QUEST Integration - Benefit Policies Section

Original Effective Date:

07/01/2012

Current Effective Date:

01/01/2015

Table of Contents

QUEST Integration - 3D Reconstruction7
QUEST Integration - Abortion 11
QUEST Integration - Air Transportation 12
QUEST Integration - Ambulatory Blood Pressure Monitoring 13
QUEST Integration - Ambulatory Surgical Services 15
QUEST Integration - Anesthesia 16
QUEST Integration - Anesthesia Services for Gastrointestinal Endoscopic Procedures 18
QUEST Integration - Annual Gynecological Examination 23
QUEST Integration - Apnea Monitor for Infants 24
QUEST Integration - Artificial Disc Replacement, Cervical 27
QUEST Integration - Assistant Surgeon 32
QUEST Integration - Autologous Chondrocyte Implantation 34
QUEST Integration - Behavioral Health Services 41
QUEST Integration - Bevacizumab (Avastin) 44
QUEST Integration - Biological Agents for the Treatment of Plaque Psoriasis 51
QUEST Integration - Blepharoplasty and Repair of Blepharoptosis 54
QUEST Integration - Blood Lead Testing 58
QUEST Integration - Blood Occult Screening 60
QUEST Integration - Bone (Mineral) Density Studies 61
QUEST Integration - Bortezomib (Velcade) 69
QUEST Integration - Casts and Strappings 73
QUEST Integration - Circumcision 74
QUEST Integration - Clinical Trials 75
QUEST Integration – Cognitive Rehabilitation Services 79
QUEST Integration - Collection and Handling 81
QUEST Integration - Contraceptive Services 82
QUEST Integration - Cosmetic and Reconstructive Surgery and Services 84
QUEST Integration - Critical Care 87
QUEST Integration - Cytopathology 90
QUEST Integration - Developmental Testing 91
QUEST Integration - Diabetes Education 92
QUEST Integration - Donor Services 95
QUEST Integration - Pharmacy and Drug Formulary 96
QUEST Integration - Drug Formulary Exception 99
QUEST Integration - Durable Medical Equipment - DME, Prosthetics and Orthotics 102
QUEST Integration - Early and Periodic Screening, Diagnostic and Treatment (EPSDT) 108
QUEST Integration - Efalizumab (Raptiva) 123
QUEST Integration - Electromagnetic Stimulation - Bone Growth 124
QUEST Integration - Emergency Room Services 125
QUEST Integration - Endoscopic Radiofrequency Ablation for Barretts Esophagus 126
QUEST Integration - Home Enteral Nutrition Therapy 130
QUEST Integration - Erythropoiesis Stimulating Agents (ESA) 133
QUEST Integration - Esophageal pH Monitoring 138
QUEST Integration - Extracorporeal Membrane Oxygenation (ECMO) for Neonates 145
QUEST Integration - Family Planning 149
QUEST Integration - FDA-Approved Drugs Requiring Precertification 150
QUEST Integration - Fetal Non-Stress Test 153
QUEST Integration – Fluoride Varnish Application 154
QUEST Integration - Gamma Knife 155
QUEST Integration - Genetic Testing for Hereditary Breast and/or Ovarian Cancer 156
QUEST Integration - Genetic Testing for Lynch Syndrome/Colorectal Cancer and Polyposis Syndromes 171
QUEST Integration - Genetic Testing for Non-Cancerous Inheritable Diseases 180
QUEST Integration - Genetic Testing - Oncology 196
QUEST Integration - Global Fee for Surgery 204
QUEST Integration - Glucose Monitoring of Interstitial Fluid 207
QUEST Integration - Growth Hormone Therapy 212
QUEST Integration - Gynecological Exam 219
QUEST Integration – Habilitation Services 220
QUEST Integration - Hearing Aids 221
QUEST Integration - HIV/AIDS 223
QUEST Integration - Home Health Care 224
QUEST Integration - Home Infusion Pain Management Therapy 227
QUEST Integration - Home Inotropic Infusion Therapy 230
