Medical Policies




Current Policies


    Please click the links below to open or save the desired document.

Upcoming Policies


    There are currently no new policies to be implemented.

Archived Policies


    Please click the links below to open or save the desired document.
Skip Navigation Links.
Collapse Archived PoliciesArchived Policies
Expand TMMP 1 - Patient Under Twelve Years of AgeTMMP 1 - Patient Under Twelve Years of Age
Expand TMMP 2 - Conditions/Diagnoses of Severity AdjustingTMMP 2 - Conditions/Diagnoses of Severity Adjusting
Expand TMMP 3 - Frequency of CareTMMP 3 - Frequency of Care
Expand TMMP 9 - Management of Chronic Musculoskeletal Pain - Physical MedicineTMMP 9 - Management of Chronic Musculoskeletal Pain - Physical Medicine
Expand TMMP 10 - Use of Physical Modalities and Therapeutic ProceduresTMMP 10 - Use of Physical Modalities and Therapeutic Procedures
Expand TMMP 11 - Use of Spinal Mobilization/ManipulationTMMP 11 - Use of Spinal Mobilization/Manipulation
Expand TMMP 12 - Use of Non-Spinal/Extremity Mobilization/ManipulationTMMP 12 - Use of Non-Spinal/Extremity Mobilization/Manipulation
Expand TMMP 13 - Convergent Modalities &/or Therapeutic ProceduresTMMP 13 - Convergent Modalities &/or Therapeutic Procedures
Expand TMMP 14 - Redundant Modalities &/or Therapeutic ProceduresTMMP 14 - Redundant Modalities &/or Therapeutic Procedures
Expand TMMP 15 - Minimal Clinical ProgressTMMP 15 - Minimal Clinical Progress
Expand TMMP 16 - Definition of "Established" ServicesTMMP 16 - Definition of "Established" Services
Expand TMMP 17 - Contraindications to CareTMMP 17 - Contraindications to Care
Expand TMMP 18 - Medical NecessityTMMP 18 - Medical Necessity
Expand TMMP 19 - E & M Services New PatientTMMP 19 - E & M Services New Patient
Expand TMMP 20 - E & M Services Established PatientTMMP 20 - E & M Services Established Patient
Expand TMMP 21 - Concurrent E & M ServicesTMMP 21 - Concurrent E & M Services
Expand TMMP 23 - Therapeutic CareTMMP 23 - Therapeutic Care
Expand TMMP 24 - Criteria for Determining Consideration of Medical Necessary ServicesTMMP 24 - Criteria for Determining Consideration of Medical Necessary Services
Expand TMMP 25 - Use of Electrodiagnostic TestingTMMP 25 - Use of Electrodiagnostic Testing
Expand TMMP 26 - Durable Medical EquipmentTMMP 26 - Durable Medical Equipment
Expand TMMP 28 - Neuromusculoskeletal PolicyTMMP 28 - Neuromusculoskeletal Policy
Expand TMMP 29 - Use of Radiolographic ExaminationsTMMP 29 - Use of Radiolographic Examinations
Expand TMMP 31 - Coding and Reporting CMTTMMP 31 - Coding and Reporting CMT
Expand TMMP 32 - Exploratory or Confirmatory Diagnostic EvaluationTMMP 32 - Exploratory or Confirmatory Diagnostic Evaluation
Expand TMMP 33 - Clinical JudgmentTMMP 33 - Clinical Judgment
Expand TMMP 34 - Billing for Family/Staff Members PolicyTMMP 34 - Billing for Family/Staff Members Policy
Expand TMMP 35 - Treatment of Family/Staff Members PolicyTMMP 35 - Treatment of Family/Staff Members Policy
Expand TMMP 36 - Treatment of Abnormal Spinal CurvaturesTMMP 36 - Treatment of Abnormal Spinal Curvatures
Expand TMMP 37 - Quality of Care IssuesTMMP 37 - Quality of Care Issues
Expand TMMP 57 - Transitional CareTMMP 57 - Transitional Care
Expand TMMP 58 - Identification and Referral of Case Management to PlanTMMP 58 - Identification and Referral of Case Management to Plan
Expand TMMP 100 - Application of Hot or Cold PacksTMMP 100 - Application of Hot or Cold Packs
Expand TMMP 101 - Traction - MechanicalTMMP 101 - Traction - Mechanical
Expand TMMP 102 - Electrical Stimulation Therapy - UnattendedTMMP 102 - Electrical Stimulation Therapy - Unattended
Expand TMMP 103 - Vasopneumatic DevicesTMMP 103 - Vasopneumatic Devices
Expand TMMP 104 - Paraffin Bath TherapyTMMP 104 - Paraffin Bath Therapy
Expand TMMP 105 - Whirlpool TherapyTMMP 105 - Whirlpool Therapy
Expand TMMP 106 - DiathermyTMMP 106 - Diathermy
Expand TMMP 107 - Infrared Light/Low Level Laser TherapyTMMP 107 - Infrared Light/Low Level Laser Therapy
