Cooling caps and other scalp cooling products are considered incidental to chemotherapy administration and are not separately reimbursed. Items purchased directly by the member (e.g., scalp cooling caps or related supplies) are treated as supplies and are generally excluded from coverage under plans that exclude supplies. Relevant example codes include CPT 0662T, 0663T and HCPCS E0218, E0236.

Proprietary lab analysis (PLA) codes — those ending with the letter 'U' (PLA/'U' codes) — are not covered for Medicaid members because NYS Medicaid does not reimburse these proprietary PLA codes. Examples of PLA codes referenced in the gene expression profiling rows include 0046U, 0049U, 0050U.

Vagus nerve stimulation (VNS) is designated investigational for most indications listed in the database (for example: addictions, Alzheimer disease, anxiety, atrial fibrillation, autism spectrum disorders, chronic pain, headache disorders, essential tremor, and many others). However, VNS is explicitly not considered investigational for epilepsy (see MCG #A-0424) and has a Medicare-specific allowance for Treatment Resistant Depression (TRD) under the Medicare NCD via Coverage with Evidence Development (CED). Providers submitting requests for VNS should reference applicable NCD/MCG policy identifiers and the related CPT/HCPCS device codes listed in the policy when documenting exceptions.

The policy lists multiple examples of procedures and devices that are designated investigational or otherwise require case-specific review. Examples include: cryoablation for chronic rhinitis (unlisted CPT examples 30999, 31299), various applications of transcranial magnetic stimulation (TMS) for neurologic or psychological indications other than depression (CPT 90867–90869), tremor analysis devices (e.g., physiologic tremor recordings using accelerometers, CPT 0778T, 95999), and other miscellaneous unlisted procedure codes used for emerging therapies. These entries are intended to alert providers that such services are generally considered investigational for the enumerated indications.

Technologies and indications listed as investigational or unproven in this document are considered not medically necessary / non-covered when billed for those specified indications. Specific examples called out include: transcranial magnetic stimulation (TMS) for non-depression indications (CPT 90867–90869), tremor analysis devices (CPT 0778T, 95999), vagus nerve stimulation for indications other than epilepsy or Medicare TRD (multiple CPT/HCPCS and implant/device codes listed), and venoplasty for relapsing remitting multiple sclerosis (CPT 36901–36906).

Proprietary PLA codes (PLA/'U' codes) are not covered for Medicaid members per NYS Medicaid reimbursement rules. This exclusion applies to proprietary PLA codes referenced in gene expression profiling rows (examples: 0046U, 0049U, 0050U); providers should reference the commercial and Medicaid distinctions shown in the coding rows when submitting claims.

Cooling caps and other scalp cooling products used in association with chemotherapy are considered incidental to the chemotherapy administration and are not separately reimbursed. Items purchased by the member are treated as supplies and are generally excluded from coverage under plans that exclude supplies. Relevant example codes include CPT 0662T, 0663T and HCPCS E0218, E0236.

The database lists tremor analysis devices (e.g., physiologic tremor recording using accelerometers, CPT examples 0778T, 95999) and venoplasty for relapsing remitting multiple sclerosis (CPT 36901–36906) as investigational/unproven; these are designated not covered for the specified indications when billed for those uses.

This document summarizes EmblemHealth's positions on investigational or unproven technologies, noting which procedures, devices, and laboratory tests are considered investigational (designated 'N') or allowed (designated 'Y') and identifying payer-specific exceptions. It also references special program notes including Humanitarian Device Exemption (HDE) guidance and transplant case management review processes, and provides associated CPT/HCPCS codes for the listed technologies. The Medical Technologies Database serves as the operational reference for prior authorization, claims adjudication, and provider guidance.