QUEST Integration - Home IV Therapy - Criteria for Coverage 234
QUEST Integration - Home IV Therapy - Per Diem Payment Method 236
QUEST Integration - Home Phototherapy for Neonatal Jaundice 241
QUEST Integration - Home Total Parenteral Nutrition for Adults 244
QUEST Integration - Hormone Therapy 251
QUEST Integration - Hospice Care 252
QUEST Integration - Hospital and Long-Term Care Facility Visits 253
QUEST Integration - Hospital Inpatient Confinements 254
QUEST Integration - Hospital Pass Days 255
QUEST Integration - Home IV Hydration Therapy for Hyperemesis Gravidarum 256
QUEST Integration - Home IV Hydration Therapy for Adults 259
QUEST Integration - Hyperbaric Oxygen Pressurization (HBO) 262
QUEST Integration – Hysterectomy 282
QUEST Integration - Ibritumomab tiuxetan (Zevalin) 284
QUEST Integration - Radiology Guidelines for Advanced Imaging Studies 288
QUEST Integration - Immune Globulin Therapy 289
QUEST Integration - Immunizations 299
QUEST Integration - Implantable Ventricular Assist Device and Total Artificial Hearts 301
QUEST Integration - Infliximab (Remicade) 308
QUEST Integration - Insulin Pumps - External 316
QUEST Integration - Intrastromal Corneal Ring Segments for Keratoconus 320
QUEST Integration - Intensity Modulated Radiation Therapy (IMRT) 323
QUEST Integration - Interferon, gamma-1b (Actimmune) for Idiopathic Pulmonary Fibrosis 330
QUEST Integration - Interisland Transportation 334
QUEST Integration - In Vitro Fertilization 335
QUEST Integration - Kyphoplasty and Vertebroplasty 336
QUEST Integration - Laboratory Panels 342
QUEST Integration - Language Translation 344
QUEST Integration - Lenalidomide (Revlimid) 345
QUEST Integration - Leuprolide Acetate (Lupron) and Histrelin Acetate (Supprelin LA) Subcutaneous Implant 350
QUEST Integration - Lipid Risk Factors (Novel) in Risk Assessment and Management of Cardiovascular Disease 357
QUEST Integration - Long-Acting Opioid Analgesics 385
QUEST Integration – Long-Term Services and Supports (LTSS) 388
QUEST Integration - Low-Molecular-Weight Heparin 395
QUEST Integration - Lung-Volume Reduction Surgery 400
QUEST Integration - Maternity - Global Billing 407
QUEST Integration - Medical Policies 410
QUEST Integration - Mammography 413
QUEST Integration - Maternity - Length of Stay and Provisions of the Newborns' and Mothers' Health Protection Act (NMHPA) 417
QUEST Integration - Medical Foods for Inborn Errors of Metabolism 418
QUEST Integration - Metabolic Screening Program - Newborns 424
QUEST Integration - Miscellaneous Home Intravenous Administration 427
QUEST Integration - Modafinil (Provigil) and Armodafinil (Nuvigil) 430
QUEST Integration - Modifier Code 25 434
QUEST Integration - Modifier Code 47 437
QUEST Integration - MRI, Functional 440
QUEST Integration - Negative Pressure Wound Therapy (NPWT) 444
QUEST Integration - Neonatal Intensive Care 449
QUEST Integration - Noncovered Services 451
QUEST Integration - Bariatric Surgery 452
QUEST Integration - Observation Services 456
QUEST Integration - Occupational Therapy 459
QUEST Integration - Office Consultations and Visits 467
QUEST Integration - Off-Label Drug Use 469
QUEST Integration - Omalizumab (Xolair) 472
QUEST Integration - OncoScint 477
QUEST Integration - Oncotype DX 478
QUEST Integration - Optical Coherence Biometry 491
QUEST Integration - Organ Transplants 493
QUEST Integration - Organ Transplants - Donor Services 496
QUEST Integration - Oscillatory Device for Bronchial Drainage (The Vest) 497
