Insurance Procedure List

METROPOLITAN LITHOTRIPTOR ASSOCIATES, P.C.

HEALTH PLAN COVERAGE AND PROCEDURE LIST March 2011 Issue Health Plan

Lithotripsy CPT 50590

Laser Prostatectomy CPT 52648

Female Sling Procedure CPT 57288

Bladder Fulguration CPT 52224

Aetna

4

4

4

4

Anthem BCBS

4

4

4

4

Beechstreet

4

Cigna (GreatWest)

4

4

4

Empire BCBS

4

4

4

4

Fidelis Health NY

4

GHI (Emblem)

4

HIP (Emblem)

4

Healthnet

4

4

4

Island Group Administrators Local 1199

4

Local 3

4

Local 6

4

4

4

Local 456

4

Magnacare

4

Multiplan

4

National Health Admin.

4

NY State Empire Plan

4

4

4

Oxford Health Plans

4

4

PHCS

4

POMCO

4

4

United Healthcare

4

4

Interstim Nerve Test/PNE CPT 64561 TM

4

TM

TUNA/Prostiva

Targis /Prolieve

CPT 53852

CPT 53850

TM

4

4

4

4

®

4 4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

Please call Metro Litho at (877) ALLIED-0 concerning any health plan — even if the health plan is not listed above — since many health plans use outside provider networks.

WWW.ALLIEDMETROMEDICAL.COM