https://www.premera.com/medicalpolicies/1.01.24.pdf#search=policy
MEDICAL POLICY - 1.01.24 Interferential Current Stimulation BCBSA Ref. Policy: 1.01.24 Effective Date: Aug. 1, 2024 Last Revised: July 22, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/1.01.538.pdf#search=policy
MEDICAL POLICY - 1.01.538 Cooling Devices Used in the Outpatient Setting BCBSA Ref. Policy: 1.01.26 Effective Date: June 1, 2024 Last Revised: May 13, 2024 Replaces: 1.01.26 ...
https://www.premera.com/medicalpolicies/1.01.539.pdf#search=policy
MEDICAL POLICY - 1.01.539 Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions BCBSA Ref. Policy: 1.01.15 Effective Date: Nov. 1, 2024 Last ...
https://www.premera.com/medicalpolicies/2.02.26.pdf#search=policy
MEDICAL POLICY - 2.02.26 Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation BCBSA Ref. Policy: 2.02.26 Effective Date: August 1, 2024 ...
https://www.premera.com/medicalpolicies/2.02.507.pdf#search=policy
MEDICAL POLICY - 2.02.507 Coronary Angiography for Known or Suspected Coronary Artery ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/2.04.136.pdf#search=policy
MEDICAL POLICY - 2.04.136 Nutrient/Nutritional Panel Testing BCBSA Ref. Policy: 2.04.136 Effective Date: Mar. 1, 2024 Last Revised: May 1, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/5.01.532.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.532 Cutaneous T-Cell Lymphomas (CTCL): Systemic ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.563_2025-01-03.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.563 Pharmacotherapy of Inflammatory Bowel Disorder ... Oct. 8, 2024 Replaces: Extracted from 5.01.550 *Click here to view current policy. ...
https://www.premera.com/medicalpolicies/5.01.598.pdf#search=policy
PHARMACY POLICY - 5.01.598 Pharmacologic Treatment to Reduce Serum Phosphorus Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.609.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.609 Spravato (esketamine) Nasal Spray BCBSA Ref. Policy: 5.01.34 Effective Date: Nov. 1, 2024 Last Revised: Oct. 8, 2024 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.616.pdf#search=policy
MEDICAL POLICY - 5.01.616 Pharmacologic Treatment of Gout Effective Date: Mar. 1, 2024 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.624_2025-01-03.pdf#search=policy
MEDICAL POLICY - 5.01.624 Alpha-1 Proteinase Inhibitors Effective Date: Jan. 3, 2025* Last Revised: Sept. 10, 2024 Replaces: N/A *Click here to view the current policy. RELATED ...
https://www.premera.com/medicalpolicies/5.01.628.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.628 Pharmacologic Treatment of Atopic Dermatitis ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/8.01.15.pdf#search=policy
MEDICAL POLICY - 8.01.15 Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma BCBSA Ref. Policy: 8.01.15 Effective Date: April 1, 2024 ...
https://www.premera.com/medicalpolicies/8.01.532.pdf#search=policy
MEDICAL POLICY - 8.01.532 Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors BCBSA Ref. Policy: 8.01.35 Effective Date: April 1, 2024 Last Revised: Oct. 9, ...
https://www.premera.com/medicalpolicies/8.01.66.pdf#search=policy
MEDICAL POLICY - 8.01.66 Chimeric Antigen Receptor Therapy for Multiple Myeloma BCBSA Ref. Policy: 8.01.66 Effective Date: July 1, 2024 Last Revised: Oct. 1, 2024 Replaces: N/A ...
https://www.premera.com/medicalpolicies/1.01.530.pdf#search=policy
MEDICAL POLICY - 1.01.530 Children's Therapeutic Positioning Equipment Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/1.01.540.pdf#search=policy
MEDICAL POLICY - 1.01.540 Continuous Passive Motion in the Home Setting BCBSA Ref. Policy: 1.01.10 Effective Date: June 1, 2024 Last Revised: May 13, 2024 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/10.01.532.pdf#search=policy
MEDICAL POLICY - 10.01.532 ASAM Criteria: Services Reviewed for Medical Necessity ... N/A RELATED MEDICAL POLICIES: None This policy only applies to Washington Individual ...
https://www.premera.com/medicalpolicies/2.01.106.pdf#search=policy
MEDICAL POLICY - 2.01.106 Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel Syndrome BCBSA Ref. Policy: 2.01.106 Effective Date: Nov. 1, 2024 Last Revised: Oct. ...