QUEST Integration - Out-of-State Transportation 502
QUEST Integration - Outpatient Surgical Procedure Related Groups (PRG) 503
QUEST Integration - Oxygen and Oxygen Equipment 504
QUEST Integration - Pre-admission Testing 511
QUEST Integration - Precertification Request - Home IV Therapy 512
QUEST Integration - Prenatal Visit - Initial 513
QUEST Integration - Private Duty Nursing 515
QUEST Integration - Prostate Specific Antigen (PSA) Test 516
QUEST Integration - Palivizumab (Synagis) 517
QUEST Integration - Panitumumab (Vectibix) 522
QUEST Integration - Panniculectomy/Abdominoplasty 526
QUEST Integration - Pediatric Standby 529
QUEST Integration - Pemetrexed (Alimta) 530
QUEST Integration - Percutaneous Transluminal Angioplasty 534
QUEST Integration - Perinatal Care 535
QUEST Integration - Photochemotherapy 536
QUEST Integration - Photodynamic Therapy for the Treatment of Actinic Keratoses and Other Skin Lesions 542
QUEST Integration - Physical Examinations 548
QUEST Integration - Physical Therapy 549
QUEST Integration - Place of Treatment - Office Procedures List 557
QUEST Integration - Place of Treatment - Outpatient Procedures List 574
QUEST Integration - Polysomnography - Sleep Studies 595
QUEST Integration - Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea 603
QUEST Integration - Prophylactic Mastectomy 611
QUEST Integration - Pulmonary Hypertension Drugs 617
QUEST Integration - Pulse Oximeter for Children 624
QUEST Integration - Reference Laboratory 627
QUEST Integration - Catheter Ablation of the Pulmonary Veins as Treatment for Atrial Fibrillation 628
QUEST Integration - Readmissions and Transfers 641
QUEST Integration - Reduction Mammaplasty 644
QUEST Integration - Smoking Cessation 648
QUEST Integration - Standby Services 649
QUEST Integration - Sterilizations 651
QUEST Integration - Surgery - Cutting 654
QUEST Integration - Surgery - Non-Cutting 657
QUEST Integration - Screening Colonoscopy 658
QUEST Integration - Speech Therapy 660
QUEST Integration - Spinal Cord Stimulators for Pain Management 668
QUEST Integration - Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 676
QUEST Integration - Subcutaneous and Intramuscular Injectables 681
QUEST Integration - Supplies 683
QUEST Integration - Surgical Treatment of Femoroacetabular Impingement 685
QUEST Integration - Telemedicine 692
QUEST Integration - Transplants 695
QUEST Integration - Transportation - Ground (Non-Emergent) 696
QUEST Integration - Transportation - Interisland Air Transportation 699
QUEST Integration - Transportation - Out-of-State 702
QUEST Integration - Trigger Point Injections 704
QUEST Integration - Tuberculin Testing/Treatment 705
QUEST Integration - Tympanometry 706
QUEST Integration - Teriparatide (Forteo) 707
QUEST Integration - Thoracic Sympathectomy for Hyperhidrosis 712
QUEST Integration - Transcutaneous Electrical Nerve Stimulation (TENS) 716
QUEST Integration - Treatment of Varicose Veins 721
QUEST Integration - Ultrasound 726
QUEST Integration - Unbundling (Fragmentation) 728
QUEST Integration - Uterine Artery Embolization to Treat Fibroids 730
QUEST Integration - Vision Examination With Refraction 735
QUEST Integration - Vision Eyewear 737
QUEST Integration - Vacation Supplies 741
QUEST Integration - Vacuum Assisted Breast Biopsy 742
QUEST Integration - Venipuncture 747
QUEST Integration - Virtual Colonoscopy 748
QUEST Integration - Well-Child Care Visits 749
QUEST Integration - Well-Woman Exam 750

Revision History

Date Nature of Revision
08/03/2026 Migrated to new platform.