The Health Care Service Corporation (HCSC) Medical Policy manual contains Medical Policies used by Health Care Service Corporation,  a Mutual Legal Reserve Company, operating health plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. 

Medical Policies are based on research that provides evidence of scientific merit for a particular medical technology. Technology determinations used in Medical Policies are based in part on criteria from peer-reviewed scientific literature, criteria developed by specialty societies and other sources. Medical Policies are used as guidelines for coverage determinations in health care benefit programs, unless otherwise indicated.

Medical technology is constantly evolving, and these Medical Policies are subject to change without notice, except as required by law. Additional Medical Policies may be developed from time to time, and some may be withdrawn from use. 

Restrictions and Limitations

The Medical Policies do not constitute medical advice or medical care. They do not guarantee any results or outcomes. Treating health care providers are solely responsible for diagnosis, treatment, and medical advice. Members should discuss the information in the Medical Policies with their treating health care providers. HCSC is not a provider of health care and does not render medical advice.

Medical Policies can be highly technical and complex and are provided here for informational purposes.

HCSC is under no obligation to update this site. Therefore, the Medical Policies displayed may be out of date. 

CPT codes and descriptions are the property of the American Medical Association with all rights reserved.

The five-character codes included in the HCSC Medical Policies are obtained from the Physician's Current Procedural Terminology (CPT), copyright 2022 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. CPT is a registered trademark of the AMA.

The responsibility for the content of the Medical Policy is with HCSC, and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in the Medical Policy. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose.

No fee schedules, basis unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of the Medical Policy should refer to the most current Physician's Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

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