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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828

Shoulder

Indicates Non-covered Service

Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries
Aetna
Manipulation Under Anesthesia of the Shoulder
UHC
Shoulder Arthroplasty and Arthrodesis
Aetna
Cigna
Shoulder Arthroplasty
Anthem
Humana
UHC
Shoulder Arthroscopy
Anthem
Cigna
Humana
UHC
Shoulder Arthrotomy
UHC
Winged Scapula Surgery
Aetna

Indicates Non-covered Service

Articular Cartilage Repair of the Shoulder
Cooling & Heating Devices Used in the Outpatient Settings
Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions
Intramedullary Lengthening Devices – Humerus
Subacromial Balloon Spacer
Cigna
Thermal Shrinkage
Cigna
Cigna
FloridaBlue
UHC
Humana
Shoulder Surgery
Point32Health

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