• 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.

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315 results found for policy
https://www.premera.com/medicalpolicies/7.01.161.pdf
Policy: 7.01.161 Effective Date: Oct. 1, 2019 Last Revised: Sept. 5, 2019 Replaces: N/A ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.592.pdf
below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ... This policy describes when this specific form of chemotherapy may be considered medically ...
https://www.premera.com/medicalpolicies/5.01.552.pdf
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... This policy describes when this medication may be considered medically necessary. Note: ...
https://www.premera.com/medicalpolicies/7.01.568.pdf
N/A RELATED MEDICAL POLICIES: None This policy ONLY applies to members whose plan ... This policy does not apply to member plans that do not include this program. Select a ...
https://www.premera.com/medicalpolicies/2.04.144.pdf
Policy: 2.04.144 Effective Date: July 1, 2020 Last Revised: June 18, 2020 Replaces: ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/7.01.583.pdf
Policy: 7.01.149 Effective Date: Aug. 1, 2020 Last Revised: July 14, 2020 Replaces: N/A ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.571.pdf
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... This policy describes when Soliris and Ultomiris may be considered medically necessary. ...
https://www.premera.com/medicalpolicies/5.01.586.pdf
Policy: 5.01.16 Effective Date: Feb. 1, 2020 Last Revised: Jan. 9, 2020 Replaces: 5.01.16 ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/2.04.100.pdf
Policy: 2.04.100 Effective Date: March 1, 2020 Last Revised: Feb. 4, 2020 Replaces: ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/5.01.545.pdf
below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ... However, it was discovered that Cialis also addresses symptoms of BPH. This policy ...
https://www.premera.com/medicalpolicies/2.04.516.pdf
Policy: 2.04.84 Effective Date: Feb. 1, 2020 Last Revised: Jan. 9, 2020 Replaces: 2.04.84 ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/6.01.525.pdf
Policy: 6.01.60 Effective Date: Nov. 1, 2019 Last Revised: Jan. 1, 2020 Replaces: 6.01.60 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.555.pdf
below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ... to help maintain breathing capacity. This policy describes when medications for IPF may be ...
https://www.premera.com/medicalpolicies/8.01.502.pdf
Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to ...
https://www.premera.com/medicalpolicies/5.01.566.pdf
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... This policy discusses the different types of treatment for thrombocytopenia with ...
https://www.premera.com/medicalpolicies/7.01.559.pdf
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... This policy outlines the history and therapies that are recommended before proceeding to a ...
https://www.premera.com/medicalpolicies/5.01.517.pdf
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... These drugs reduce or stop the blood vessel growth that tumors need. This policy describes ...
https://www.premera.com/medicalpolicies/7.01.160.pdf
Policy: 7.01.160 Effective Date: Oct. 1, 2019 Last Revised: Sept. 5, 2019 Replaces: N/A ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | APPENDIX | ...
https://www.premera.com/medicalpolicies/7.01.158.pdf
Policy: 7.01.158 Effective Date: May 1, 2019 Last Revised: April 18, 2019 Replaces: N/A ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/7.01.147.pdf
Policy: 7.01.147 Effective Date: Sept. 1, 2019 Last Revised: Aug. 22, 2019 Replaces: N/A ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...