Varicose veins L85., L86., L87. Policy in place. Circumcision N30.3 Policy in place. Grommets D15.1 Policy in place

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1 Varicose veins L85., L86., L87. Haemorrhoidectomy H51.1 Inguinal hernia T20. Laparoscopic repair inguinal hernia T20. Y50.8 NICE guidelines Gastroplasty G30.1 Circumcision N30.3 Surgery for gallstones J18. ENT Grommets D15.1 Snoring Sleep apnoea Tonsillectomy F34. Bone Anchored Hearing Aids (BAHA) Grazax for rhinitis Cochlear implants for children and adults with severe to profound hearing loss D24.1, D24.2, D24.3 NICE Guidance Muscuol skeletal Surgery Hip and knee replacement surgery Hips W37., W38., W39. Knees W40., W41., W42. Carpel tunnel surgery A65.1 Dupytrens release T52.1 Trigger finger T72.3 Ganglion T59., T60. Spinal fusion V37., V38., V39.

2 Arthroscopic debribement and washout W85.2, W85.8 Diagnostic arthroscopy W87.9, W88.9 Arthroscopic washout of acute knee joint W85.2 Facet joint injections V54.4 Joint injections W90.3, W90.4 Spinal epidural injections for chronic back pain A52.1 Plain x rays and MRI back Excision of acromi clavicular joint Oral Surgery Wisdom teeth removal F09.1, F09.3 Orthodontic treatment Apiectomy F12.1 Temperomandibular joint replacement V20. Urological genitary problems Erectile dysfunction drug treatment Prostatectomy M61. Dilation and curettage (D&C) Q10.3, Q18.9 Hysteroscopy Q18.9 Hysterectomy for menorrhagia (heavy menstrual bleeding) Female sterilization Q07.4 (ICD 10 code N92.0) Q27. Q28. Q35. Q36. Reversal of female sterilization Q29., Q37. Reversal of male sterilization N18.1 IVF Penile implants N29. Caesarian section for non clinical reasons Labiaplasty/ vaginoplasty Ophthalmology R17.1 (ICD 10 Code O82.0) P05.5 P21.3

3 Laser surgery for myopia (short sightedness) Photodynamic therapy (PDT) for Age Related Macular Degeneration (ARMD) C88.2 NICE Guidance Anti vascular endothelial growth factor (VEGF) treatment for NICE approved indications NICE Guidance Anti vascular endothelial growth factor (VEGF) treatment for non NICE approved indications Cataract surgery (1st and 2nd eye) Eyelid surgery including: Correction of ptosis C71., C72., C73., C74., C75. C13. Blepharoplasty C16. Tarsorrhaphy C18. Minor skin surgery around the eye area for asymptomatic conditions: Hordeolum including abscess, furnuncle, stye Chalazion Xanthelasma Skin tags Benign pigmented naevi (moles) Seborrhoeic keratosis (benign skin growths, warts) Dermatofibroma Lipomata (fatty deposits under the skin) Small sebaceous warts and cysts Plastic surgery Abdominoplasty S02.1, S02.2 Breast augmentation B31.2 Breast reduction B31.1 Breast prosthesis removal/ replacement B30. Gender reassignment surgery X15. Pinnaplasty D03.3 Blepharoplasty C13. Face/brow lift S01. Gynaecomastia B31.1 Hair removal Hair grafting for male baldness S33. Hyperhydrosis treatment with botox S53.2

4 Hyperhydrosis endoscopic thoracic sympathectomy A76.2 Inverted nipple correction B35.6 Liposuction to correct distribution of fat S62.1, S62.2 Mastopexy B31.3 Removal of tattoos S60.1, S60.2, S60.3 Removal of benign skin lesions Removal of lipomata S04., S05., S06., S09., S10., S11. (ICD 10 codes D17, E882) Repair of lobe of external ear D06.2 Resurfacing procedures: dermabrasion S60.1, S60.2, S09., S10.3, S11.3 Revision mammoplasty B31.4, B30.2 Rhinoplasty E02.3, E02.4, E02.5, E02.6 Thigh, buttock, arm lift S03. Scars and keloid scars (ICD 10 codes L92.0) Botox injections for aging face Neurology/Neurosurgery Spinal cord stimulation failed back surgery syndrome, complex regional pain syndrome and chronic refractory angina A48.3 Sacral Nerve Stimulation faecal and urinary incontinence Miscellaneous Bariatric surgery Bi ventricular pacing K60.1, Y70.5 NICE guidance Fenestrated EVAR Hyperbaric oxygen therapy Preimplantation Genetic Diagnosis Therapy

