https://www.premera.com/medicalpolicies/5.01.660.pdf#search=policy
PHARMACY POLICY - 5.01.660 Inhaled Corticosteroids Effective Date: Jan. 1, 2026 Last ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/6.01.54.pdf#search=policy
MEDICAL POLICY - 6.01.54 Dopamine Transporter Single-Photon Emission Computed Tomography BCBSA Ref. Policy: 6.01.54 Effective Date: Jan. 1, 2026 Last Revised: Dec. 8, 2025 ...
https://www.premera.com/medicalpolicies/6.01.68.pdf#search=policy
MEDICAL POLICY - 6.01.68 Irreversible Electroporation of Tumors Located in the Liver, Pancreas, Kidney, Lung, or Prostate BCBSA Ref. Policy: 6.01.68 Effective Date: Jan. 1, 2026 ...
https://www.premera.com/medicalpolicies/10.01.512.pdf#search=policy
MEDICAL POLICY - 10.01.512 Ambulance and Medical Transport Services Effective Date: Feb. ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/15.01.001.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.001 Allergen Testing Ref. Policy: G2031 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 Replaces: N/A RELATED POLICIES: 15.01.036 ...
https://www.premera.com/medicalpolicies/2.01.544.pdf#search=policy
MEDICAL POLICY - 2.01.544 Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation for Benign Prostatic Hyperplasia BCBSA Ref. Policy: 2.01.49 Effective Date: ...
https://www.premera.com/medicalpolicies/5.01.584.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.584 CGRP Inhibitors for Migraine Prophylaxis BCBSA Ref. Policy: 5.01.29 Effective Date: Nov. 1, 2025 Last Revised: Oct. 14, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/5.01.589.pdf#search=policy
PHARMACY POLICY - 5.01.589 BRAF and MEK Inhibitors Effective Date: Mar. 1, 2026 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.595.pdf#search=policy
PHARMACY/MEDICAL POLICY - 5.01.595 Injectable Clostridial Collagenase for Fibroproliferative Disorders BCBSA Ref. Policy: 5.01.19 Effective Date: Apr. 1, 2025 Last Revised: Mar. ...
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/7.01.583.pdf#search=policy
MEDICAL POLICY - 7.01.583 Amniotic Membrane and Amniotic Fluid BCBSA Ref. Policy: 7.01.149 Effective Date: Jul. 1, 2025 Last Revised: Jan. 1, 2026 Replaces: N/A RELATED MEDICAL ...
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: Sep. 1, 2025 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: Jul. 1, 2025 Last Revised: Jun. 23, 2025 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: Dec. 1, 2025 Last Revised: Nov. 10, 2025 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, 2025 Last Revised: Sep. 8, 2025 ...
https://www.premera.com/medicalpolicies/8.01.62.pdf#search=policy
MEDICAL POLICY - 8.01.62 Electronic Brachytherapy for Nonmelanoma Skin Cancer BCBSA Ref. Policy: 8.01.62 Effective Date: Oct. 1, 2025 Last Revised: Jan. 1, 2026 Replaces: N/A ...
https://www.premera.com/medicalpolicies/5.01.613.pdf#search=policy
PHARMACY POLICY - 5.01.613 Oral Iron Chelating Agents BCBSA Ref. Policy: 8.01.02 Effective Date: Mar. 1, 2025 Last Revised: Feb. 24, 2025 Replaces: N/A RELATED MEDICAL POLICIES: ...
https://www.premera.com/medicalpolicies/5.01.627.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.627 Thymic Stromal Lymphopoietin (TSLP) Inhibitors ... Medical Necessity criteria within this policy DOES NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/5.01.658.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.658 Denosumab Products Effective Date: Mar. 1, 2026 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/1.01.29.pdf#search=policy
MEDICAL POLICY - 1.01.29 Tumor Treating Fields Therapy BCBSA Ref. Policy: 1.01.29 Effective Date: Dec. 1, 2025 Last Revised: Feb. 10, 2026 Replaces: N/A RELATED MEDICAL POLICIES: ...