Expand TMMP 108 - Ultraviolet Light TherapyTMMP 108 - Ultraviolet Light Therapy
Expand TMMP 109 - Iontophoresis TherapyTMMP 109 - Iontophoresis Therapy
Expand TMMP 110 - Contrast BathsTMMP 110 - Contrast Baths
Expand TMMP 111 - Ultrasound/PhonophoresisTMMP 111 - Ultrasound/Phonophoresis
Expand TMMP 112 - Therapeutic ExerciseTMMP 112 - Therapeutic Exercise
Expand TMMP 113 - Neuromuscular Re-EducationTMMP 113 - Neuromuscular Re-Education
Expand TMMP 114 - Aquatic TherapyTMMP 114 - Aquatic Therapy
Expand TMMP 115 - Massage TherapyTMMP 115 - Massage Therapy
Expand TMMP 116 - Therapeutic ActivitiesTMMP 116 - Therapeutic Activities
Expand TMMP 117 - Casting/Splinting/Strapping ProceduresTMMP 117 - Casting/Splinting/Strapping Procedures
Expand TMMP 118 - Activities of Daily Living/Self-Care Management TrainingTMMP 118 - Activities of Daily Living/Self-Care Management Training
Expand TMMP 119 - Cognitive Skills DevelopmentTMMP 119 - Cognitive Skills Development
Expand TMMP 120 - Gait TrainingTMMP 120 - Gait Training
Expand TMMP 121 - Group Therapeutic ProceduresTMMP 121 - Group Therapeutic Procedures
Expand TMMP 122 - Manual TherapyTMMP 122 - Manual Therapy
Expand TMMP 123 - Wheelchair ManagementTMMP 123 - Wheelchair Management
Expand TMMP 124 - Prosthetic TrainingTMMP 124 - Prosthetic Training
Expand TMMP 125 - Orthotic/Prosthetic CheckoutTMMP 125 - Orthotic/Prosthetic Checkout
Expand TMMP 126 - Orthotic(s) Management and TrainingTMMP 126 - Orthotic(s) Management and Training
Expand TMMP 127 - TapingTMMP 127 - Taping
Expand TMMP 128 - Community/Work Reintegration TrainingTMMP 128 - Community/Work Reintegration Training
Expand TMMP 129 - Electrical Stimulation - AttendedTMMP 129 - Electrical Stimulation - Attended
Expand TMMP 200 - Epidural Steroid InjectionsTMMP 200 - Epidural Steroid Injections
Expand TMMP 201 - Facet Joint Injection/Medial Branch BlockTMMP 201 - Facet Joint Injection/Medial Branch Block
Expand TMMP 202 - Trigger Point InjectionsTMMP 202 - Trigger Point Injections
Expand TMMP 203 - Sacroiliac Joint InjectionsTMMP 203 - Sacroiliac Joint Injections
Expand TMMP 204 - ProlotherapyTMMP 204 - Prolotherapy
Expand TMMP 205 - Botulinum Neurotoxin Injections (Chemodenervation)TMMP 205 - Botulinum Neurotoxin Injections (Chemodenervation)
Expand TMMP 206 - AcupunctureTMMP 206 - Acupuncture
Expand TMMP 207 - Epidural AdhesiolysisTMMP 207 - Epidural Adhesiolysis
Expand TMMP 208 - Radiofrequency Joint AblationTMMP 208 - Radiofrequency Joint Ablation
Expand TMMP 209 - Regional Sympathetic BlocksTMMP 209 - Regional Sympathetic Blocks
Expand TMMP 210 - Impantable Intrathecal Drug Delivery SystemsTMMP 210 - Impantable Intrathecal Drug Delivery Systems
Expand TMMP 211 - Spinal Cord StimulatorsTMMP 211 - Spinal Cord Stimulators
Expand TMMP 212 - ViscosupplementationTMMP 212 - Viscosupplementation
Expand TMMP 302 - Spinal FusionTMMP 302 - Spinal Fusion
Expand TMMP 306 - Laminectomy/Discectomy/DecompressionTMMP 306 - Laminectomy/Discectomy/Decompression
Expand TMMP 307 - Kyphoplasty/VertebroplastyTMMP 307 - Kyphoplasty/Vertebroplasty
Expand TMMP 308 - Thermal Intradiscal ProceduresTMMP 308 - Thermal Intradiscal Procedures
Expand TMMP 310 - Manipulation Under AnesthesiaTMMP 310 - Manipulation Under Anesthesia
Expand TMMP 311 - Knee Arthroplasty - Total & PartialTMMP 311 - Knee Arthroplasty - Total & Partial
Expand TMMP 312 - Knee Surgery - Arthroscopic & Open ProceduresTMMP 312 - Knee Surgery - Arthroscopic & Open Procedures
Expand TMMP 313 - Hip Arthroplasty - Total & PartialTMMP 313 - Hip Arthroplasty - Total & Partial
Expand TMMP 314 - Hip Surgery - Arthroscopic & Open ProceduresTMMP 314 - Hip Surgery - Arthroscopic & Open Procedures
Expand TMMP 401 - Advanced Diagnostic ImagingTMMP 401 - Advanced Diagnostic Imaging
Expand TMMP 403 - DiscographyTMMP 403 - Discography
Expand TMMP 501 - Bone Growth Stimulators TMMP 501 - Bone Growth Stimulators
Expand TRIAD Non Spinal Related Diagnosis ListTRIAD Non Spinal Related Diagnosis List
Expand TRIAD Spinal Related Diagnosis ListTRIAD Spinal Related Diagnosis List