• Medical Policies

    Premera offers access to more than 300 medical policies online. Since we’re continually updating these pages, we encourage you to visit often. The policies are in Adobe PDF format. Individual plans use different medical policies. View individual plan medical policies and also View our HMO medical policies.

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61 results found for preventive
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https://www.premera.com/medicalpolicies/10.01.523.pdf#search=preventive
BENEFIT COVERAGE GUIDELINE - 10.01.523 Preventive Care Effective Date: Jan. 1, 2026 Last ... Introduction The health plan covers preventive services that are required by the ...
https://www.premera.com/medicalpolicies/6.01.521.pdf#search=preventive
10.01.523 Preventive Care Select a hyperlink below to be directed to that section. ... under the Affordable Care Act as a preventive benefit) o Men aged 70 and older, ...
https://www.premera.com/medicalpolicies/13.01.500.pdf#search=preventive
10.01.523 Preventive Care Select a hyperlink below to be directed to that section. ... RevitalVision Page | 4 of 49 ∞ Coding Note: Please see 10.01.523 Preventive Care for FDA ...
https://www.premera.com/medicalpolicies/7.01.171.pdf#search=preventive
2 of 15 ∞ Procedure Medical Necessity Preventive treatment: Initiation of use Remote ... to 2 or more guideline-recommended preventive headache medications (e.g., ...
https://www.premera.com/medicalpolicies/10.01.535.pdf#search=preventive
This policy includes additional preventive coverage for certain high-risk conditions that ... | 2 of 6 ∞ Service Coverage Criteria Preventive services . Periodic oral evaluation . ...
https://www.premera.com/medicalpolicies/5.01.584.pdf#search=preventive
... necessary for the preventive treatment of migraine when all the following are met: . ... considered medically necessary for the preventive treatment of migraine in adults when ...
https://www.premera.com/medicalpolicies/8.03.501.pdf#search=preventive
Treatment for preventive or maintenance therapy (see Definition of Terms) . Treatment to ... Chiropractic preventive service: Treatment to prevent pain/disability, promote health, and ...
https://www.premera.com/medicalpolicies/7.01.567.pdf#search=preventive
... Reductive/ablative techniques o Direct excision Preventive surgical treatment Lymphatic ... Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) is a preventive ...
https://www.premera.com/medicalpolicies/2.04.509.pdf#search=preventive
... care that has the potential to focus on and direct preventive and diagnostic activities. ... evidence. 43 Page | 11 of 15 ∞ US Preventive Services Task Force Recommendations No ...
https://www.premera.com/medicalpolicies/15.01.050.pdf#search=preventive
... 1 uCyt+ ImmunoCyt test USPSTF US Preventive Services Task Force UT Urine derived ... have not been properly validated. 53 US Preventive Services Task Force The USPSTF ...
https://www.premera.com/medicalpolicies/2.04.152.pdf#search=preventive
... in risk and is recommended by the US Preventive Services Task Force (USPSTF) and the ... US Preventive Services Task Force Recommendations The US Preventive Services Task Force ...
https://www.premera.com/medicalpolicies/15.01.027.pdf#search=preventive
... drug resistance USPSTF United States Preventive Services Task Force Evidence Review ... HIV-2 infection." 49 United States Preventive Services Task Force The USPSTF ...
https://www.premera.com/medicalpolicies/5.01.649.pdf#search=preventive
... necessary for the preventive treatment of migraines when the following criteria are met: . ... necessary for the preventive treatment of migraines when the following criteria are met: . ...
https://www.premera.com/medicalpolicies/15.01.045.pdf#search=preventive
... US Ultrasound USPSTF United States Preventive Services Task Force Evidence Review ... United States Preventive Services Task Force Within the 2018 USPSTF recommendation ...
https://www.premera.com/medicalpolicies/15.01.003.pdf#search=preventive
... CTFPHC Canadian Task Force on Preventive Health Care DNA Deoxyribonucleic acid ... T3 TT4 Total T4 USPSTF United States Preventive Services Task Force Evidence Review ...
https://www.premera.com/medicalpolicies/15.01.015.pdf#search=preventive
... UA Urinalysis USPSTF United States Preventive Services Task Force UTI Urinary tract ... US Preventive Services Task Force (USPSTF) The USPSTF recommends screening for ...
https://www.premera.com/medicalpolicies/2.04.507.pdf#search=preventive
... vitamin D supplements are covered as preventive care for individuals age 65 and older ... D levels as a preventive strategy (see Practice Guidelines and Position Statements). ...
https://www.premera.com/medicalpolicies/15.01.013.pdf#search=preventive
... US Ultrasonography USPSTF United States Preventive Services Task Force VCTE Vibration ... United States Preventive Services Task Force (USPSTF) The USPSTF published their final ...
https://www.premera.com/medicalpolicies/15.01.024.pdf#search=preventive
... UL Upper limits USPSTF United States Preventive Services Task Force Evidence Review ... Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive ...
https://www.premera.com/medicalpolicies/7.01.159.pdf#search=preventive
... Given that SPG blocks are being proposed as a preventive therapy for chronic migraines, ... interventional strategies for the preventive treatment of migraine. 18 SPG blocks ...
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