5 Surrogacy Pulmonary Arterial Hypertension

6 Published Commissioning Policies Appendix 1b WM Ref No Policy Posted Acupuncture Commissioning Policy Jan-10 WM20 Antibody Incompatible Renal Transplantation (AIT) Jan-10 Bariatric Surgery Commissioning Policy Sep-10 Circumcision Policy Jul-10 WM18 Closure of Patent Foramen Ovale (PFO) for Migraine Headache Jan-10 Cochlear Implants for Children and Adults with severe to profound deafness Oct-09 Commissioning of Aesthetic Surgery Endovascular Repair of Abdominal Aortic Aneurysm (EVAR) for patients with a higher perioperative mortality risk Sep-08 WM21 Extracorporeal Cardiac Life Support (Paediatric) (ECLS) Jan-10 WM22 Extracorporeal Photopheresis (ECP) for Erythrodermic Cutaneous T Cell Lymphoma (CTCL), Sezary Syndrome and Graft Versus Host Disease (GVHD) Jan-10 Facet Joint and Lumbar Epidural Interventions for Chronic Spinal Pain Mar-10 Gender Dysphoria Services and Gender Reassignment Surgery in Adults, Guidelines for Aug-08 (Grommets) Insertion of Ventilation Tube through Tympanic Membrane Dec-10 Individual Funding Requests (IFR) Policy IFR Proforma for Primary Care Clinicians IFR Proforma for Secondary Care Clinicians ICATS Clinician guide Knee score guide QoL Oxford hip score QoL Oxford knee score Hip score Commissioning guidelines for GP's Final version April 2010 Management of Obstructive Sleep Apnoea Musculoskeletal Surgical Interventions Prioritisation Framework for the Commissioning of Healthcare Services Radio Frequency Ablation (RFA) for Atrial Fibrillation (AF) performed concurrently with other cardiac surgery Radio Frequency Ablation (RFA) for Liver Cancer Ranibizumab and Pegaptanib for the Treatment of Age-Related Macular Degeneration Referral Proforma for Worcestershire NHS Funded Fertility Treatment Reversal of Sterilisation (men and women) Spinal Cord Stimulation for the Management of Failed Back Surgery Syndrome, Complex Regional Pain Syndrome (Type 1), and Chronic Refractory Angina Temporomandibular Joint Replacement Nov-10 Oct-10 Oct-10 Aug-08 Nov-06 Nov-06 Nov-08 May-07 Mar-07 Aug-08 Apr-07

7 Published Commissioning Policies WM Ref No Policy Posted Tertiary Treatment for Assisted Conception Services Sep-08 Treatment of Snoring Tonsillectomy Policy Dec-10 Varicose Vein Referral Guidelines WM01 WM01 - Ethical Framework to support priority setting and resource allocation within collaborative commissioning arrangements WM02 WM02 - Orphan Drugs WM03 WM03 - Ongoing access to treatment following the ending of industry sponsored clinical trials or funding WM05 WM05 - Guidance produced by the National Institute for Health and Clinical Excellence WM07 WM07 - Choice WM08 WM08 - In-Year Service Developments and the PCT's approach to treatments not yet assessed and prioritised WM09 WM09 - Individual Funding Requests Sep-10 WM10 WM10 - Ongoing access to treatment following completion of non-commercially funded trials WM11 WM11 - Ongoing access to treatment following completion of NHS commissioner-funded trials WM12 WM12 - Patients changing responsible commissioner WM13 WM13 - Defining the boundaries between NHS and Private Healthcare WM14 WM14 - Experimental and Unproven Treatments WM15 WM15 - Ongoing access to treatment following a 'trial of treatment' which has not been sanctioned by the responsible Primary Care Trust and which is not routinely funded or has not been formally assessed and prioritised WM17 WM17 - Patients Seeking NHS Funded Hospital Treatment in the European Union, European Economic Area or Switzerland -This document has been removed pending review GN01 GN01 - Access to NHS funding following third party funded treatment GN02 GN02 - The role of commissioners in the evaluation of individual treatments and the funding of clinical research WM00 Definition of Terms