https://www.premera.com/medicalpolicies/7.01.516.pdf#search=policy
MEDICAL POLICY - 7.01.516 Bariatric Surgery BCBSA Ref. Policy: 7.01.47 Effective Date: Jan. 1, 2024 Last Revised: Dec. 26, 2023 Replaces: 7.01.47 RELATED MEDICAL POLICIES: 2.01.38 ...
https://www.premera.com/medicalpolicies/7.01.586.pdf#search=policy
MEDICAL POLICY - 7.01.586 Cochlear Implant BCBSA Ref. Policy: 7.01.05 Effective Date: May 1, 2023 Last Revised: Apr. 11, 2023 Replaces: 7.01.05 RELATED MEDICAL POLICIES: 1.01.528 ...
https://www.premera.com/medicalpolicies/2.01.26.pdf#search=policy
MEDICAL POLICY - 2.01.26 Prolotherapy BCBSA Ref. Policy: 2.01.26 Effective Date: Feb. 1, 2024 Last Revised: Jan. 8, 2024 Replaces: N/A RELATED MEDICAL POLICIES: 2.01.16 ...
https://www.premera.com/medicalpolicies/7.01.503.pdf#search=policy
MEDICAL POLICY - 7.01.503 Breast Reduction (Mammaplasty) BCBSA Ref. Policy: 7.01.21 Effective Date: May 1, 2023 Last Revised: Nov. 21, 2023 Replaces: 7.01.21 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/8.01.36.pdf#search=policy
MEDICAL POLICY - 8.01.36 Extracorporeal Photopheresis BCBSA Ref. Policy: 8.01.36 Effective Date: Jan. 1, 2024 Last Revised: Dec. 11, 2023 Replaces: 8.01.501 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/10.01.504.pdf#search=policy
MEDICAL POLICY - 10.01.504 Technology Review Effective Date: Mar. 1, 2024 Last Revised: Feb. 12, 2024 Replaces: N/A RELATED MEDICAL POLICIES / GUIDELINES: 10.01.511 Medical Policy ...
https://www.premera.com/medicalpolicies/2.01.505.pdf#search=policy
MEDICAL POLICY - 2.01.505 Hyperbaric Oxygen Therapy BCBSA Ref. Policy: 2.01.04 Effective Date: Sept. 1, 2023 Last Revised: Aug. 21, 2023 Replaces: N/A RELATED MEDICAL POLICIES: ...
https://www.premera.com/medicalpolicies/7.01.20.pdf#search=policy
MEDICAL POLICY - 7.01.20 Vagus Nerve Stimulation BCBSA Ref. Policy: 7.01.20 Effective Date: May 1, 2023 Last Revised: Jan. 1, 2024 Replaces: N/A RELATED MEDICAL POLICIES: 2.01.526 ...
https://www.premera.com/medicalpolicies/7.01.521.pdf#search=policy
MEDICAL POLICY - 7.01.521 Mastectomy for Gynecomastia BCBSA Ref. Policy: 7.01.13 Effective Date May 1, 2023 Last Revised: April 10, 2023 Replaces: 7.01.13 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/7.01.522.pdf#search=policy
MEDICAL POLICY - 7.01.522 Gastric Electrical Stimulation BCBSA Ref. Policy: 7.01.73 Effective Date: May 1, 2023 Last Revised: April 10, 2023 Replaces: 7.01.73 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/8.01.01.pdf#search=policy
MEDICAL POLICY - 8.01.01 Adoptive Immunotherapy BCBSA Ref. Policy: 8.01.01 Effective Date: Jan. 1, 2024 Last Revised: Dec. 11, 2023 Replaces: N/A RELATED MEDICAL POLICIES: 8.01.53 ...
https://www.premera.com/medicalpolicies/8.01.503.pdf#search=policy
PHARMACY / MEDICAL POLICY - 8.01.503 Immune Globulin Therapy BCBSA Ref. Policy: 8.01.05 Effective Date: Feb. 1, 2024 Last Revised: Mar. 1, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/7.01.69.pdf#search=policy
MEDICAL POLICY - 7.01.69 Sacral Nerve Neuromodulation/Stimulation BCBSA Ref. Policy: 7.01.69 Effective Date: July 1, 2023 Last Revised: Jan. 1, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/7.01.63.pdf#search=policy
MEDICAL POLICY - 7.01.63 Deep Brain Stimulation BCBSA Ref. Policy: 7.01.63 Effective Date: July 1, 2023 Last Revised: June 12, 2023 Replaces: N/A RELATED MEDICAL POLICIES: 7.01.20 ...
https://www.premera.com/medicalpolicies/8.01.519.pdf#search=policy
MEDICAL POLICY - 8.01.519 Nonpharmacologic Treatment of Hyperhidrosis BCBSA Ref. Policy: 8.01.19 Effective Date: Nov. 1, 2023 Last Revised: Oct. 10, 2023 Replaces: 8.01.19 RELATED ...
https://www.premera.com/medicalpolicies/1.01.507.pdf#search=policy
MEDICAL POLICY - 1.01.507 Electrical Stimulation Devices BCBSA Ref. Policy: 1.01.09 Effective Date: Mar. 1, 2024 Last Revised: Feb. 12, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/5.01.500.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.500 Growth Hormone Therapy BCBSA Ref. Policy: 5.01.06 Effective Date: Dec. 1, 2023 Last Revised: Nov. 14, 2023 Replaces: 5.01.06 & 5.01.505 ...
https://www.premera.com/medicalpolicies/5.01.513.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.513 Xolair (omalizumab) Effective Date: Aug. 1, 2023 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/7.01.15.pdf#search=policy
MEDICAL POLICY - 7.01.15 Meniscal Allografts and Other Meniscal Implants BCBSA Ref. Policy: 7.01.15 Effective Date: July 1, 2023 Last Revised: Nov. 1, 2023 Replaces: 7.01.517 ...
https://www.premera.com/medicalpolicies/7.01.508.pdf#search=policy
MEDICAL POLICY - 7.01.508 Blepharoplasty, Blepharoptosis and Brow Ptosis Surgery ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...