https://www.premera.com/medicalpolicies/5.01.646.pdf#search=policy
PHARMACY POLICY - 5.01.646 SGLT2 Inhibitors Effective Date: May 1, 2025 Last Revised: ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/7.01.126.pdf#search=policy
MEDICAL POLICY - 7.01.126 Image-Guided Minimally Invasive Decompression for Spinal Stenosis BCBSA Ref. Policy: 7.01.126 Effective Date: July 1, 2024 Last Revised: June 10, 2024 ...
https://www.premera.com/medicalpolicies/7.01.142.pdf#search=policy
MEDICAL POLICY - 7.01.142 Surgery for Groin Pain in Athletes BCBSA Ref. Policy: 7.01.142 Effective Date: May 1, 2025 Last Revised: Apr. 7, 2025 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/7.01.564.pdf#search=policy
MEDICAL POLICY - 7.01.564 Pulsed Radiofrequency Effective Date: Oct. 1, 2024 Last ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/7.01.567.pdf#search=policy
MEDICAL POLICY - 7.01.567 Surgical Treatments for Lymphedema and Lipedema BCBSA Ref. Policy: 7.01.162, 7.01.169, 7.01.173 Effective Date: March 5, 2025 Last Revised: Nov. 12, 2024 ...
https://www.premera.com/medicalpolicies/7.01.588.pdf#search=policy
MEDICAL POLICY - 7.01.588 Percutaneous Electrical Nerve Stimulation and Percutaneous Neuromodulation Therapy BCBSA Ref. Policy: 7.01.29 Effective Date: Sept. 1, 2024 Last Revised: ...
https://www.premera.com/medicalpolicies/7.01.592.pdf#search=policy
MEDICAL POLICY - 7.01.592 Surgical Treatment of Femoroacetabular Impingement BCBSA Ref. Policy: 7.01.118 Effective Date: Dec. 1, 2024 Last Revised: Nov. 11, 2024 Replaces: N/A ...
https://www.premera.com/medicalpolicies/7.03.07.pdf#search=policy
MEDICAL POLICY - 7.03.07 Lung and Lobar Lung Transplant BCBSA Ref. Policy: 7.03.07 Effective Date: Nov. 1, 2024 Last Revised: Oct. 7, 2024 Replaces: Extracted from 7.03.509 ...
https://www.premera.com/medicalpolicies/8.01.531.pdf#search=policy
MEDICAL POLICY - 8.01.531 Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia BCBSA Ref. Policy: 8.01.54 Effective Date: Oct. 1, 2024 Last Revised: Sept. 23, ...
https://www.premera.com/medicalpolicies/10.01.520.pdf#search=policy
BENEFIT COVERAGE GUIDELINE - 10.01.520 Review for Coverage in the Absence of a Medical Policy, Pharmacy Policy, or Utilization Management Guideline Effective Date: Aug. 1, 2024 ...
https://www.premera.com/medicalpolicies/2.04.509.pdf#search=policy
MEDICAL POLICY - 2.04.509 Cardiovascular Risk Panels BCBSA Ref. Policy: 2.04.65 Effective Date: May 1, 2024 Last Revised: Aug. 2, 2024 Replaces: 2.04.509 RELATED MEDICAL POLICIES: ...
https://www.premera.com/medicalpolicies/2.04.520.pdf#search=policy
MEDICAL POLICY - 2.04.520 Laboratory Testing Investigational Services BCBSA Ref. Policy: 2.04.159 Effective Date: Jan. 1, 2025 Last Revised: Jun. 6, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.545.pdf#search=policy
PHARMACY POLICY - 5.01.545 Pharmacologic Treatment of Benign Prostatic Hyperplasia ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.562.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.562 Imlygic (talimogene laherparepvec) Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.570.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.570 Pharmacologic Treatment of Duchenne Muscular Dystrophy BCBSA Ref. Policy: 5.01.27 Effective Date: Feb. 1, 2025 Last Revised: Jan. 27, 2025 ...
https://www.premera.com/medicalpolicies/5.01.571.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.571 C3 and C5 Complement Inhibitors BCBSA Ref. Policy: 5.01.39 Effective Date: Apr. 1, 2025 Last Revised: Mar. 11, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.576.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.576 Drugs for Rare Diseases BCBSA Ref. Policy: 5.01.37 and 5.01.40 Effective Date: May 1, 2025 Last Revised: Apr. 8, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.581.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.581 Pharmacologic Treatment of Hemophilia BCBSA Ref. Policy: 8.01.65 Effective Date: May 1, 2025 Last Revised: Apr. 8, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.582.pdf#search=policy
MEDICAL POLICY - 5.01.582 Antibody-Drug Conjugates Effective Date: Aug. 1, 2024 Last ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/5.01.585.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.585 Pharmacologic Treatment of Phenylketonuria Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...