone Deficiency Somatropin Injectable Growth Hormone       X  
09-1453 Chronic Hepatitis C Pegylated Interferon Injections & Ribavirin Injections X        
09-1454 Patellar Tendinopathy & Complex Regional Pain Syndrome Physical Therapies     X    
09-1455 Physical Limitations And Discomfort Breast Reduction         X
09-1456 Amputated Hand Proximal To The Wrist Myoelectric Upper Extremity Prosthetic Device     X    
09-1457 Shoulder Pain MRI       X  
09-1458 Reiter's Syndrome Physical Therapies       X  
09-1459 Congenital Speech Disorder. Speech Easy Device And Speech Therapy     X    
09-1460 Crohn Disease Remicade: Anti-TNF Agent     X    
09-1461 Multiple Myeloma In Bones PET Scan     X    
09-1462 Anorexic & Bulimic SPECT Scan   X      
09-1463 Post Roux-En-Y Gastric Bypass SX Revisional Surgery Of Prior Bariatric Surgery   X      
09-1464 Myelopathy PET Scan X        
09-1465 Mild Disc Degeneration Of L5-S1 Total Disc Replacement   X      
09-1466 Back Pain X-Stop Back Surgery   X      
09-1467 Morbid Obesity Sleeve Gastrectomy X        
09-1468 Advanced Resectable Pancreatic Adenocarcinoma Stereotactic Body Radiotherapy   X      
09-1469 Neuroendocrine Cancer Of The Liver Transarterial Chemoembolization X        
09-1470 Nasal Type Non Hodgkins Lymphoma Autologous Harvest Of Patient's Own Stem Cells X        
09-1471 Growth Hormone Disorder Genotropin (RX)       X  
09-1472 Prostate Cancer Magnetic Resonance Spectroscopy   X      
09-1473 Breast Cancer With Brain Metastases Magnetic Resonance Spectroscopy X        
09-1474 Myeloma/Plasmacytoma. PET Scan X        
09-1475 Leg Pain Sclerotherapy Of Varicosities     X    
09-1476 Autism Speech Therapy     X    
09-1477 Right Cervical Neuritis & Myofascial Pain Anesthesia       X  
09-1478 Osteosarcoma Of Right Femur Patella Resurfacing     X    
09-1479 Cervical Genic Headache Facets Injection       X  
09-1480 Chronic Right Upper Extremity And Neuropathy Botox Injections       X  
09-1481 Postural Deficiency W/ Dorsal Kyphosis Bilateral Reduction Mammaplasty     X    
09-1482 Cervical Myofascitis And Right Thumb Tenosynovitis Physical Therapy   X      
09-1483 Right Proximal Humerus Fracture Physical Therapy       X  
09-1484 Family Hx Of Coronary Artery Disease Homocysteine And Lipoprotein Lab Test   X      
09-1485 Depressive Disorder In-Patient Residential Care       X  
09-1486 Aphasia Speech & Language Therapy       X  
09-1487 Autism ABA Services     X    
09-1488 Anorexia Nervosa Disorder Intensive Outpatient Program Services       X  
09-1489 Post Acute Myocardian Infarction Skilled Nursing Facility Care       X  
09-1490 Chronic Venous Insufficiency Radiofrequency Ablation   X      
09-1491 Sacroiliac Joint Dysfunction Radiofrequency Ablation   X      
09-1492 Chest Pain CT Angiography X        
09-1493 Elevated CA 125 Test = 312 Pet Scan Tumor Full Body Image   X      
09-1494 Allergic Rhinitis Nitric Oxide Tests And Rx: Sublingual Drops   X      
09-1495 Long QT Syndrome Genetic Testing   X      
09-1496 Attention Deficit Hyperactivity Disorder (ADHD) Bio-Feedback   X      
09-1497 Breast Pain MRI       X  
09-1498 Right Knee Instability And Pain ACL Knee Brace     X    
09-1499 Osteoporosis DEXA Scan     X    
09-1500 Severe Chest Tightness Nuclear Cardiac Scan       X  
09-1501 Pain In Lateral Aspect Of Elbow Extracorporeal Shockwave   X      
09-1502 Neck Pain, Herniated Nucleus Pulposus-Progressive Neurological Deficit Artificial Cervical Disc Replacement.   X      
09-1503 Multiple Sclerosis Autologous Bone Marrow Stem Cell Transplant X        
09-1504 Advanced Grade IIIB Lung Cancer IMRT Treatment X        
09-1505 Cervical Disc Disease Artificial Cervical Disc Arthroplasty   X      
09-1506 Post-Traumatic Stress Disorder Psychiatric Residential Treatment Facility       X  
09-1507 Idiopathic Short Stature Growth Hormone Therapy       X  
09-1508 Growth Hormone Deficiency RX - Genotropin       X  
09-1509 ADHD / Anxiety / Depression Neuropsychological Testing       X  
09-1510 Post Right Upper Quadrant Hernia Repair Inpatient Hospital Stay       X  
09-1511 Unknown - Possible Behavioral Problem Hearing And Diagnostic Tests     X (partial)    
TOTAL:     69 70 109 141 5

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