Version 1.0 Effective July 1, 2021

Cigna Musculoskeletal Program Interventional Pain ...

1 July 2016 Cigna Musculoskeletal Program Interventional Pain Management . Frequently Asked Questions . Note: Prior authorization requests should only include those codes for the current Interventional

  Programs, Management, Frequently, Pain, Interventional, Musculoskeletal, Musculoskeletal program interventional pain management

CT Chest, Abdomen and Pelvis Imaging Request

Don't Know. Phone call with office staff Phone call with physician Don't Know 3.Is abodminal or pelvic pain present? Yes. No Don't Know: 4.Where is the location of pain?

  Chest, Request, Imaging, Abdomen, Pelvis, Abdomen and pelvis imaging request

Musculoskeletal and Pain Management Program …

•190+ board-certified medical directors • Diverse representation of medical specialties • 450 nurses with diverse specialties and experience • Dedicated nursing and physician

  Programs, Management, Board, Pain, Musculoskeletal, Musculoskeletal and pain management program

CT Abdomen and Pelvis - General Imaging Request

1.Date of most recent office visit or other contact with physician: Don't Know Phone call with office staff Phone call with physician Don't know

  Pelvis

er emb mm/dd/yyyy - eviCore

Member requires treatment for a different condition Additional care for same condition treated in the last 60 days 2. What is the primary diagnosis?

  Yyyy, Er emb mm dd yyyy

eviCore healthcare and Cigna Integrated Oncology ...

1 eviCore healthcare and Cigna Integrated Oncology Management Program Frequently Asked Questions Who is eviCore healthcare? eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides

  Programs, Management, Frequently, Healthcare, Integrated, Oncology, Cigna, Healthcare and cigna integrated oncology, Healthcare and cigna integrated oncology management program frequently

er emb mm/dd/yyyy - eviCore

Reduced strength full range Can't move against gravity Hand function. Reduced strength full range Fingertips don't reach palm Normal strength Normal strength Raises with bent knee Unable

  Yyyy, Mm dd yyyy

eviCore Radiation Therapy 2019 Guidelines

for Radiation Oncology (ASTRO) Evidence-Based Guidelines, or supported by other acceptable peer-reviewed publications. As such, eviCore will not automatically certify a case based solely on the fact that it

Cigna Medical Coverage Policies – Radiology Cardiac Imaging

IMAGING STUDY Estimate of Effective Radiation Dose . Sestamibi myocardial perfusion study (MPI) 9-12 mSv PET myocardial perfusion study: Rubidium-82

  Imaging, Perfusion

Bone Metastases Radiation Therapy Physician Worksheet (As ...

Bone Metastases Radiation Therapy Physician Worksheet (As of 23 July 2018) 6. What is the reason for treatment? Select all that apply. Extension into viscera or a soft tissue component

HUMANA Pain Management Prior Authorization Request …

Pain Pump: Facet Medial Branch Nerve Block: Local Steroid RFA 1. Primary Diagnosis Code Cervical Thoracic Lumbar Sacral Please Select Spinal Region(s) which applies: If yes, ____% Pain Relief lasted ____ weeks from last (Epidural or Facet injection) performed on Date:_____ 4. Previous Epidural or Facet Injections(s)? Yes No

  Management, Request, Authorization, Injection, Spinal, Pain, Prior, Steroid, Humana, Epidural, Humana pain management prior authorization request

Percutaneous Decompression Laminotomy (CPT 0275T)

• Epidural Steroid Injections treat inflammation…NOT ischemia. • Decompression is required to treat thecal sac compression/ischemia. 1Fukusaki, M et al., Symptoms of Spinal Stenosis Do Not Improve After Epidural Steroid Injection. Clinical Journal of Pain: 6/1998;14(2):148-151. 2Porter RW, Spinal stenosis & neurogenic claudication.

  Decompression, Injection, Spinal, Pain, Percutaneous, Steroid, Epidural, Epidural steroid injections, Epidural steroid, Laminotomy, Percutaneous decompression laminotomy, Cpt 0275t, 0275t

Epidural Steroid Injections for Spinal Pain – Commercial ...

• Epidural Steroid Injections (ESI) for treating radicular pain caused by spinal stenosis, disc herniation, degenerative changes in the vertebrae or for the short -term management of spine pain when the following criteria are met:

  Injection, Spinal, Pain, Steroid, Epidural, Epidural steroid injections, Epidural steroid injections for spinal pain

Epidural Steroid Injections for Spinal Pain

Epidural Steroid Injections (ESI) for treating radicular pain caused by spinal stenosis, disc herniation, degenerative changes in the vertebrae or for the short-term management of spine pain when the following criteria are met:

  Injection, Spinal, Pain, Steroid, Epidural, Epidural steroid injections, Epidural steroid injections for spinal pain

Musculoskeletal Surgical Quality & Safety Management …

– Pain management: Epidural steroid injections – Pain management: Facet joint injections – Pain management: Neuroablationprocedures – Pain management: Sacroiliac joint injections Fax completed forms to the utilization management fax number at the top of each form. Provider Relations Support Team: Email: BCBSMProviderRelations@tpshealth.com

  Injection, Pain, Steroid, Epidural, Epidural steroid injections

Epidural Steroid Injections Medications and Dosages

Another systematic review (Liu 2015) investigated the effectiveness and safety of epidural steroid injections in patients with lumbar spinal stenosis (LSS). The epidural local anesthetic injection group in the analysis reported no significant difference for most common measures.

  Injection, Spinal, Steroid, Epidural, Epidural steroid injections

Preparing for Spine Injection Therapy

• Epidural injection: (picture on the right) Epidural injections place 2 medications in your epidural space. This is the space alongside your spinal canal (not inside of it). Nerves from your spinal cord pass through this space. The medications will bathe those nerves. You must have a driver for this procedure. We will need to reschedule your

  Injection, Spinal, Epidural, Epidural injections