Clinical Policies
Keystone First is dedicated to providing the most comprehensive, outcomes-driven health solutions for our members. Part of this approach means making it a priority to reduce unnecessary variations in care. We've used the latest scientific evidence and research to create the clinical policies, which represent the latest in current professional standards.
While these guidelines are intended to inform, they aren't intended to replace a physician's clinical judgment. The physician remains responsible for determining the applicable treatment for each individual.
Navigate directly to a letter:
-
A
- Abdominoplasty
- Acoustic cardiography/heart sound recording
- Acupuncture
- Air ambulance transport
- Altered auditory feedback devices for speech dysfluency (stuttering)
- Ambulatory blood pressure monitoring
- Apnea Monitors for Infants - In Home Use
- Auricular Stimulation for Abdominal Pain From Irritable Bowel Syndrome
- Autologous fat grafting and injectable soft-tissue fillers
- Automated scalp cooling
-
B
- Balloon Spacer Devices for Management of Massive Rotator Cuff Tears
- Balloon dilation of the Eustachian tube
- Behavioral health weight management interventions for children with increased body mass index screenings
- Biofeedback for chronic pain
- Bioimpedance devices for detecting lymphedema
- Bone graft substitutes
- Bone marrow transplant for children with hyper IgM disorder
- Breast Pumps
- Bronchial Thermoplasty for Severe Asthma
-
C
- Cervical Traction Devices for Neck Pain for Home Use
- Chronic inflammatory response syndrome
- Computer-aided detection and diagnosis for chest imaging
- Corneal cross-linking
- Coronary intravascular lithotripsy
- Cryopreservation of reproductive tissue, gametes, and embryos
- Customized lymphedema garments
-
D
- Dermabrasion and chemical peel
- Digestive enzyme cartridge
- Disposable insulin delivery devices
- Drug-eluting sinus implants
- Dynamic Splinting
- Dynamic movement orthoses (suit therapy)
-
E
- Electrical muscle stimulation
- Embrace 2 watch for seizure detection
- EpiSign Testing for DNA Methylation Analysis
- Epidermal nerve fiber density testing
- Equine-assisted therapy
- Erectile dysfunction treatments other than pharmaceuticals
-
F
- Face transplantation
- Fetal Surgeries In Utero
- Fluorescence in situ hybridization for cervical cancer screening
- Fluorescence spectroscopy for prostate cancer diagnosis
- Frenuloplasty for ankyloglossia
-
G
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H
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I
- Inhaled nitric oxide
- Intermittent pneumatic compression for peripheral artery disease
- Intracranial hypertension stent
- Intravascular ultrasound
-
K
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L
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M
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O
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P
- Pediatric bed enclosures
- Pediatric rhinoplasty
- Percutaneous arteriovenous fistula creation
- Percutaneous peripheral nerve stimulators for chronic nerve pain
- Peristeen® anal irrigation system
- Peroral endoscopic myotomy
- Phototherapy and photochemotherapy for skin conditions
- Phrenic (diaphragmatic) nerve stimulation
- Platelet rich plasma for nonhealing diabetic wounds
- Prescription digital therapeutics for attention deficit hyperactivity disorder
- Prescription digital therapeutics for contraception
- Prolotherapy
- Pulsed dye laser for port-wine stain and infantile hemangioma
-
R
- Radiofrequency ablation for nasal valve collapse
- Robotic orthoses – lower limb
- Robotic orthoses – upper limb
- Room humidifiers
-
S
- Scoliosis vertebral body tethering and stapling
- Shoe Lifts for Leg Length Discrepancy
- Sialendoscopy and lithotripsy for salivary stones
- Skin Substitutes for Chronic Wounds
- Smell and taste dysfunction testing
- Specialized infant formula
- Speech therapy
- Stereotactic navigation in sinus surgery
- Supraglottoplasty and Laryngoplasty
-
T
- Therapeutic Contact Lenses
- Three-dimensional imaging and interpretation
- Topical oxygen therapy
- Total artificial heart
- Transanal radiofrequency for fecal incontinence
- Transcatheter coronary infusion of supersaturated oxygen therapy in acute myocardial infarction
- Transperineal laser ablation of the prostate for benign prostatic hyperplasia
-
V
- Vagus nerve stimulation for post-stroke upper limb rehabilitation
- Vestibular evoked myogenic potential testing
- Volatile organic compounds for urinary tract infection
-
W
- Wheelchair mounted robotic arm – Kinova Jaco2
- Wireless pulmonary artery pressure monitoring devices for heart failure