Evidence Based Intervention Policies and Prior Approval Applications

Abdominoplasty and Apronectomy

Arthroscopic sub-acromial decompression

Biological Mesh

Blepharoplasty and Brow Lift

• Secondary care prior approval application form

Bobath Therapy

Body Contouring

• Primary care prior approval application form

Breast prosthesis removal

• Primary care prior approval application form

Breast reduction surgery (Academy of Medical Royal Colleges)

• Primary care prior approval application form

Breast Surgery

• Primary care prior approval application form

Carpal tunnel syndrome release (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Cataract Surgery

• Primary care prior approval application form

• Secondary care prior approval application form

Chalazia (meibomian cysts) removal (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Cholecystectomy

Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS & ME) Inpatient Treatment

Complementary & Alternative Therapies

Continuous Glucose Monitoring - Adults Policy

• Prior approval application form - initiation
• Prior approval application form - Continuation

Continuous Glucose Monitoring - Paediatric Policy

• Prior approval application form - initiation

Correction of Congenital Ear Deformity, Pinnaplasty – Otoplasty

• Primary care prior approval application form

Correction of Privately Funded Treatments

Corrective Surgery for Breast Asymmetry

• Primary care prior approval application form

Cosmetic interventions for individuals with gender dysphoria or post gender reassignment surgery

Cosmetic Procedures

• Primary care prior approval application form

Dilation and cutterage for heavy menstrual bleeding (Academy of Medical Royal Colleges)

Diastasis Repair

• Primary care prior approval application form

Dupuytren’s contracture release in adults (CCH injections) (Academy of Medical Royal Colleges)

• Primary care prior approval application form
• Secondary care prior approval application form

Dupuytren’s contracture release in adults (Surgery) (Academy of Medical Royal Colleges)

• Primary care prior approval application form
• Secondary care prior approval application form

Dysthyroid Eye Disease

Epidural Injections and Therapeutic Nerve Blocks for Lumbar or Sacral Radiculopathy

• Secondary care prior approval application form

Exogen

Faecal Microbiota Transplants

Female Sterilisation

Fertility Treatment and referral Criteria for Tertiary level Assisted Conception

Fitness for Surgery

Functional Electrical Stimulation

Gamete Storage

Ganglion surgical excision (Academy of Medical Royal Colleges)

• Primary care prior approval application form
• Secondary care prior approval application form

Grommets for glue ear in children (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Grommet insertion in adults

• Secondary care prior approval application form

Haemorrhoid Surgery

• Secondary care prior approval application form

Hair Transplantation

Hallux Valgus (Bunion) Surgery

• Secondary care prior approval application form

Hip Arthroscopy

• Primary care prior approval application form

Hyperhidrosis

Hysterectomy for heavy menstrual bleeding (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Individual Funding Requests for Individual and Exceptional Cases and Prior Approval of Evidence Based Interventions

• Primary care prior approval application form

Injections and Radiofrequency Denervation for non-specific back pain

• Secondary care prior approval application form

Injections for nonspecific low back pain without sciatica (Academy of Medical Royal Colleges)

• Secondary care prior approval application form (Injections and Radiofrequency Denervation)

• Secondary care prior approval application form (Epidural Injections and Therapeutic Nerve Blocks)

Knee Arthroscopy - local supplement

• Secondary care prior approval application form

Knee arthroscopy for patients with osteoarthritis (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Labiaplasty, Vaginoplasty & Hymenorrhaphy

• Primary care prior approval application form

Liposuction

• Primary care prior approval application form

Lycra Dynamic Splinting for Children with Neurological Impairment

Lymphoedema Services – Specialist treatment in the private sector

Mechanical Insufflation-Exsufflation (MI-E) Devices CoughAssist

Gynaecomastia

• Primary care prior approval application form

Nasal Surgery

• Secondary care prior approval application form

Open MRI

• Secondary care prior approval application form

Pathological Dmand Avoidance

Penile Circumcision 

Peyronie's Disease

Primary Hip Replacement

• Secondary care prior approval application form

Primary Knee Replacement

• Secondary care prior approval application form

Referral and Surgery for snoring, sleep disordered breathing and obstructive sleep apnoea

Referral for Bariatric Surgery 

• Secondary care prior approval application form

Removal of abnormally placed hair and hirsutism

Repair to Earlobes

• Primary care prior approval application form

Residential exercise therapy rehabilitation courses for the management of Ankylosing Spondylitis

Reversal of Sterilisation

Revision Surgery for Hip & Knee Replacements

Rhinophyma Surgical Treatment

Scar Revision

• Primary care prior approval application form

Shoulder Arthroscopy

• Secondary care prior approval application form

Simultaneous Joint Replacement

Sleep Apnoea

Spinal Cord Stimulation

Surgical removal of benign skin lesions (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Tattoo Removal

Temporomandibular Joint Replacement

The National EBI Programme and Local EBI Policies

Tongue Tie

Tonsillectomy for tonsilloliths

Tonsillectomy for recurrent tonsillitis (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Transcranial Magnetic Stimulation (TMS and rTMS)

Trigger finger release / thumb surgery (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Ultrasound Guided Joint Injections

• Secondary care prior approval application form

Uterine Vaginal Prolapse (part of Pelvic Organ Prolapse)

Varicose vein surgical intervention (Academy of Medical Royal Colleges)

• Secondary care prior approval application form

Vasectomy

Virulite Cold Sore Machine

Wigs and Hair Pieces