Rapidly progressing infectious endophthalmitis.
This Clinical Policy Bulletin addresses vitrectomy.Īetna considers the following medically necessary: Worth, Wichita Falls, Temple, Waco, Houston, Bellaire, Galveston, San Antonio, Corpus Christi, McAllen, Harlingen, Austin, Lubbock, Amarillo, El Paso UT- Utah VT- Vermont: Burlington CT- Connecticut: Manchester, New Britain, Hartford, Hamden, New Haven, Bridgeport, Waterbury, Danbury, Greenwich, Stamford VA- Virginia: Fairfax, Winchester, Charlottesville, Richmond, Chesapeake, Virginia Beach, Norfolk, Newport News, Roanoke, Lynchburg WA- Washington WV- West Virginia: Charleston, Huntington, Morgantown WI- Wisconsin: Sheboygan, Milwaukee, Madison, Green Bay, Wausau, Marshfield, Neenah WY- Wyoming.Number: 0393 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References Louis, Cape Girardeau, Kansas City, Columbia, Springfield MT- Montana NE- Nebraska: Omaha, Scottsbluff NV- Nevada NH- New Hampshire: Concord, Lebanon, NJ- New Jersey: Livingston, Milburn, Newark, Belleville, Ridgewood, Teaneck, Newton, Cherry Hill, Moorestown, Northfield, New Brunswick NM- New Mexico NY- New York: New York, Staten Island, Bronx, Harrison, Mt Kisco, Scarsdale, Yonkers, Bronxville, Suffern, Great Neck, New Hyde Park, Brooklyn, Flushing, Forest Hills, Kew Gardens, Mineola, Rockville Centre, Bayville, Hauppauge, Slingerlands, Albany, Fishkill, Poughkeepsie, Syracuse, Williamsville, Buffalo, Canandaigua, Rochester NC- North Carolina: Winston-Salem, Burlington, Greensboro, Chapel Hill, Raleigh, Durham, Greenville, Charlotte, Wilmington, Morganton, Asheville ND- North Dakota: Fargo OH- Ohio: Columbus, Toledo, Cleveland, Beachwood, Akron, Canton, Cincinnati, Dayton OK- Oklahoma: Oklahoma City, Tulsa OR- Oregon PA- Pennsylvania: Pittsburgh, Brookville, Hermitage, Erie, Camp Hill, Hershey, Williamsport, Bethlehem, Allentown, Scranton, Bala Cynwyd, Huntingdon Valley, Wyndmoor, Wynnewood, Philadelphia, West Chester, North Wales RI- Rhode Island: Warwick, Providence SC- South Carolina: Columbia, Florence, Greenville SD- South Dakota: Rapid City TN- Tennessee: Nashville, Chattanooga, Johnson City, Kingsport, Knoxville, Memphis MS- Mississippi: Jackson TX- Texas: Dallas, Tyler, Arlington, Ft. Paul, Minneapolis, Rochester MO- Missouri: Florissant, St. Wayne, New Albany, Evansville, Lafayette IA- Iowa: West Des Moines, Cedar Falls, Iowa City KS- Kansas: Kansas City, Prairie Village, Topeka, Wichita KY- Kentucky: Louisville, Lexington, Paducah, Owensboro LA- Louisiana: Metairie, New Orleans, Lafayette, Baton Rouge, Shreveport ME- Maine: Portland, Lewiston, Bangor MD- Maryland: Waldorf, Chevy Chase, Bethesda, Rockville, Potomac, Germantown, Owings Mills, Baltimore, Towson, Annapolis, Salisbury MA- Massachusetts: Springfield, Natwick, Worcester, Burlington, Lawrence, Boston, Brookline, Quincy MI- Michigan: Southfield, Detroit, Royal Oak, Ann Arbor, Livonia, Ypsilanti, Pontiac, Flint, Saginaw, East Lansing, Grand Rapids, Traverse City, Williamsburg, MN- Minnesota: St.
Myers, Naples, Sarasota, Ocala, Palm Harbor, Tarpon Springs GA- Georgia: Decatur, Atlanta, Augusta, Savannah, ID- Idaho IL- Illinois: Arlington Heights, Des Plaines, Park Ridge, West Dundee, Maywood, Wheaton, Oak Park, Harvey, Joliet, Oak Lawn, Oak Brook, Riverside, Chicago, Rockford, Peoria, Urbana, Springfield IN- Indiana: Indianapolis, Munster, Merrillville, South Bend, Ft. Petersburg, Clearwater, Largo, Winter Haven, Ft. Lauderdale, West Palm Beach, Palm Beach Gardens, Boca Raton, Lake Worth, Zephyrhills, Tampa, St.
AL- Alabama: Birmingham, Montgomery, Huntsville, Mobile AK- Alaska AZ- Arizona AR- Arkansas: Little Rock, Fayetteville CA- California CO- Colorado: Aurora, Denver, Boulder, Colorado Springs DE- Delaware: Wilmington District of Columbia: Washington, DC FL- Florida: Daytona Beach, Jacksonville, Tallahassee, Pensacola, Gainesville, Orlando, Melbourne, Miami, Aventura, Ft.
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